Panelists' views of 68 NIH consensus conference.

OBJECTIVES: To analyze the response patterns and trends of 68 surveys of successive NIH consensus panels' views on the NIH consensus process. METHODS: Each panel's responses were compared to an "average" panel's responses calculated by determining the mean response for each survey question across panels. RESULTS: The results show a stable pattern of panelists' generally positive views. However, several conferences were judged very positively and some very negatively compared to the norm. Most negatively viewed conferences occurred early in the consensus program's history. CONCLUSIONS: The disparate perceptions are discussed and interpreted as reflecting favorable panels' views of recent changes in the NIH Consensus Development Program.

Atropine sulfate--a current review of a useful agent for controlling salivation during dental procedures.

After reading this article, the reader should be able to describe techniques for the control of saliva during dental procedures; discuss the problems associated with saliva contamination of an operative field; explain the clinical benefits, dosing guidelines, and contraindications for using atropine sulfate to temporarily reduce saliva flow during dental procedures.

Influence of the NIH Consensus Conference on Helicobacter pylori on physician prescribing among a Medicaid population.

OBJECTIVES: In February 1994, an National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate Helicobacter pylori in the treatment of peptic ulcer disease. The goal of this study was to determine if these recommendations resulted in a change in physician prescribing among an underserved population. METHODS: Computerized Pennsylvania Medicaid data from January 1993 through February 1996 were used to evaluate prescribing patterns in the year before and 2 years after the NIH conference. An interrupted time series model, based on 12,737 outpatient peptic ulcer disease encounters, assessed the impact of the conference in influencing physician prescribing. RESULTS: The prescription of antimicrobial agents for the treatment of peptic ulcer disease significantly increased across the study period, from 6.5% in January 1993 to 10.2% in February 1996. Similarly, the prescription rate for the proton pump inhibitor, omeprazole, significantly increased from 9.4% in January 1993 to 25.6% in February 1996. Neither trend, however, could be attributed to the NIH Consensus Development Conference. Stratification by physician specialty, ulcer type, nonsteroidal anti-inflammatory drug use, and patient demographics did not affect these results. The traditional treatment approach, using H2-receptor antagonists, remained the preferred pharmacotherapy (72% of all prescriptions). CONCLUSIONS: Two years after the highly publicized NIH conference on the eradication of Helicobacter pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. In treating this underserved population, physicians do not appear to be using recommendations developed by an NIH expert panel based on recent scientific advances.

The Consensus Development Program. Detecting changes in medical practice following a consensus conference on the treatment of prostate cancer.

The treatment of prostate cancer was reviewed at a U.S. National Institutes of Health Consensus Development Conference in June 1987. Data from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registries were analyzed and showed that the proportion of eligible prostate cancer patients receiving the recommended therapies did not increase at a faster rate after the conference than before.

Postdoctoral research training of full-time faculty in academic departments of medicine.

This report shows the results of a survey of 5604 faculty in departments of medicine, 4200 of whom had postdoctoral research training. As a follow-up to a previous study of research activity in the same population, this retrospective survey focused on location of training, source of funding, structure of the training program, impact of the training experience on career development, and respondents' recommendations for changes in training programs. A predominant finding is that most postdoctoral training occurred in medical schools, and the primary source of funding was the National Institutes of Health. For faculty members with the MD degree, being an active researcher and principal investigator for a peer-reviewed research grant were associated with length of training. The average length of time between the end of postdoctoral research training and obtaining the first peer-reviewed research grant was 24 months, regardless of length of training, source of training support, training site, or type of academic degree (MD, MD-PhD, or PhD). The results of this survey suggest a tentative formula to be a successful researcher in academic medicine: 2 or more years of postdoctoral research training, including formal course work in the fundamental sciences pertinent to biomedical research; 2 to 3 years of full research support from the academic institution until the first extramural grant is obtained; and commitment of at least 33% of time to research activities. The results also suggest directions for change and improvement in future research training programs.

Educational origins of M.D. faculty members in five groups of medical schools.

Five groups of medical schools are used to describe the relationship between the type of institution where a physician serves as a full-time faculty member and the type of institution where the M.D. degree was awarded. For each group of schools, percentage distributions are presented showing where the graduates now teach full time. The educational origins of all U.S.-trained full-time M.D. faculty members in each group are also shown in percentage distributions. These distributions are presented including and excluding individuals who are faculty members at the same schools where the M.D. was earned. Research schools are seen to contribute proportionally more of their graduates to U.S. faculties in all groups of schools. The group with proportionally more students oriented toward primary care specialties contributes faculty members largely to other schools in the same group. Research schools also evidence a similar "group breeding." All groups are net contributors to faculties at medical schools founded after the mid-1960s.

The role of M.D.-Ph.D. training in increasing the supply of physician-scientists.

Since 1968 the number of postdoctoral research fellows with M.D.s or other professional degrees has fallen from about 4100 to 1730 in training each year. By 1980, the number of M.D. postdoctoral fellows entering and completing research training was about 850 per year. During the past 12 years, the number of M.D.-Ph.D. trainees has risen to about 650 in the federal Medical Scientist Training Program (MSTP) and about 500 in nonfederal programs. The attrition rate in non-federal M.D.-Ph.D. programs has been shown to be 44 per cent, and that from the MSTP, 9 per cent. When the length of the training program, the attrition rate, and other factors are considered, present trainees will account for about 150 M.D.-Ph.D. graduates annually in the immediate future. Current training programs can meet only about half the estimated national need for physician researchers. The federal M.D.-Ph.D. program should be expanded to ensure that the country's future research and teaching needs will be met.