Developing standards for the development of glaucoma virtual clinics using a modified Delphi approach.

PubMed

Kotecha, Aachal; Longstaff, Simon; Azuara-Blanco, Augusto; Kirwan, James F; Morgan, James Edwards; Spencer, Anne Fiona; Foster, Paul J

2018-04-01

To obtain consensus opinion for the development of a standards framework for the development and implementation of virtual clinics for glaucoma monitoring in the UK using a modified Delphi methodology. A modified Delphi technique was used that involved sampling members of the UK Glaucoma and Eire Society (UKEGS). The first round scored the strength of agreement to a series of standards statements using a 9-point Likert scale. The revised standards were subjected to a second round of scoring and free-text comment. The final standards were discussed and agreed by an expert panel consisting of seven glaucoma subspecialists from across the UK. A version of the standards was submitted to external stakeholders for a 3-month consultation. There was a 44% response rate of UKEGS members to rounds 1 and 2, consisting largely of consultant ophthalmologists with a specialist interest in glaucoma. The final version of the standards document was validated by stakeholder consultation and contains four sections pertaining to the patient groups, testing methods, staffing requirements and governance structure of NHS secondary care glaucoma virtual clinic models. Use of a modified Delphi approach has provided consensus agreement for the standards required for the development of virtual clinics to monitor glaucoma in the UK. It is anticipated that this document will be useful as a guide for those implementing this model of service delivery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Methodology: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Ornelas, Joe; Dichter, Jeffrey R; Devereaux, Asha V; Kissoon, Niranjan; Livinski, Alicia; Christian, Michael D

2014-10-01

Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The field of disaster medicine does not have the required body of evidence needed to undergo a traditional guideline development process. In result, consensus statement-development methodology was used to capture the highest-caliber expert opinion in a structured, scientific approach. Task Force Executive Committee members identified core topic areas regarding the provision of care to critically ill or injured patients from pandemics or disasters and subsequently assembled an international panel for each identified area. International disaster medicine experts were brought together to identify key questions (in a population, intervention, comparator, outcome [PICO]-based format) within each of the core topic areas. Comprehensive literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions that are presented in this supplement using a modified Delphi process. A total of 315 suggestions were drafted across all topic groups. After two rounds of a Delphi consensus-development process, 267 suggestions were chosen by the panel to include in the document and published in a total of 12 manuscripts composing the core chapters of this supplement. Draft manuscripts were prepared by the topic editor and members of the working groups for each of the topics, producing a total of 11 papers. Once the preliminary drafts were received, the Executive Committee (Writing Committee) then met to review, edit, and promote alignment of all of the primary drafts of the manuscripts prepared by the topic editors and their groups. The topic editors then revised their manuscripts based on the Executive Committee's edits and comments. The Writing Committee subsequently reviewed the updated drafts and prepared the final manuscripts for submission to the Guidelines Oversight Committee (GOC). The manuscripts subsequently underwent review by the GOC, including external review as well as peer review for the journal publication. The Writing Committee received the feedback from the reviewers and modified the manuscripts as required. Based on a robust and transparent process, this project used rigorous methodology to produce clinically relevant, trustworthy consensus statements, with the aim to provide needed guidance on treatment and procedures for practitioners, hospital administrators, and public health and government officials when addressing the care of critically ill or injured patients in disasters or pandemics.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med 2015;11(8):931–952. PMID:26235159

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. SLEEP 2015;38(8):1161–1183. PMID:26194576

Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.

PubMed

Pufulete, Maria; Brierley, Rachel C; Bucciarelli-Ducci, Chiara; Greenwood, John P; Dorman, Stephen; Anderson, Richard A; Harris, Jessica; McAlindon, Elisa; Rogers, Chris A; Reeves, Barnaby C

2017-06-22

To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. Formal consensus study using literature review and cardiologist expert opinion to formulate consensus statements and setting up a consensus panel to review the statements (by completing a web-based survey, attending a face-to-face meeting to discuss survey results and modify the survey to reflect group discussion and completing the modified survey to determine which statements were in consensus). Formulation of consensus statements: four cardiologists (two CMR and two interventional) and six non-clinical researchers. Formal consensus: seven cardiologists (two CMR and three interventional, one echocardiography and one heart failure). Forty-nine additional cardiologists completed the modified survey. Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease. There was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion.

PubMed

Watson, Nathaniel F; Badr, M Safwan; Belenky, Gregory; Bliwise, Donald L; Buxton, Orfeu M; Buysse, Daniel; Dinges, David F; Gangwisch, James; Grandner, Michael A; Kushida, Clete; Malhotra, Raman K; Martin, Jennifer L; Patel, Sanjay R; Quan, Stuart F; Tasali, Esra

2015-08-01

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. © 2015 Associated Professional Sleep Societies, LLC.

Cofactor specificity switch in Shikimate dehydrogenase by rational design and consensus engineering.

