To review the literature on diagnostic testing in syncope and provide recommendations for a comprehensive, cost-effective approach to establishing its cause.

Screening for colorectal cancer with fecal occult blood tests or sigmoidoscopy can reduce mortality rates. If occult blood testing is done, clinicians must decide how to interpret the results and plan further management. If the results are positive, a decision must be made about evaluating the colon. This report provides information that can be used to perform fecal occult blood tests, interpret the results of those tests, and plan patient management.

To evaluate the potential benefits, harms, and economic consequences of digital rectal examination and measurement of prostate-specific antigen (PSA) for the early detection of prostate cancer.

To estimate the prevalence of clinically important prostate cancer and to evaluate the effectiveness of digital rectal examination and measurement of prostate-specific antigen (PSA) in early detection of prostate cancer.

To develop guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura (ITP) and to document the extent to which those guidelines are based on either scientific evidence or opinion, the AMerican Society of Hematology established a panel composed of 13 hematologists with expertise in ITP, a clinical epidemiologist, and a practice guidelines methodologist. A comprehensive review was done of all published English-language studies that met explicit inclusion criteria and that evaluated the natural history of ITP or the effectiveness of testing and treatment options for ITP. The quality of each study was graded by two reviewers using formal methodologic rules. In subject areas for which data was inadequate, recommendations were based on opinion and were derived by using a formal screening procedure. Confidential questionnaires were used to survey the hematologists on the panel about the appropriateness of testing and treatment options in hundreds of clinical scenarios. Practice recommendations were derived from the mean appropriateness scores for each indication. Voting was kept confidential to give each panel member an equal voice and to limit biases introduced by group dynamics. The recommendations were peer reviewed by eight outside experts. This report focuses on data and on recommendations for adults with ITP. Little high-quality scientific evidence with which to assess the efficacy of diagnostic tests and treatments for ITP is available. The opinion of the panel was that most diagnostic tests are unnecessary in the routine work-ups of patients suspected of having ITP and that ITP accompanied by severe bleeding requires treatment with glucocorticoids, intravenous immunoglobin, and other measures. However, treatment and hospitalization is often unnecessary when patients have only mild or moderate thrombocytopenia or minimal bleeding. Special therapeutic measures are sometimes indicated in pregnant women with ITP.

The complexities of the chronic fatigue syndrome and the methodologic problems associated with its study indicate the need for a comprehensive, systematic, and integrated approach to the evaluation, classification, and study of persons with this condition and other fatiguing illnesses. We propose a conceptual framework and a set of guidelines that provide such an approach. Our guidelines include recommendations for the clinical evaluation of fatigued persons, a revised case definition of the chronic fatigue syndrome, and a strategy for subgrouping fatigued persons in formal investigations.

To define the basic state-of-the-art medical care of the patients after bone marrow transplantation as practiced by the Eastern Cooperative Oncology Group.

To outline the preferable approach to the management of patients with nonfamilial colorectal polyps.