OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.

• Keywords
• cardiac surgery, consensus, mortality, mortality reduction, perioperative, review,
• MeSH
• Internet trends   MeSH
• Cardiac Surgical Procedures adverse effects   mortality   trends   MeSH
• Congresses as Topic trends   MeSH
• Consensus Development Conferences as Topic * MeSH
• Consensus MeSH
• Humans MeSH
• Mortality trends   MeSH
• Perioperative Care methods   trends   MeSH
• Postoperative Complications mortality   prevention & control   MeSH
• Randomized Controlled Trials as Topic methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Systematic Review MeSH

OBJECTIVE: The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013. PARTICIPANTS: The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration. EVIDENCE: This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities. CONSENSUS PROCESS: Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system. CONCLUSIONS: Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality.

• Keywords
• acromegaly, comorbidities, consensus, diagnosis, treatment,
• MeSH
• Acromegaly diagnosis   therapy   MeSH
• Comorbidity MeSH
• Consensus MeSH
• Quality of Life * MeSH
• Humans MeSH
• Practice Guidelines as Topic standards   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The concept of animal welfare is evolving due to progress in our scientific understanding of animal biology and changing societal expectations. Animal welfare science has been primarily concerned with minimizing suffering, but there is growing interest in also promoting positive experiences, grouped under the term positive animal welfare (PAW). However, there are discrepancies in the use of the term PAW. An interdisciplinary group arrived at a consensus that 'PAW can be defined as the animal flourishing through the experience of predominantly positive mental states and the development of competence and resilience. PAW goes beyond ensuring good physical health and the prevention and alleviation of suffering. It encompasses animals experiencing positive mental states resulting from rewarding experiences, including having choices and opportunities to actively pursue goals and achieve desired outcomes'. The definition also considers individual and species-specific differences. It provides a framework for researchers to investigate PAW and thereby generate innovative, informative and reproducible science. Studies of PAW can contribute to a richer picture of an animal's life and may elucidate the biological foundations of happiness. The definition creates opportunities to inspire scientific progress in animal biology and to align animal care practices, legislation and markets with societal expectations.

• Keywords
• animal emotion, flourishing, good life, good welfare, happiness, pleasure,
• MeSH
• Animal Husbandry methods   MeSH
• Consensus * MeSH
• Animal Welfare * MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: As patents for multiple sclerosis (MS) therapies expire, follow-on disease-modifying treatments (FO-DMTs) become available at reduced cost. Concerns exist that cheaper FO-DMTs are used simply to reduce healthcare costs. However, the well-being of people with MS should take priority. OBJECTIVES: To identify best practices for FO-DMT development and use by agreeing on principles and consensus statements through appraisal of published evidence. METHODS: Following a systematic review, we formulated five overarching principles and 13 consensus statements. Principles and statements were voted on by a multidisciplinary panel from 17 European countries, Argentina, Canada and the United States. RESULTS: All principles and statements were endorsed by >80% of panellists. In brief, FO-DMTs approved within highly regulated areas can be considered effective and safe as their reference products; FO-DMTs can be evaluated case by case and do not always require Phase III trials; long-term pharmacovigilance and transparency are needed; there is lack of evidence for multiple- and cross-switching among FO-DMTs; and education is needed to address remaining concerns. CONCLUSION: Published data support the use of FO-DMTs in MS. The consensus may aid shared decision-making. While our consensus focused on Europe, the results may contribute to enhanced quality standards for FO-DMTs use elsewhere.

• Keywords
• Biosimilar, consensus, disease-modifying treatments, expert opinion, guidelines, interchangeability, multiple sclerosis, non-biological complex drugs, switching,
• MeSH
• Consensus MeSH
• Humans MeSH
• Health Care Costs MeSH
• Multiple Sclerosis * drug therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Systematic Review MeSH
• Geographicals
• Argentina MeSH
• Canada MeSH

