Improving Consensus Development for Health Technology Assessment An International Perspective (1990) / Chapter Skim
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Documentation and Use of Evidence in the Consensus Conference Process
Documentation and Use of Evidence in the Consensus Conference Process
Pages 23-31
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From page 23... ...
states that: The quality and quantity of data available for specific questions at these recent conferences still varied considerably. The separate elements of the consensus statements, however, did not always reflect this variability in how strongly conclusions were stated, resulting in inappropriately strong conclusions.
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From page 24... ...
must allow room for decisions based on scientific data. These three conditions have to be kept in mind throughout the organization of the following stages of the consensus development process: · preparation of the process · review of the existing evidence · selection of the panel · selection of the speakers .
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From page 25... ...
(Unpublished studies may tend to have negative findings more often than published ones do.) The review should consider articles related to efficacy or effectiveness of the therapeutic or preventive method evaluated and papers that address other criteria for assessments, for example: · actual practices in the field and consequences for the health care system of any modification in practice · direct or indirect adverse effects of the evaluated procedure.
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From page 26... ...
should contain balanced representation from var'ous sectors of professional and community life and should not be professionally identified with advocacy or promotional positions with respect to the consensus topic (OMAR, NIH, 19881. In addition, it may be useful to give the panel basic articles concerning the evaluation of the quality of data.
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From page 27... ...
SCIENTIFIC EVIDENCE AND CLINICAL PRACTICE The discussion on how to increase the use of scientific evidence in a consensus development process can also be broadened to the discussion of the relation between scientific evidence and use of innovative procedures. Surveys conducted in France in the field of perinatology (i.e., on ultrasound examinations, electronic fetal monitoring, and prescription of beta-mimetics)
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From page 28... ...
When asked under what circumstances they prescribed these drugs, 74 percent of the doctors said that they administered oral beta-mimetics prophylactically, 63 percent used intravenous or oral beta-mimetics when they detected signs of premature maturation of the cervix, 76 percent prescribed them for women with ruptured membranes, and 49 percent prescribed them when the cervix was dilated 4 cm or more. The principal reason given by 65 percent of the obstetricians for using beta-mimetics was the tocolytic effect of these drugs; 38 percent indicated delay of delivery as a primary concern.
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From page 29... ...
The surveys conducted in France also revealed that the decision to modify any given practice seems to be based on possible side effects rather than on doubts concerning its effectiveness. Therefore, if clinical practice is mainly based on "theoretical" consideration, as well as on side effects, this must be taken into consideration in the consensus development process.
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From page 30... ...
The utility of early detection depends upon how well these intermediate steps lead to prevention of CHD in asymptomatic individuals with high serum cholesterol levels (step 5~. A very careful search of published and unpublished results should be performed to address the issue of side effects.
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From page 31... ...
1984. Un probleme de decision en perinatologie: l'Enregistrement continu du coeur foetal pendant le travail.
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