PubMed

García-Guevara, Fernando; Bravo, Iris; Martínez-Anaya, Claudia; Segovia, Lorenzo

2017-08-01

Consensus engineering has been used to design more stable variants using the most frequent amino acid at each site of a multiple sequence alignment; sometimes consensus engineering modifies function, but efforts have mainly been focused on studying stability. Here we constructed a consensus Rossmann domain for the Shikimate dehydrogenase enzyme; separately we decided to switch the cofactor specificity through rational design in the Escherichia coli Shikimate dehydrogenase enzyme and then analyzed the effect of consensus mutations on top of our design. We found that consensus mutations closest to the 2' adenine moiety increased the activity in our design. Consensus engineering has been shown to result in more stable proteins and our findings suggest it could also be used as a complementary tool for increasing or modifying enzyme activity during design. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Facilitating a Faculty Learning Community: Determining Consensus Using Q Methodology

ERIC Educational Resources Information Center

Ramlo, Susan

2011-01-01

With plans to improve a Technical Report Writing course, writing faculty and engineering technology faculty formed a faculty learning community (FLC). Although discussions were often productive, it was often difficult to gauge consensus and differing views among the group members. In a previous study, Q methodology, a measure of subjectivity, was…

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union

PubMed Central

Fuller, Colin W; Molloy, Michael G; Bagate, Christian; Bahr, Roald; Brooks, John H M; Donson, Hilton; Kemp, Simon P T; McCrory, Paul; McIntosh, Andrew S; Meeuwisse, Willem H; Quarrie, Kenneth L; Raftery, Martin; Wiley, Preston

2007-01-01

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to reach an agreement on the appropriate definitions and methodologies to standardise the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin in order to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow‐up meeting was arranged in Dublin, at which time all definitions and procedures were finalised. At this stage, all authors confirmed their agreement with the consensus statement. The agreed document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, non‐fatal catastrophic injury, and training and match exposures, together with criteria for classifying injuries in terms of severity, location, type, diagnosis and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union. PMID:17452684

The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review.

PubMed

Humphrey-Murto, Susan; Varpio, Lara; Wood, Timothy J; Gonsalves, Carol; Ufholz, Lee-Anne; Mascioli, Kelly; Wang, Carol; Foth, Thomas

2017-10-01

Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

AMS 4.0: consensus prediction of post-translational modifications in protein sequences.

PubMed

Plewczynski, Dariusz; Basu, Subhadip; Saha, Indrajit

2012-08-01

We present here the 2011 update of the AutoMotif Service (AMS 4.0) that predicts the wide selection of 88 different types of the single amino acid post-translational modifications (PTM) in protein sequences. The selection of experimentally confirmed modifications is acquired from the latest UniProt and Phospho.ELM databases for training. The sequence vicinity of each modified residue is represented using amino acids physico-chemical features encoded using high quality indices (HQI) obtaining by automatic clustering of known indices extracted from AAindex database. For each type of the numerical representation, the method builds the ensemble of Multi-Layer Perceptron (MLP) pattern classifiers, each optimising different objectives during the training (for example the recall, precision or area under the ROC curve (AUC)). The consensus is built using brainstorming technology, which combines multi-objective instances of machine learning algorithm, and the data fusion of different training objects representations, in order to boost the overall prediction accuracy of conserved short sequence motifs. The performance of AMS 4.0 is compared with the accuracy of previous versions, which were constructed using single machine learning methods (artificial neural networks, support vector machine). Our software improves the average AUC score of the earlier version by close to 7 % as calculated on the test datasets of all 88 PTM types. Moreover, for the selected most-difficult sequence motifs types it is able to improve the prediction performance by almost 32 %, when compared with previously used single machine learning methods. Summarising, the brainstorming consensus meta-learning methodology on the average boosts the AUC score up to around 89 %, averaged over all 88 PTM types. Detailed results for single machine learning methods and the consensus methodology are also provided, together with the comparison to previously published methods and state-of-the-art software tools. The source code and precompiled binaries of brainstorming tool are available at http://code.google.com/p/automotifserver/ under Apache 2.0 licensing.

Parenting online and lay literature on infant spanking: information readily available to parents.

PubMed

Cain, Daphne S

2008-01-01

Professional consensus exists against the spanking of infants based on the risk of escalation and injury. Moreover, infants are unable to recognize connections between their behavior and punishment and to modify their behavior in response. However, pediatricians and other health care professionals do not frequently discuss the issue of infant spanking with parents. Meanwhile, parents are increasingly seeking parenting information from other sources including the Internet and lay parenting books. Using content analysis methodology, online parenting sites and popular "how to" parenting books were reviewed with regard to the advisability of corporal punishment with infants. Results reveal that although the vast majority of online and popular print literature on infant parenting is developmentally sound, a small constituency of spanking advocates does exist. Given that some of the information available to parents contradicts professional consensus against the spanking of infants, it seems important for professionals concerned with the well being of infants to address the gaps in information and inherent dangers of infant spanking.

Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy.

PubMed

Zang, Lei; Fan, Ning; Hai, Yong; Lu, S B; Su, Q J; Yang, J C; Du, Peng; Gao, Y J

2015-06-01

Although cervical radiculopathy is very common, there is no standard treatment for this condition, with little high-level evidence available to guide the treatment choice. Thus, this study aimed to review the current data on the management of cervical radiculopathy; and, further, to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy using the Delphi method. First, a systematic review of the previously established treatment guidelines and of articles related to cervical radiculopathy was conducted to establish a protocol for the clinical consensus of the treatment for cervical radiculopathy. Second, from February 2012 to June 2014, we performed a modified Delphi survey in which the current professional opinions from 30 experienced experts, representing almost all of the Chinese provinces, were gathered. Three rounds were performed, and consensus was defined as ≥70% agreement. Consensus of the treatments for cervical radiculopathy was reached on seven aspects, including the proportion of patients requiring only non-surgical therapies; the effectiveness of neck immobilization, physiotherapy, pharmacologic treatment; surgical indications; contraindications; surgery. The modified Delphi study conducted herein reached a consensus concerning several treatment issues for cervical radiculopathy. In the absence of high-level evidence, at present, these expert opinion findings will help guide health care providers to define the appropriate treatment in their regions. Items with no consensus provide excellent areas for future research.