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) with the European Society of Gynaecological Oncology (ESGO) jointly developed clinically relevant and evidence-based statements on performing ultrasound-guided biopsies in gynecological oncology. The objective of this Consensus Statement is to assist clinicians, including gynecological sonographers, gynecological oncologists and radiologists, to achieve the best standards of practice in ultrasound-guided biopsy procedures. ISUOG/ESGO nominated a multidisciplinary international group of 16 experts who have demonstrated leadership in the use of ultrasound-guided biopsy in the clinical management of patients with gynecological cancer. In addition, two early-career gynecological fellows were nominated to participate from the European Network of Young Gynae Oncologists (ENYGO) within ESGO and from ISUOG. The group also included a patient representative from the European Network of Gynaecological Cancer Advocacy Groups. The document is divided into six sections: (1) general recommendations; (2) image-guided biopsy (imaging guidance, sampling methods); (3) indications and contraindications; (4) technique; (5) reporting; and (6) training and quality assurance. To ensure that the statements are evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on this review of the literature. During a conference call, the whole group discussed each preliminary statement, and a first round of voting was carried out. The group achieved consensus on all 46 preliminary statements without the need for revision. These ISUOG/ESGO statements on ultrasound-guided biopsy in gynecological oncology, together with a summary of the evidence supporting each statement, are presented herein. This Consensus Statement is supplemented by detailed narrated videoclips presenting different approaches and indications for ultrasound-guided biopsy, a patient leaflet, and an extended version which includes a detailed review of the evidence.

• Keywords
• Consensus Statement, Gynecologic oncology, Ultrasound-guided biopsy,
• MeSH
• Gynecology standards   MeSH
• Ultrasonography, Interventional * methods   standards   MeSH
• Consensus MeSH
• Medical Oncology standards   MeSH
• Humans MeSH
• Genital Neoplasms, Female * pathology   diagnostic imaging   MeSH
• Image-Guided Biopsy * methods   standards   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Review MeSH

National and international experts in cervical cancer prevention met at the International Workshop on Human Papillomaviruses and Consensus Recommendations for Cervical Cancer Prevention to review the current evidence and assess the potential for improvement in cervical cancer prevention and to develop plans for implementation of cervical cancer prevention programmes in Croatia. Key recommendations were developed and adopted during the course of the meeting. The process of bringing national experts together with internationally recognized experts in an open forum for the development of consensus recommendations could serve as a model for other countries seeking to implement or improve cervical cancer prevention programmes.

• MeSH
• Alphapapillomavirus growth & development   MeSH
• Papillomavirus Infections prevention & control   MeSH
• Consensus Development Conferences as Topic MeSH
• Humans MeSH
• Uterine Cervical Neoplasms epidemiology   prevention & control   virology   MeSH
• Mass Screening MeSH
• Papillomavirus Vaccines therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Congress MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Papillomavirus Vaccines MeSH

BACKGROUND: Fabry disease, an inherited lysosomal storage disorder, causes multi-organ pathology resulting in substantial morbidity and a reduced life expectancy. Although Fabry disease is an X-linked disorder, both genders may be affected, but generally to a lesser extent in females. The disease spectrum ranges from classic early-onset disease to non-classic later-onset phenotypes, with complications occurring in multiple organs or being confined to a single organ system depending on the stage of the disease. The impact of therapy depends upon patient- and disease-specific factors and timing of initiation. METHODS: A European panel of experts collaborated to develop a set of organ-specific therapeutic goals for Fabry disease, based on evidence identified in a recent systematic literature review and consensus opinion. RESULTS: A series of organ-specific treatment goals were developed. For each organ system, optimal treatment strategies accounted for inter-patient differences in disease severity, natural history, and treatment responses as well as the negative burden of therapy and the importance of multidisciplinary care. The consensus therapeutic goals and proposed patient management algorithm take into account the need for early disease-specific therapy to delay or slow the progression of disease as well as non-specific adjunctive therapies that prevent or treat the effects of organ damage on quality of life and long-term prognosis. CONCLUSIONS: These consensus recommendations help advance Fabry disease management by considering the balance between anticipated clinical benefits and potential therapy-related challenges in order to facilitate individualized treatment, optimize patient care and improve quality of life.

