College of American Pathologists Consensus Conference XXXVI: Diagnostic Issues in Thrombophilia

2002 ◽  
Vol 126 (11) ◽  
pp. 1277-1280 ◽  
Author(s):  
John D. Olson
Keyword(s):  
Clinical Studies ◽  
Laboratory Testing ◽  
Medical Literature ◽  
State Of The Art ◽  
Data Extraction ◽  
Consensus Conference ◽  
The State ◽  
Data Sources ◽  
Level Of Evidence ◽  
Thrombotic Risk

Abstract Objectives.—To review the state of the art relating to laboratory testing for thrombophilia, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations regarding laboratory testing (whom to test, when to test, what tests to perform, rationale for testing, and other issues) in the assessment of thrombotic risk in individual patients and their family members. Data Sources.—Review of the medical literature (primarily from the last 10 years) and the experience and opinions of experts in the field were used as data sources. Data Extraction and Synthesis.—Participating authors evaluated the medical literature and prepared manuscripts with specific proposed recommendations. Drafts of all of the manuscripts were prepared and circulated to every participant in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. Each of the conclusions and associated recommendations was then presented for discussion. Recommendations were accepted if a consensus of 70% or more of the 27 experts attending the conference was reached. The results of the discussion were then used to revise the manuscripts and recommendations into final form. Conclusions.—Consensus was reached on 179 recommendations, all of which are presented in articles in this issue of the Archives. Detailed discussion of the rationale for each of these recommendations is found in the text of the respective articles, along with citations to justify the level of evidence for the recommendations. This is an evolving area of research, and it is certain that further clinical studies will change many of the recommendations, cause some to be deleted, and add others in the future.

Heparin Cofactor II Deficiency

2002 ◽  
Vol 126 (11) ◽  
pp. 1394-1400
Author(s):  
Douglas M. Tollefsen
Keyword(s):  
Medical Literature ◽  
State Of The Art ◽  
Data Extraction ◽  
Thromboembolic Disease ◽  
Data Sources ◽  
Initial Assessment ◽  
Insufficient Evidence ◽  
Heparin Cofactor Ii ◽  
Laboratory Methods ◽  
Thrombotic Risk

Abstract Objectives.—To review of the state of the art relating to congenital heparin cofactor II deficiency as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of laboratory assays for assessing this thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, including review of clinical study design and laboratory methods, a draft manuscript was prepared and circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia. Recommendations were accepted if a consensus of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached that there is insufficient evidence to recommend testing for heparin cofactor II deficiency in patients with thromboembolic disease.

Elevated Hemostatic Factor Levels as Potential Risk Factors for Thrombosis

2002 ◽  
Vol 126 (11) ◽  
pp. 1405-1414 ◽  
Author(s):  
Wayne L. Chandler ◽  
George M. Rodgers ◽  
Jason T. Sprouse ◽  
Arthur R. Thompson
Keyword(s):  
Potential Risk ◽  
Medical Literature ◽  
State Of The Art ◽  
Data Extraction ◽  
Initial Assessment ◽  
Factor Level ◽  
Thrombotic Risk ◽  
Key Points ◽  
Hemostatic Factor ◽  
Potential Risk Factors

Abstract Objectives.—To review the state of the art relating to elevated hemostatic factor levels as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of specific measurements of hemostatic factor levels in the assessment of thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. Each of the key points and associated recommendations was then presented for discussion at the conference. Recommendations were accepted if a consensus of the 27 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 8 recommendations concerning the use of hemostatic factor levels in the assessment of thrombotic risk in individual patients. Detailed discussion of the rationale for each of these recommendations is presented in the article. This is an evolving area of research. While routine use of factor level measurements is not recommended, improvements in assay methodology and further clinical studies may change these recommendations in the future.

Dysfibrinogenemia and Thrombosis

2002 ◽  
Vol 126 (11) ◽  
pp. 1387-1390 ◽  
Author(s):  
Timothy Hayes
Keyword(s):  
Medical Literature ◽  
State Of The Art ◽  
Data Extraction ◽  
Initial Assessment ◽  
Laboratory Evaluation ◽  
Diverse Group ◽  
Review Of The Literature ◽  
Thrombotic Risk ◽  
Routine Testing ◽  
Key Points

Abstract Objectives.—To review the state of the art relating to congenital dysfibrinogenemia as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of laboratory assays for assessing this thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 5 conclusions and 2 recommendations concerning the use of testing for dysfibrinogens in the assessment of thrombotic risk in individual patients. Detailed discussion of the rationale for each of these recommendations is found in the text of this article. Compared with the other, more common hereditary thrombophilias, dysfibrinogenemia encompasses a diverse group of defects with varied clinical expressions. Congenital dysfibrinogenemia is a relatively rare cause of thrombophilia. Therefore, routine testing for this disorder is not recommended as part of the laboratory evaluation of a thrombophilic patient. This is an evolving area of research, and further clinical studies may change these recommendations in the future.

Diagnostic Studies for Thrombophilia in Women on Hormonal Therapy and During Pregnancy, and in Children

2002 ◽  
Vol 126 (11) ◽  
pp. 1296-1303
Author(s):  
Benjamin R. Brenner ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
Marilyn Manco-Johnson ◽  
Michael Laposata
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Oral Contraceptive ◽  
Medical Literature ◽  
Data Extraction ◽  
Data Sources ◽  
Current Clinical Practice ◽  
Extensive Review ◽  
Prothrombotic Risk Factors

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

Frontal Fibrosing Alopecia: To Treat or Not to Treat?