Cross-cultural adaptation of the Window to Hope: a psychological intervention to reduce hopelessness among U.S. veterans with traumatic brain injury.

PubMed

Matarazzo, Bridget B; Hoffberg, Adam S; Clemans, Tracy A; Signoracci, Gina M; Simpson, Grahame K; Brenner, Lisa A

2014-01-01

To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of U.S. Veterans. Three-stage mixed-methods approach. Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions. Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized. RESULTS of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.

Clinical Decision Rules for Diagnostic Imaging in the Emergency Department: A Research Agenda.

PubMed

Finnerty, Nathan M; Rodriguez, Robert M; Carpenter, Christopher R; Sun, Benjamin C; Theyyunni, Nik; Ohle, Robert; Dodd, Kenneth W; Schoenfeld, Elizabeth M; Elm, Kendra D; Kline, Jeffrey A; Holmes, James F; Kuppermann, Nathan

2015-12-01

Major gaps persist in the development, validation, and implementation of clinical decision rules (CDRs) for diagnostic imaging. The objective of this working group and article was to generate a consensus-based research agenda for the development and implementation of CDRs for diagnostic imaging in the emergency department (ED). The authors followed consensus methodology, as outlined by the journal Academic Emergency Medicine (AEM), combining literature review, electronic surveys, telephonic communications, and a modified nominal group technique. Final discussions occurred in person at the 2015 AEM consensus conference. A research agenda was developed, prioritizing the following questions: 1) what are the optimal methods to justify the derivation and validation of diagnostic imaging CDRs, 2) what level of evidence is required before disseminating CDRs for widespread implementation, 3) what defines a successful CDR, 4) how should investigators best compare CDRs to clinical judgment, and 5) what disease states are amenable (and highest priority) to development of CDRs for diagnostic imaging in the ED? The concepts discussed herein demonstrate the need for further research on CDR development and implementation regarding diagnostic imaging in the ED. Addressing this research agenda should have direct applicability to patients, clinicians, and health care systems. © 2015 by the Society for Academic Emergency Medicine.

Priority issues for pressure injury research: An Australian consensus study.

PubMed

Haesler, Emily; Carville, Keryln; Haesler, Paul

2018-06-08

Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off-loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web-based nominal group voting process was successful in engaging expert decision-making and has wide-reaching international appeal in facilitating cost-effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research. © 2018 Wiley Periodicals, Inc.

A research agenda for the European Association for Endoscopic Surgeons (EAES).

PubMed

Francis, Nader; Kazaryan, Airazat M; Pietrabissa, Andrea; Goitein, David; Yiannakopoulou, Eugenia; Agresta, Ferdinando; Khatkov, Igor; Schulze, Svend; Arulampalam, Tan; Tomulescu, Victor; Kim, Young-Woo; Targarona, Eduardo Mª; Zaninotto, Giovanni

2017-05-01

The European Association of Endoscopic Surgeons (EAES) conducted this study aiming to identify the top research questions which are relevant to surgeons in Minimal Access Surgery (MAS). This is in order to promote and link research questions to the current clinical practice in MAS in Europe. Using a systematic methodology, (modified Delphi), the EAES members and leadership teams were surveyed to obtain consensus on the top research priorities in MAS. The responses were categorized and redistributed to the membership to rate the level of importance of each research question. The data were reported as the weighted average score with a scale from 1 (lowest agreement) to 5 (highest agreement). In total, 324 of 2580 (12.5%) of the EAES members and the leaders responded to the survey and contributed to the final consensus. The ranked responses over the 80th percentile identified 39 research priorities with rating ranged from 4.22 to 3.67. The top five highest ranking research priorities in the EAES were centered on improving training in MAS, laparoscopic surgery for benign upper gastrointestinal conditions, integration of novel technology in OR, translational and basic science research in bariatric surgery and investigating the role of MAS in rectal cancer. An EAES research agenda was developed using a systematic methodology and can be used to focus MAS research. This study was commissioned by the European Association for Endoscopic Surgery (EAES).

Evaluation of Nine Consensus Indices in Delphi Foresight Research and Their Dependency on Delphi Survey Characteristics: A Simulation Study and Debate on Delphi Design and Interpretation.

PubMed

Birko, Stanislav; Dove, Edward S; Özdemir, Vural

2015-01-01

The extent of consensus (or the lack thereof) among experts in emerging fields of innovation can serve as antecedents of scientific, societal, investor and stakeholder synergy or conflict. Naturally, how we measure consensus is of great importance to science and technology strategic foresight. The Delphi methodology is a widely used anonymous survey technique to evaluate consensus among a panel of experts. Surprisingly, there is little guidance on how indices of consensus can be influenced by parameters of the Delphi survey itself. We simulated a classic three-round Delphi survey building on the concept of clustered consensus/dissensus. We evaluated three study characteristics that are pertinent for design of Delphi foresight research: (1) the number of survey questions, (2) the sample size, and (3) the extent to which experts conform to group opinion (the Group Conformity Index) in a Delphi study. Their impacts on the following nine Delphi consensus indices were then examined in 1000 simulations: Clustered Mode, Clustered Pairwise Agreement, Conger's Kappa, De Moivre index, Extremities Version of the Clustered Pairwise Agreement, Fleiss' Kappa, Mode, the Interquartile Range and Pairwise Agreement. The dependency of a consensus index on the Delphi survey characteristics was expressed from 0.000 (no dependency) to 1.000 (full dependency). The number of questions (range: 6 to 40) in a survey did not have a notable impact whereby the dependency values remained below 0.030. The variation in sample size (range: 6 to 50) displayed the top three impacts for the Interquartile Range, the Clustered Mode and the Mode (dependency = 0.396, 0.130, 0.116, respectively). The Group Conformity Index, a construct akin to measuring stubbornness/flexibility of experts' opinions, greatly impacted all nine Delphi consensus indices (dependency = 0.200 to 0.504), except the Extremity CPWA and the Interquartile Range that were impacted only beyond the first decimal point (dependency = 0.087 and 0.083, respectively). Scholars in technology design, foresight research and future(s) studies might consider these new findings in strategic planning of Delphi studies, for example, in rational choice of consensus indices and sample size, or accounting for confounding factors such as experts' variable degrees of conformity (stubbornness/flexibility) in modifying their opinions.

