Methodology Of Echm Consensus Conferences

Consensus Conferences aim to create an objective and complete review of current literature and solidify knowledge on a particular topic or field. This method has the advantage of involving a diverse group of experts, thus increasing objectivity. Participants in Consensus Conferences are selected from a broad range of relevant backgrounds to provide consideration of all aspects of the chosen topic and maximum objectivity. The opportunity to meet with other experts in the same field and share comments and information is also a valuable aspect of Consensus meetings.

In a Consensus Conference, experts present their review of the literature relating to a specific topic in front of a jury and an audience. Thereafter, the jury gathers in a secluded place to discuss the presentations, and presents its finding in a Consensus Statement that includes recommendations for clinical practice based on the evidence that was presented. These recommendations are then published in the medical literature.

The application of Evidence-Based Medicine methodology to the consensus conference process helps the jury members reach a consensus and strengthens the recommendation made. Thus, each jury member is expected to assess the literature and the evidence presented by the experts, and grades them according to their quality.

We recommend that jury members use the same grading scale, which has been extensively validated.

- Basic studies (tissue, cellular or sub-cellular levels)

1. Strong evidence of beneficial action

2. Evidence of beneficial action

3. Weak evidence of beneficial action

4. No evidence of beneficial action, or methodological or interpretation bias precluding any conclusion.

- Animal studies with control groups

1. Strong evidence of beneficial action

2. Evidence of beneficial action

3. Weak evidence of beneficial action

4. No evidence of beneficial action, or methodological or interpretation bias precluding any conclusion

- Human studies

1. Strong evidence of beneficial action based on at least two concordant, large, double-blind, controlled randomised studies with no or only weak methodological bias.

2. Evidence of beneficial action based on double-blind controlled, randomised studies but with methodological bias, or concerning only small samples, or only a single study.

3. Weak evidence of beneficial action based only on expert consensus or uncontrolled studies (historic control group, cohort study,...)

4. No evidence of beneficial action (case report only), or methodological or interpretation bias precluding any conclusion.

ECHM Recommendations

The Jury issues its recommendations using a 3 grade scale according to the strength of each recommendation that has been evaluated.

Type 1 : Strongly Recommended. The Jury considers the implementation of the recommendation of critical importance for final outcome of the patient/quality of practice/future specific knowledge.

Type 2 : Recommended. The Jury considers the implementation of the recommendation as positively affecting final outcome of the patient/quality of practice/future specific knowledge.

Type 3 : Optional. The Jury considers the implementation of the recommendation as an option.

The Jury also reports the level of evidence which supports, in its view, the recommendation. During the last consensus conference (Lille, December 2004), for example, after having listened to the experts and with the assistance of literature reviewers, the jury graded the existing evidence using the scale we have defined here.

Conditions where the use of HBO was supported by level A, B or C evidence were considered accepted indications

In order to make the jury discussion and decision on conditions not considered accepted indications for HBO more transparent, these levels D, E, and F were also reported with the jury's evaluation of the existing evidence. The scale used in this table is an extension of that used for accepted indications.

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