2010 ◽  
Vol 14 (4) ◽  
pp. 161-166 ◽  
Author(s):  
Eustathios Rallis ◽  
Stamatis Gregoriou ◽  
Eleftheria Christofidou ◽  
Dimitrios Rigopoulos
Keyword(s):  
Stable Disease ◽  
Outpatient Clinic ◽  
Clinical Studies ◽  
Medical Literature ◽  
Therapeutic Agents ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Once Daily ◽  
Systemic Corticosteroids ◽  
Active Disease

Background: Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce. Objective: To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature. Patients/Methods: Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment. Results: Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients. Conclusion: To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.

Laboratory Evaluation of Hypercoagulability With Venous or Arterial Thrombosis

2002 ◽  
Vol 126 (11) ◽  
pp. 1281-1295 ◽  
Author(s):  
Elizabeth M. Van Cott ◽  
Michael Laposata ◽  
Martin H. Prins
Keyword(s):  
Arterial Thrombosis ◽  
Medical Literature ◽  
Consensus Conference ◽  
Data Sources ◽  
Laboratory Evaluation ◽  
Supporting Evidence ◽  
Test Selection ◽  
Consensus Recommendations ◽  
Consensus Opinion ◽  
Current Practices

Abstract Objective.—To provide recommendations for hypercoagulation testing for patients with venous, arterial, or neurovascular thrombosis, as reflected in the medical literature and the consensus opinion of recognized experts in the field. Data Sources, Extraction, and Synthesis.—The authors extensively examined the literature and current practices, and prepared a draft manuscript with preliminary recommendations. The draft manuscript was circulated to each of the expert participants (n = 30) in the consensus conference prior to the convening of the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 28 experts attending the conference was reached. The discussions were also used to revise the manuscript into its final form. Conclusions.—The resulting article provides 17 recommendations for hypercoagulation testing in the setting of venous, arterial, or neurovascular thrombosis. The supporting evidence for test selection is analyzed and cited, and consensus recommendations for test selection are presented. Issues for which a consensus was not reached at the conference are also discussed.

scholarly journals Hematologic Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S74-S78
Author(s):  
Jennifer A. Muszynski ◽  
Jill M. Cholette ◽  
Marie E. Steiner ◽  
Marisa Tucci ◽  
Allan Doctor ◽  
...  
Keyword(s):  
Platelet Count ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
English Language ◽  
Data Extraction ◽  
Case Series ◽  
Hemoglobin Concentration ◽  
Consensus Conference ◽  
Data Sources ◽  
Critically Ill Children

CONTEXT Studies of organ dysfunction in children are limited by a lack of consensus around organ dysfunction criteria. OBJECTIVES To derive evidence-informed, consensus-based criteria for hematologic dysfunction in critically ill children. DATA SOURCES Data sources included PubMed and Embase from January 1992 to January 2020. STUDY SELECTION Studies were included if they evaluated assessment/scoring tools to screen for hematologic dysfunction and assessed outcomes of mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, small case series, and non-English language studies with inability to determine eligibility were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment. RESULTS Twenty-nine studies were included. The systematic review supports the following criteria for hematologic dysfunction: thrombocytopenia (platelet count <100000 cells/µL in patients without hematologic or oncologic diagnosis, platelet count <30000 cells/µL in patients with hematologic or oncologic diagnoses, or platelet count decreased ≥50% from baseline; or leukocyte count <3000 cells/µL; or hemoglobin concentration between 5 and 7 g/dL (nonsevere) or <5 g/dL (severe). LIMITATIONS Most studies evaluated pre-specified thresholds of cytopenias. No studies addressed associations between the etiology or progression of cytopenias overtime with outcomes, and no studies evaluated cellular function. CONCLUSIONS Hematologic dysfunction, as defined by cytopenia, is a risk factor for poor outcome in critically ill children, although specific threshold values associated with increased mortality are poorly defined by the current literature.

scholarly journals Science and society: a dialogue without communicators?

2008 ◽  
Vol 07 (01) ◽  
pp. C07 ◽  
Author(s):  
Nico Pitrelli
Keyword(s):  
Science Communication ◽  
State Of The Art ◽  
Consensus Conference ◽  
The State ◽  
Controversial Issues ◽  
Science And Society ◽  
Traditional Media ◽  
Public Speech ◽  
Policy Makers ◽  
Deep Knowledge

To give a good public speech is art; but definitely more difficult is to organize a productive exchange of points of views between scientists, experts, non-experts and policy-makers on controversial issues such as a scenario workshop or a consensus conference. Many skills and a deep knowledge both of the topic and of the methodology are required. But this is the future of science communication, a field where the dialogical model will impose new and complex formats of communication and a new sensibility, using also the most traditional media. But are science communicators prepared for that? What is the state of the art of science communicator training?

scholarly journals Clinical Applications of End-to-Side Neurorrhaphy: An Update

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Pierluigi Tos ◽  
Giulia Colzani ◽  
Davide Ciclamini ◽  
Paolo Titolo ◽  
Pierfrancesco Pugliese ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Facial Palsy ◽  
Clinical Studies ◽  
State Of The Art ◽  
Nerve Repair ◽  
Clinical Applications ◽  
The State ◽  
Nerve Function ◽  
Biological Mechanisms ◽  
Mixed Nerve

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.

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