Evaluation of Nine Consensus Indices in Delphi Foresight Research and Their Dependency on Delphi Survey Characteristics: A Simulation Study and Debate on Delphi Design and Interpretation

PubMed Central

Birko, Stanislav; Dove, Edward S.; Özdemir, Vural

2015-01-01

The extent of consensus (or the lack thereof) among experts in emerging fields of innovation can serve as antecedents of scientific, societal, investor and stakeholder synergy or conflict. Naturally, how we measure consensus is of great importance to science and technology strategic foresight. The Delphi methodology is a widely used anonymous survey technique to evaluate consensus among a panel of experts. Surprisingly, there is little guidance on how indices of consensus can be influenced by parameters of the Delphi survey itself. We simulated a classic three-round Delphi survey building on the concept of clustered consensus/dissensus. We evaluated three study characteristics that are pertinent for design of Delphi foresight research: (1) the number of survey questions, (2) the sample size, and (3) the extent to which experts conform to group opinion (the Group Conformity Index) in a Delphi study. Their impacts on the following nine Delphi consensus indices were then examined in 1000 simulations: Clustered Mode, Clustered Pairwise Agreement, Conger’s Kappa, De Moivre index, Extremities Version of the Clustered Pairwise Agreement, Fleiss’ Kappa, Mode, the Interquartile Range and Pairwise Agreement. The dependency of a consensus index on the Delphi survey characteristics was expressed from 0.000 (no dependency) to 1.000 (full dependency). The number of questions (range: 6 to 40) in a survey did not have a notable impact whereby the dependency values remained below 0.030. The variation in sample size (range: 6 to 50) displayed the top three impacts for the Interquartile Range, the Clustered Mode and the Mode (dependency = 0.396, 0.130, 0.116, respectively). The Group Conformity Index, a construct akin to measuring stubbornness/flexibility of experts’ opinions, greatly impacted all nine Delphi consensus indices (dependency = 0.200 to 0.504), except the Extremity CPWA and the Interquartile Range that were impacted only beyond the first decimal point (dependency = 0.087 and 0.083, respectively). Scholars in technology design, foresight research and future(s) studies might consider these new findings in strategic planning of Delphi studies, for example, in rational choice of consensus indices and sample size, or accounting for confounding factors such as experts’ variable degrees of conformity (stubbornness/flexibility) in modifying their opinions. PMID:26270647

Indian Society of Gastroenterology consensus statements on Crohn's disease in India.

PubMed

Ramakrishna, Balakrishnan S; Makharia, Govind K; Ahuja, Vineet; Ghoshal, Uday C; Jayanthi, Venkataraman; Perakath, Benjamin; Abraham, Philip; Bhasin, Deepak K; Bhatia, Shobna J; Choudhuri, Gourdas; Dadhich, Sunil; Desai, Devendra; Goswami, Bhaba Dev; Issar, Sanjeev K; Jain, Ajay K; Kochhar, Rakesh; Loganathan, Goundappa; Misra, Sri Prakash; Ganesh Pai, C; Pal, Sujoy; Philip, Mathew; Pulimood, Anna; Puri, Amarender S; Ray, Gautam; Singh, Shivaram P; Sood, Ajit; Subramanian, Venkatraman

2015-01-01

In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Curriculum development for a national cardiotocography education program: a Delphi survey to obtain consensus on learning objectives.

PubMed

Thellesen, Line; Hedegaard, Morten; Bergholt, Thomas; Colov, Nina P; Hoegh, Stinne; Sorensen, Jette L

2015-08-01

To define learning objectives for a national cardiotocography (CTG) education program based on expert consensus. A three-round Delphi survey. One midwife and one obstetrician from each maternity unit in Denmark were appointed based on CTG teaching experience and clinical obstetric experience. Following national and international guidelines, the research group determined six topics as important when using CTG: fetal physiology, equipment, indication, interpretation, clinical management, and communication/responsibility. In the first Delphi round, participants listed one to five learning objectives within the predefined topics. Responses were analyzed by a directed approach to content analysis. Phrasing was modified in accordance with Bloom's taxonomy. In the second and third Delphi rounds, participants rated each objective on a five-point relevance scale. Consensus was predefined as objectives with a mean rating value of ≥ 3. A prioritized list of CTG learning objectives. A total of 42 midwives and obstetricians from 21 maternity units were invited to participate, of whom 26 completed all three Delphi rounds, representing 18 maternity units. The final prioritized list included 40 objectives. The highest ranked objectives emphasized CTG interpretation and clinical management. The lowest ranked objectives emphasized fetal physiology. Mean ratings of relevance ranged from 3.15 to 5.00. National consensus on CTG learning objectives was achieved using the Delphi methodology. This was an initial step in developing a valid CTG education program. A prioritized list of objectives will clarify which topics to emphasize in a CTG education program. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Descriptive analysis of bacon smoked with Brazilian woods from reforestation: methodological aspects, statistical analysis, and study of sensory characteristics.

