Consensus statement. National Institutes of Health Consensus Development Conference最新文献

The National Institutes of Health Consensus Development Conference on Triglyceride, High Density Lipoprotein, and Coronary Heart Disease brought together experts in lipid metabolism, epidemiologists, and clinicians as well as other health care professionals and the public to address the following questions: (1) is the relationship of high triglyceride and/or low HDL cholesterol with coronary heart disease causal? (2) Will reduction of high triglyceride and/or elevation of HDL cholesterol help prevent coronary heart disease? (3) Under what circumstances should triglycerides and HDL cholesterol be measured? (4) Under what circumstances should active intervention to lower triglyceride and/or raise HDL cholesterol be considered in high risk individuals and the general population? (5) What can be accomplished by dietary, other hygienic, and drug treatments? (6) What are the significant questions for future research? Following two days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) existing data provide considerable support for a causal relationship between low HDL and CHD; however, with respect to TG data are mixed and the evidence on a causal relationship is incomplete; (2) initial TG and/or HDL levels modify benefit achieved by lowering low density lipoprotein cholesterol (LDL-C); however, evidence from clinical trials is insufficient to draw conclusions about specific benefits of TG and/or HDL altering therapy; (3) HDL-C measurement should be added to total cholesterol measurement when evaluating CHD risk in healthy individuals provided accuracy of measurement, appropriate counseling, and followup can be assured; (4) there is general agreement with the Adult Treatment Panel (ATP) guidelines that LDL-C is essential in cardiovascular risk assessment, as well as that persons with elevations of LDL-C greater than 150 mg/dl refractory to nondrug therapies may require drug treatment; (5) there is a strong consensus that hygienic approaches (diet, exercise, smoking cessation, weight loss) should be employed to lower TG and/or raise HDL; there is no consensus for the use of drug treatment in patients with borderline hypertriglyceridemia and low HDL-C levels in the presence of a desirable LDL-C level.

The National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Early Melanoma brought together experts in dermatology, pathology, epidemiology, public education, surveillance techniques, and potential new technologies as well as other health care professionals and the public to address (1) the clinical and histological characteristics of early melanoma; (2) the appropriate diagnosis, management, and followup of patients with early melanoma; (3) the role of dysplastic nevi and their significance; and (4) the role of education and screening in preventing melanoma morbidity and mortality. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighted the scientific evidence and prepared their consensus statement. Among their findings, the panel recommended that (1) melanoma in situ is a distinct entity effectively treated surgically with 0.5 centimeter margins; (2) thin invasive melanoma, less than 1 millimeter thick has the potential for long-term survival in more than 90 percent of patients after surgical excision with a 1 centimeter margin; (3) elective lymph node dissections and extensive staging evaluations are not recommended in early melanoma; (4) patients with early melanoma are at low risk for relapse but may be at high risk for development of subsequent melanomas and should be followed closely; (5) some family members of patients with melanoma are at increased risk for melanoma and should be enrolled in surveillance programs; and (6) education and screening programs have the potential to decrease morbidity and mortality from melanoma. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Acoustic Neuroma brought together neurosurgeons, radiosurgeons, otologists, neurologists, audiologists, otolaryngologists, and other health care professionals as well as the public to reach agreement (1) on defining the clinical types of acoustic neuroma, (2) on which procedures are useful for screening and diagnosis, (3) on the options available for managing the disorder as well as the complications of treatment, and (4) on the key clinical and biological areas for future research. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) the term vestibular schwannoma is preferred over acoustic neuroma as these tumors are composed of Schwann cells and typically involve the vestibular rather than the acoustic division of the 8th cranial nerve; (2) treatment for vestibular schwannoma must be individualized and requires an experienced, well-integrated, multidisciplinary team approach; (3) surgery remains the treatment of choice, but research is needed on the relative benefits and risks of all management options, including pharmaceutical and other alternative medical treatments such as tumor suppressing agents; (4) routine intraoperative monitoring of the facial nerve should be included in surgical therapy for vestibular schwannoma; (5) neurofibromatosis 2 (NF2) should be carefully considered in all patients newly diagnosed with vestibular schwannoma, and, when found, genetic evaluation and counseling should be provided for all relevant family members; and (6) a registry for all patients with vestibular schwannoma, whether undergoing observation or active management, should be established.

The National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life brought together biomedical and behavioral scientists, surgeons, and other health care professionals as well as the public to address the epidemiology, pathogenesis, pathophysiology, prevention, and treatment of depression in the elderly and to alert both the professional and lay public to the seriousness of depression in late life, to its manifestations and useful treatments, and to areas needing further study. Following 2 days of scientific presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) depression in late life occurs in the context of numerous social and physical problems that often obscure or complicate diagnosis and impede management of the illness; (2) because there is no specific diagnostic test for depression, an attentive and focused clinical assessment is essential for diagnosis; (3) depressed elderly people should be treated vigorously with sufficient doses of antidepressants and for a sufficient length of time to maximize the likelihood of recovery; (4) electroconvulsive therapy and psychosocial treatments also can be effective in the treatment of elderly depressed patients; and (5) estimates of the prevalence of depression vary widely, but the highest rates are in nursing homes and other residential settings, and staff in many of these facilities are not equipped to recognize or treat depressed patients. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity brought together surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals as well as the public to address: the nonsurgical treatment options for severe obesity, the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that (1) patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support, (2) gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable operative risks, (3) patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise, (4) the operation be performed by a surgeon substantially experienced with the appropriate procedures and working in a clinical setting with adequate support for all aspects of management and assessment, and (5) lifelong medical surveillance after surgical therapy is a necessity. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Clinical Use of Botulinum Toxin brought together neurologists, ophthalmologists, otolaryngologists, speech pathologists, and other health care professionals as well as the public to address: the mechanisms of action of botulinum toxin, the indications and contraindications for botulinum toxin treatment, the general principles of technique of injection and handling for its safe and effective use, and the short-term and long-term side effects and complications of therapy. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that (1) botulinum toxin therapy is safe and effective for treating strabismus, blepharospasm, hemifacial spasm, adductor spasmodic dysphonia, jaw-closing oromandibular dystonia, and cervical dystonia; (2) botulinum toxin is not curative in chronic neurological disorders; (3) the safety of botulinum toxin therapy during pregnancy, breast feeding, and chronic use during childhood is unknown; (4) the long-term effects of chronic treatment with botulinum toxin remain unknown; and (5) botulinum toxin should be administered by committed interdisciplinary teams of physicians and related health care professionals with appropriate instrumentation. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Diagnosis and Management of Asymptomatic Primary Hyperparathyroidism brought together endocrinologists, surgeons, radiologists, epidemiologists, and primary health care providers as well as the public to address indications for surgery in asymptomatic patients with hyperparathyroidism (HPT) and how patients not operated on should be monitored and managed to minimize the risk of complications of HPT. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) a diagnosis of HPT is established by demonstrating persistent hypercalcemia together with an elevated serum parathyroid hormone concentration; (2) current and acceptable treatment for HPT is surgery to cure the condition; (3) the diagnosis of HPT in an asymptomatic patient does not in all cases mandate referral for surgery; conscientious surveillance may be justified in patients whose calcium levels are only mildly elevated and whose renal and bone status are close to normal; and (4) preoperative localization in patients without prior neck operation is rarely indicated and not proven to be cost-effective.