• Keywords
• Consensus, Disease management, Enzyme replacement therapy, Fabry disease, Therapeutic goal,
• MeSH
• Enzyme Replacement Therapy standards   MeSH
• Fabry Disease therapy   MeSH
• Consensus MeSH
• Humans MeSH
• Expert Testimony * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset. The MS community has endorsed a management strategy of prompt diagnosis, timely intervention and regular proactive monitoring of treatment effectiveness and disease activity to improve outcomes in people with MS. OBJECTIVES: We sought to develop internationally applicable quality standards for timely, brain health-focused MS care. METHODS: A panel of MS specialist neurologists participated in an iterative, online, modified Delphi process to define 'core', 'achievable' and 'aspirational' time frames reflecting minimum, good and high care standards, respectively. A multidisciplinary Reviewing Group (MS nurses, people with MS, allied healthcare professionals) provided insights ensuring recommendations reflected perspectives from multiple stakeholders. RESULTS: Twenty-one MS neurologists from 19 countries reached consensus on most core (25/27), achievable (25/27) and aspirational (22/27) time frames at the end of five rounds. Agreed standards cover six aspects of the care pathway: symptom onset, referral and diagnosis, treatment decisions, lifestyle, disease monitoring and managing new symptoms. CONCLUSION: These quality standards for core, achievable and aspirational care provide MS teams with a three-level framework for service evaluation, benchmarking and improvement. They have the potential to produce a profound change in the care of people with MS.

• Keywords
• Delphi technique, Multiple sclerosis, benchmarking, consensus, quality improvement, standards,
• MeSH
• Delphi Technique MeSH
• Consensus MeSH
• Humans MeSH
• Brain * pathology   MeSH
• Neurology standards   MeSH
• Multiple Sclerosis * diagnosis   pathology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The Banff working group on preimplantation biopsy was established to develop consensus criteria (best practice guidelines) for the interpretation of preimplantation kidney biopsies. Digitally scanned slides were used (i) to evaluate interobserver variability of histopathologic findings, comparing frozen sections with formalin-fixed, paraffin-embedded tissue of wedge and needle core biopsies, and (ii) to correlate consensus histopathologic findings with graft outcome in a cohort of biopsies from international medical centers. Intraclass correlations (ICCs) and univariable and multivariable statistical analyses were performed. Good to fair reproducibility was observed in semiquantitative scores for percentage of glomerulosclerosis, arterial intimal fibrosis and interstitial fibrosis on frozen wedge biopsies. Evaluation of frozen wedge and core biopsies was comparable for number of glomeruli, but needle biopsies showed worse ICCs for glomerulosclerosis, interstitial fibrosis and tubular atrophy. A consensus evaluation form is provided to help standardize the reporting of histopathologic lesions in donor biopsies. It should be recognized that histologic parameters may not correlate with graft outcome in studies based on organs deemed to be acceptable after careful clinical assessment. Significant limitations remain in the assessment of implantation biopsies.

• Keywords
• biopsy, clinical research/practice, donors and donation: deceased, kidney (allograft) function/dysfunction, kidney failure/injury, pathology/histopathology,
• MeSH
• Tissue Donors * MeSH
• Biopsy, Needle MeSH
• Consensus MeSH
• Kidney pathology   surgery   MeSH
• Humans MeSH
• Kidney Transplantation * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.

• Keywords
• group B Streptococcus vaccines, influenza, maternal immunization, pertussis, pregnant women, respiratory syncytial virus, tetanus,
• MeSH
• Global Health MeSH
• Risk Assessment MeSH
• Health Impact Assessment MeSH
• Immunization * adverse effects   ethics   methods   trends   MeSH
• Immunogenicity, Vaccine MeSH
• Pregnancy Complications, Infectious epidemiology   prevention & control   MeSH
• Clinical Trials as Topic ethics   MeSH
• Consensus MeSH
• Ethics, Medical MeSH
• Humans MeSH
• Maternal Exposure MeSH
• Risk Factors MeSH
• Pregnancy MeSH
• Vaccination MeSH
• Vaccines administration & dosage   adverse effects   immunology   MeSH
• Research MeSH
• Health Priorities MeSH
• Prenatal Exposure Delayed Effects MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Names of Substances
• Vaccines MeSH