PubMed

Saldaña, Erick; Castillo, Luiz Saldarriaga; Sánchez, Jorge Cabrera; Siche, Raúl; de Almeida, Marcio Aurélio; Behrens, Jorge H; Selani, Miriam Mabel; Contreras-Castillo, Carmen J

2018-06-01

The aim of this study was to perform a descriptive analysis (DA) of bacons smoked with woods from reforestation and liquid smokes in order to investigate their sensory profile. Six samples of bacon were selected: three smoked bacons with different wood species (Eucalyptus citriodora, Acacia mearnsii, and Bambusa vulgaris), two artificially smoked bacon samples (liquid smoke) and one negative control (unsmoked bacon). Additionally, a commercial bacon sample was also evaluated. DA was developed successfully, presenting a good performance in terms of discrimination, consensus and repeatability. The study revealed that the smoking process modified the sensory profile by intensifying the "saltiness" and differentiating the unsmoked from the smoked samples. The results from the current research represent the first methodological development of descriptive analysis of bacon and may be used by food companies and other stakeholders to understand the changes in sensory characteristics of bacon due to traditional smoking process. Copyright © 2018 Elsevier Ltd. All rights reserved.

Consensus development of core competencies in intensive and critical care medicine training in China.

PubMed

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-10-16

The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies. The output from the online survey was edited and then reviewed by a nominal group of 13 intensive care professionals to identify each competence for importance. The resulting list was then recirculated in the nominal group for iterative rating. The online survey yielded a list of 199 competencies for nominal group reviewing. After five rounds of rating, 129 competencies entered the final set defined as core competencies. We have generated a set of core competencies using a consensus technique which can serve as an indicator for training program development.

Reporting standards for studies of diagnostic test accuracy in dementia

PubMed Central

Noel-Storr, Anna H.; McCleery, Jenny M.; Richard, Edo; Ritchie, Craig W.; Flicker, Leon; Cullum, Sarah J.; Davis, Daniel; Quinn, Terence J.; Hyde, Chris; Rutjes, Anne W.S.; Smailagic, Nadja; Marcus, Sue; Black, Sandra; Blennow, Kaj; Brayne, Carol; Fiorivanti, Mario; Johnson, Julene K.; Köpke, Sascha; Schneider, Lon S.; Simmons, Andrew; Mattsson, Niklas; Zetterberg, Henrik; Bossuyt, Patrick M.M.; Wilcock, Gordon

2014-01-01

Objective: To provide guidance on standards for reporting studies of diagnostic test accuracy for dementia disorders. Methods: An international consensus process on reporting standards in dementia and cognitive impairment (STARDdem) was established, focusing on studies presenting data from which sensitivity and specificity were reported or could be derived. A working group led the initiative through 4 rounds of consensus work, using a modified Delphi process and culminating in a face-to-face consensus meeting in October 2012. The aim of this process was to agree on how best to supplement the generic standards of the STARD statement to enhance their utility and encourage their use in dementia research. Results: More than 200 comments were received during the wider consultation rounds. The areas at most risk of inadequate reporting were identified and a set of dementia-specific recommendations to supplement the STARD guidance were developed, including better reporting of patient selection, the reference standard used, avoidance of circularity, and reporting of test-retest reliability. Conclusion: STARDdem is an implementation of the STARD statement in which the original checklist is elaborated and supplemented with guidance pertinent to studies of cognitive disorders. Its adoption is expected to increase transparency, enable more effective evaluation of diagnostic tests in Alzheimer disease and dementia, contribute to greater adherence to methodologic standards, and advance the development of Alzheimer biomarkers. PMID:24944261

Applied Swarm-based medicine: collecting decision trees for patterns of algorithms analysis.

PubMed

Panje, Cédric M; Glatzer, Markus; von Rappard, Joscha; Rothermundt, Christian; Hundsberger, Thomas; Zumstein, Valentin; Plasswilm, Ludwig; Putora, Paul Martin

2017-08-16

The objective consensus methodology has recently been applied in consensus finding in several studies on medical decision-making among clinical experts or guidelines. The main advantages of this method are an automated analysis and comparison of treatment algorithms of the participating centers which can be performed anonymously. Based on the experience from completed consensus analyses, the main steps for the successful implementation of the objective consensus methodology were identified and discussed among the main investigators. The following steps for the successful collection and conversion of decision trees were identified and defined in detail: problem definition, population selection, draft input collection, tree conversion, criteria adaptation, problem re-evaluation, results distribution and refinement, tree finalisation, and analysis. This manuscript provides information on the main steps for successful collection of decision trees and summarizes important aspects at each point of the analysis.

Validation of consensus panel diagnosis in dementia.

