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

The National Institutes of Health Consensus Development Conference on Treatment of Early-Stage Breast Cancer brought together surgical, radiation, and medical oncologists, biostatisticians, psychologists, nurses, and other health care professionals as well as the public to address: the roles of mastectomy versus breast conservation, the role of adjuvant therapy, and the use of prognostic indicators in the treatment and management of early-stage breast cancer. 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) breast conservation treatment is an appropriate method of primary therapy for the majority of women with Stage I and II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary dissection while preserving the breast; (2) the majority of patients with node negative breast cancer are cured by surgery or by surgery and radiation without further therapy; (3) there is clear evidence that the rate of local and distant recurrence is decreased by both adjuvant combination cytotoxic chemotherapy and by adjuvant tamoxifen; (4) the decision to use adjuvant treatment should follow a thorough discussion with the patient regarding the possible risks and toxicities of therapy and its impact on quality of life; (5) and patients with tumors less than or equal to 1 centimeter have an excellent prognosis and do not require adjuvant therapy outside of clinical trials. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Intravenous Immunoglobulin: Prevention and Treatment of Disease brought together biomedical scientists in immunology, infectious disease, and pediatrics, as well as health care providers, patients and their families, and the public to address the safe and effective uses of intravenous immunoglobulin (IVIG) preparations. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared a consensus statement. Among their findings, the panel concluded that all currently available IVIG preparations are safe and effective in treating the conditions for which they have been licensed; however, their efficacy in treating other conditions remains to be established. Effective regimens have been developed for primary immunodeficiencies and secondary immunodeficiencies, idiopathic thrombocytopenic purpura, and Kawasaki syndrome. However, optimal dosages and treatment schedules still need to be established for patients who may benefit from IVIG therapy. The panel also concluded that the risks of IVIG therapy are minimal, and adverse events, which are rare, can often be alleviated by reducing the rate or volume of infusion. Future research is also important, particularly studies to discern the mechanisms of action of IVIG, to compare the effectiveness of IVIG preparations, and to determine their long-term effectiveness and their effect on quality of life for patients receiving IVIG. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Adjuvant Therapy for Patients With Colon and Rectum Cancer brought together surgeons, medical oncologists, radiation oncologists, gastroenterologists, other health care providers, and the public to address the issues regarding adjuvant therapy for colon and rectum cancer. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared a consensus statement. Among their findings, the panel recommended that patients with Stage III colon cancer should receive adjuvant therapy with 5-fluorouracil (5-FU) and levamisole. Specific adjuvant therapy is not recommended for Stage II colon cancer patients outside of clinical trials. For rectal cancer, the panel recommended that adjuvant therapy combining chemotherapy and radiation therapy improves local control and survival for Stage II and III patients. The most effective combination at present appears to be 5-FU, methyl-CCNU, and high-dose pelvic irradiation. However, the use of methyl-CCNU outside of clinical trials is discouraged because of documented toxicities. The panel concluded that patients with Stage I colon and rectal cancers are at low risk of recurrence and do not warrant adjuvant therapy. The panel also recommended that the American Joint Committee on Cancer system for classifying stages of colon and rectal cancer, known as the TNM system, become the standard measurement used in clinical trials and in clinical practice.

The National Institutes of Health Consensus Development Conference on the Treatment of Sleep Disorders of Older People brought together clinical specialists in pulmonology, psychiatry, psychology, geriatrics, internal medicine, other health care providers, and the public to address the cause, diagnosis, assessment, and specific treatments of sleep disorders of older people. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the scientific evidence and prepared a consensus statement. Among their findings, the panel concluded that although sleep patterns change during the aging process most older people with sleep disturbances suffer from any of a variety of medical and psychosocial disorders. The panel recommended that the diagnostic evaluation of sleep disorders begin with a careful clinical evaluation performed by an informed primary care physician. When necessary, referrals should be made to individuals or centers with specialized skills and tools for therapy. The panel recognized two types of disorders for which treatment may be beneficial: obstructive sleep apnea and insomnia. The mainstay for treatment for sleep apnea is the use of nasal continuous positive airway pressure. A thorough medical evaluation is essential prior to initiating treatment for insomnia, as its causes may be of psychiatric, pharmacological, or medical origin. The panel recommended that hypnotic medications not be the mainstay of treatment for insomnia as they may have habit forming potential if overused. The full text of the consensus panel's statement follows.

The National Institutes of Health Consensus Development Conference on Surgery for Epilepsy brought together neurologists, neurosurgeons, psychologists, other health care providers, and the public to address issues regarding epilepsy surgery including patient selection and management, localization of seizure site onset, appropriate diagnostic techniques, and postoperative outcome assessment. The panel concluded that brain surgery is an alternative treatment when medication fails. Seizure frequency, severity type, possible brain damage or injury from frequent seizures, and effect on quality of life all must be considered in deciding to evaluate for surgery. An appropriate medication trial must have been conducted, using the correct drugs for the patient's seizure type at adequate doses and blood levels. Non-epileptic attacks must be ruled out, and diagnostic tests to detect any underlying cause should be performed. If surgery is considered, patients should be evaluated by a team including neurologists, neurosurgeons, neuropsychologists, social workers, and, if needed, psychiatrists. Assessment of outcome should include standardized methods of information collection. Measures assessing quality of life and overall health status can compare epilepsy to other chronic conditions. Assessment of economic and social impact on the patient's family should be included.

The National Institutes of Health Consensus Development Conference on Noise and Hearing Loss brought together biomedical and behavioral scientists, health care providers, and the public to address the characteristics of noise-induced hearing loss, acoustic parameters of hazardous noise exposure, individual and age-specific susceptibility, and prevention strategies. Following a day and a half of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared a consensus statement. Among their findings, the panel concluded that sounds of sufficient intensity and duration will damage the ear and result in temporary or permanent hearing loss at any age. Sound levels of less than 75 dB(A) are unlikely to cause permanent hearing loss, while sound levels above 85 dB(A) with exposures of 8 hours per day will produce permanent hearing loss after many years. Current scientific knowledge is inadequate to predict that any particular individual will be safe when exposed to a hazardous noise. Strategies to prevent damage from sound exposure should include the use of individual hearing protection devices, education programs beginning with school-age children, consumer guidance, increased product noise labeling, and hearing conservation programs for occupational settings. The full text of consensus panel's statement follows.