PubMed

Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

2010-12-01

The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

Identifying the features of an exercise addiction: A Delphi study

PubMed Central

Macfarlane, Lucy; Owens, Glynn; Cruz, Borja del Pozo

2016-01-01

Objectives There remains limited consensus regarding the definition and conceptual basis of exercise addiction. An understanding of the factors motivating maintenance of addictive exercise behavior is important for appropriately targeting intervention. The aims of this study were twofold: first, to establish consensus on features of an exercise addiction using Delphi methodology and second, to identify whether these features are congruous with a conceptual model of exercise addiction adapted from the Work Craving Model. Methods A three-round Delphi process explored the views of participants regarding the features of an exercise addiction. The participants were selected from sport and exercise relevant domains, including physicians, physiotherapists, coaches, trainers, and athletes. Suggestions meeting consensus were considered with regard to the proposed conceptual model. Results and discussion Sixty-three items reached consensus. There was concordance of opinion that exercising excessively is an addiction, and therefore it was appropriate to consider the suggestions in light of the addiction-based conceptual model. Statements reaching consensus were consistent with all three components of the model: learned (negative perfectionism), behavioral (obsessive–compulsive drive), and hedonic (self-worth compensation and reduction of negative affect and withdrawal). Conclusions Delphi methodology allowed consensus to be reached regarding the features of an exercise addiction, and these features were consistent with our hypothesized conceptual model of exercise addiction. This study is the first to have applied Delphi methodology to the exercise addiction field, and therefore introduces a novel approach to exercise addiction research that can be used as a template to stimulate future examination using this technique. PMID:27554504

Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials: a consensus study

PubMed Central

2011-01-01

Background Current methodological guidelines provide advice about the assessment of sub-group analysis within RCTs, but do not specify explicit criteria for assessment. Our objective was to provide researchers with a set of criteria that will facilitate the grading of evidence for moderators, in systematic reviews. Method We developed a set of criteria from methodological manuscripts (n = 18) using snowballing technique, and electronic database searches. Criteria were reviewed by an international Delphi panel (n = 21), comprising authors who have published methodological papers in this area, and researchers who have been active in the study of sub-group analysis in RCTs. We used the Research ANd Development/University of California Los Angeles appropriateness method to assess consensus on the quantitative data. Free responses were coded for consensus and disagreement. In a subsequent round additional criteria were extracted from the Cochrane Reviewers' Handbook, and the process was repeated. Results The recommendations are that meta-analysts report both confirmatory and exploratory findings for sub-groups analysis. Confirmatory findings must only come from studies in which a specific theory/evidence based a-priori statement is made. Exploratory findings may be used to inform future/subsequent trials. However, for inclusion in the meta-analysis of moderators, the following additional criteria should be applied to each study: Baseline factors should be measured prior to randomisation, measurement of baseline factors should be of adequate reliability and validity, and a specific test of the interaction between baseline factors and interventions must be presented. Conclusions There is consensus from a group of 21 international experts that methodological criteria to assess moderators within systematic reviews of RCTs is both timely and necessary. The consensus from the experts resulted in five criteria divided into two groups when synthesising evidence: confirmatory findings to support hypotheses about moderators and exploratory findings to inform future research. These recommendations are discussed in reference to previous recommendations for evaluating and reporting moderator studies. PMID:21281501

ACR Appropriateness Criteria® Routine Chest Radiography.

PubMed

McComb, Barbara L; Chung, Jonathan H; Crabtree, Traves D; Heitkamp, Darel E; Iannettoni, Mark D; Jokerst, Clinton; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

2016-03-01

Chest radiographs are sometimes taken before surgeries and interventional procedures on hospital admissions and outpatients. This manuscript summarizes the American College of Radiology review of the literature and recommendations on routinely performed chest radiographies in these settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

The use of Delphi and Nominal Group Technique in nursing education: A review.

PubMed

Foth, Thomas; Efstathiou, Nikolaos; Vanderspank-Wright, Brandi; Ufholz, Lee-Anne; Dütthorn, Nadin; Zimansky, Manuel; Humphrey-Murto, Susan

2016-08-01

Consensus methods are used by healthcare professionals and educators within nursing education because of their presumed capacity to extract the profession's' "collective knowledge" which is often considered tacit knowledge that is difficult to verbalize and to formalize. Since their emergence, consensus methods have been criticized and their rigour has been questioned. Our study focuses on the use of consensus methods in nursing education and seeks to explore how extensively consensus methods are used, the types of consensus methods employed, the purpose of the research and how standardized the application of the methods is. A systematic approach was employed to identify articles reporting the use of consensus methods in nursing education. The search strategy included keyword search in five electronic databases [Medline (Ovid), Embase (Ovid), AMED (Ovid), ERIC (Ovid) and CINAHL (EBSCO)] for the period 2004-2014. We included articles published in English, French, German and Greek discussing the use of consensus methods in nursing education or in the context of identifying competencies. A standardized extraction form was developed using an iterative process with results from the search. General descriptors such as type of journal, nursing speciality, type of educational issue addressed, method used, geographic scope were recorded. Features reflecting methodology such as number, selection and composition of panel participants, number of rounds, response rates, definition of consensus, and feedback were recorded. 1230 articles were screened resulting in 101 included studies. The Delphi was used in 88.2% of studies. Most were reported in nursing journals (63.4%). The most common purpose to use these methods was defining competencies, curriculum development and renewal, and assessment. Remarkably, both standardization and reporting of consensus methods was noted to be generally poor. Areas where the methodology appeared weak included: preparation of the initial questionnaire; the selection and description of participants; number of rounds and number of participants remaining after each round; formal feedback of group ratings; definitions of consensus and a priori definition of numbers of rounds; and modifications to the methodology. The findings of this study are concerning if interpreted within the context of the structural critiques because our findings lend support to these critiques. If consensus methods should continue being used to inform best practices in nursing education, they must be rigorous in design. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

PubMed

Jacobs, Carmel; Graham, Ian D; Makarski, Julie; Chassé, Michaël; Fergusson, Dean; Hutton, Brian; Clemons, Mark

2014-01-01

Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored consistently lower than the others over both domains. No journals adhered to all the items related to the transparency of document development. One journal's consensus statements endorsed a product made by the sponsoring pharmaceutical company in 64% of cases. Guidance documents are an essential part of oncology care and should be subjected to a rigorous and validated development process. Consensus statements had lower methodological quality than clinical practice guidelines using AGREE II. At a minimum, journals should ensure that that all consensus statements and clinical practice guidelines adhere to AGREE II criteria. Journals should consider explicitly requiring guidelines to declare pharmaceutical company sponsorship and to identify the sponsor's product to enhance transparency.

The Italian Consensus Conference on Pain in Neurorehabilitation: rationale and methodology

PubMed Central

Tamburin, Stefano; Paolucci, Stefano; Magrinelli, Francesca; Musicco, Massimo; Sandrini, Giorgio

2016-01-01

Pain is very common in the neurorehabilitation setting, where it may not only represent a target for treatment but can also negatively influence rehabilitation procedures directly or through the side effects of painkillers. To date, there are neither guidelines nor consensus on how to assess and treat pain in neurorehabilitation. Because of the very scanty pieces of evidence on this topic, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted under the auspices of different scientific societies. This article illustrates the rationale, methodology, and topics of the ICCPN. The recommendations of the ICCPN will offer some information on how to deal with pain in neurorehabilitation and may represent the starting point for further studies. PMID:27313474

Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion

PubMed Central

Paruthi, Shalini; Brooks, Lee J.; D'Ambrosio, Carolyn; Hall, Wendy A.; Kotagal, Suresh; Lloyd, Robin M.; Malow, Beth A.; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F.; Rosen, Carol L.; Troester, Matthew M.; Wise, Merrill S.

2016-01-01

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. Commentary: A commentary on this article apears in this issue on page 1439. Citation: Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med 2016;12(11):1549–1561. PMID:27707447

Use of the Delphi process in paediatric cataract management.

PubMed

Serafino, Massimiliano; Trivedi, Rupal H; Levin, Alex V; Wilson, M Edward; Nucci, Paolo; Lambert, Scott R; Nischal, Ken K; Plager, David A; Bremond-Gignac, Dominique; Kekunnaya, Ramesh; Nishina, Sachiko; Tehrani, Nasrin N; Ventura, Marcelo C

2016-05-01

To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. A modified Delphi method. International paediatric cataract experts with a publishing record in paediatric cataract management. The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evaluating the 2008 consensus conference on genetically modified foods in Taiwan.

PubMed

Fan, Mei-Fang

2015-07-01

Genetically modified foods have become one of the most popular topics for deliberative exercises involving ordinary citizens worldwide. This paper examines the Taiwanese consensus conference on GM foods held in June 2008, and the implications and limitations of the public deliberations. The consensus conference facilitated multiparty dialogues and enhanced citizens' knowledge, and affected their attitudes. This study demonstrates the ways contextual factors have influenced the outcome of the citizens' deliberative practices, including the government's conventional technocratic decision-making style, the strong influence of the U.S. government, the political and technological culture, the government's framing of economic development concerns, and a lack of pressure from civil society to compel the government to formally respond to their concerns. The consensus conference had a limited effect on policy decision-making, and seemed to serve as a socio-political experiment. © The Author(s) 2013.

Identifying opportunities for nature engagement in cancer care practice and design: protocol for four-round modified electronic Delphi.

PubMed

Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope

2017-03-08

Opportunities to engage with nature have shown relevance in experiences of health and recovery of patients with cancer and are attracting interest in cancer care practice and design. Such healthcare innovations can widen the horizon of possible supportive care solutions but require deliberate and rigorous investigation to ensure responsible action is taken and wastage avoided. This protocol outlines a study designed to solicit knowledge from relevant experts drawn from a range of healthcare practitioners, management representatives, designers and researchers to explore levels of opinion consensus for determining opportunities for, and barriers to, providing helpful nature engagement in cancer care settings. A 4-round modified electronic Delphi methodology will be used to conduct a structured, iterative feedback process for querying and synthesising expert opinion. Round 1 administers an open-ended questionnaire to a panel of selected, relevant experts who will consider the own recommendations of patients with cancer for nature engagement (drawn from a preceding investigation) before contributing salient issues (items) with relevance to the topic. Round 2 circulates anonymised summaries of responses back to the experts who verify and, if they wish, reconsider their own responses. Rounds 3 and 4 determine and rank experts' top 10 items using a 10-point Likert-type scale. Descriptive statistics (median and mean scores) will be calculated to indicate the items' relative importance. Levels of consensus will be explored with consensus defined as 75% agreement. Ethics approval for this study was obtained from the Institution's Human Research Ethics Committee (blinded for review). It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Determining The Various Perspectives And Consensus Within A Classroom Using Q Methodology

NASA Astrophysics Data System (ADS)

Ramlo, Susan E.

2008-10-01

Q methodology was developed by PhD physicist and psychologist William Stevenson 73 years ago as a new way of investigating people's views of any topic. Yet its application has primarily been in the fields of marketing, psychology, and political science. Still, Q offers an opportunity for the physics education research community to determine the perspectives and consensus within a group, such as a classroom, related to topics of interest such as the nature of science and epistemology. This paper presents the basics of using Q methodology with a classroom application as an example and subsequent comparisons of this example's results to similar studies using qualitative and survey methods.

International consensus for neuroblastoma molecular diagnostics: report from the International Neuroblastoma Risk Group (INRG) Biology Committee

PubMed Central

Ambros, P F; Ambros, I M; Brodeur, G M; Haber, M; Khan, J; Nakagawara, A; Schleiermacher, G; Speleman, F; Spitz, R; London, W B; Cohn, S L; Pearson, A D J; Maris, J M

2009-01-01

Neuroblastoma serves as a paradigm for utilising tumour genomic data for determining patient prognosis and treatment allocation. However, before the establishment of the International Neuroblastoma Risk Group (INRG) Task Force in 2004, international consensus on markers, methodology, and data interpretation did not exist, compromising the reliability of decisive genetic markers and inhibiting translational research efforts. The objectives of the INRG Biology Committee were to identify highly prognostic genetic aberrations to be included in the new INRG risk classification schema and to develop precise definitions, decisive biomarkers, and technique standardisation. The review of the INRG database (n=8800 patients) by the INRG Task Force finally enabled the identification of the most significant neuroblastoma biomarkers. In addition, the Biology Committee compared the standard operating procedures of different cooperative groups to arrive at international consensus for methodology, nomenclature, and future directions. Consensus was reached to include MYCN status, 11q23 allelic status, and ploidy in the INRG classification system on the basis of an evidence-based review of the INRG database. Standardised operating procedures for analysing these genetic factors were adopted, and criteria for proper nomenclature were developed. Neuroblastoma treatment planning is highly dependant on tumour cell genomic features, and it is likely that a comprehensive panel of DNA-based biomarkers will be used in future risk assignment algorithms applying genome-wide techniques. Consensus on methodology and interpretation is essential for uniform INRG classification and will greatly facilitate international and cooperative clinical and translational research studies. PMID:19401703

Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete

PubMed Central

Bisciotti, G N; Volpi, P; Zini, R; Auci, A; Aprato, A; Belli, A; Bellistri, G; Benelli, P; Bona, S; Bonaiuti, D; Carimati, G; Canata, G L; Cassaghi, G; Cerulli, S; Delle Rose, G; Di Benedetto, P; Di Marzo, F; Di Pietto, F; Felicioni, L; Ferrario, L; Foglia, A; Galli, M; Gervasi, E; Gia, L; Giammattei, C; Guglielmi, A; Marioni, A; Moretti, B; Niccolai, R; Orgiani, N; Pantalone, A; Parra, F; Quaglia, A; Respizzi, F; Ricciotti, L; Pereira Ruiz, M T; Russo, A; Sebastiani, E; Tancredi, G; Tosi, F; Vuckovic, Z

2016-01-01

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem. PMID:28890800

Use of Carabids for the Post-Market Environmental Monitoring of Genetically Modified Crops

PubMed Central

Skoková Habuštová, Oxana; Svobodová, Zdeňka; Cagáň, Ľudovít; Sehnal, František

2017-01-01

Post-market environmental monitoring (PMEM) of genetically modified (GM) crops is required by EU legislation and has been a subject of debate for many years; however, no consensus on the methodology to be used has been reached. We explored the suitability of carabid beetles as surrogates for the detection of unintended effects of GM crops in general PMEM surveillance. Our study combines data on carabid communities from five maize field trials in Central Europe. Altogether, 86 species and 58,304 individuals were collected. Modeling based on the gradual elimination of the least abundant species, or of the fewest categories of functional traits, showed that a trait-based analysis of the most common species may be suitable for PMEM. Species represented by fewer than 230 individuals (all localities combined) should be excluded and species with an abundance higher than 600 should be preserved for statistical analyses. Sixteen species, representing 15 categories of functional traits fulfill these criteria, are typical dominant inhabitants of agroecocoenoses in Central Europe, are easy to determine, and their functional classification is well known. The effect of sampling year is negligible when at least four samples are collected during maize development beginning from 1 April. The recommended methodology fulfills PMEM requirements, including applicability to large-scale use. However, suggested thresholds of carabid comparability should be verified before definitive conclusions are drawn. PMID:28353663

Researching the impact of oral health on diet and nutritional status: methodological issues.

PubMed

Moynihan, Paula; Thomason, Mark; Walls, Angus; Gray-Donald, Katherine; Morais, Jose A; Ghanem, Henry; Wollin, Stephanie; Ellis, Janice; Steele, Jimmy; Lund, James; Feine, Jocelyne

2009-04-01

Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research. Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal. Relevant papers were retrieved through PubMed. Relevant texts were obtained from the library at Newcastle University, UK. A purposive sample of original articles that illustrated the application of a range of nutritional methodologies to the study of oral health impacts was identified. Original flagship texts on nutritional methodologies were reviewed. Numerous studies have shown an association between loss of teeth and inferior diet. Further research is required to elucidate the impact of novel approaches to prosthetic rehabilitation and the impact of contemporaneous dietary and dental intervention on diet, nutritional status, disease progression and quality of life. The recommendation of the consensus workshop was that future studies should adopt a comprehensive approach to the assessment of nutrition that encompasses measurement of diet, body composition, biochemical indices of intake and levels of nutrients, and functional biomarkers of disease.

The S-Layer Glycoprotein of the Crenarchaeote Sulfolobus acidocaldarius Is Glycosylated at Multiple Sites with Chitobiose-Linked N-Glycans

PubMed Central

Peyfoon, Elham; Meyer, Benjamin; Hitchen, Paul G.; Panico, Maria; Morris, Howard R.; Haslam, Stuart M.; Albers, Sonja-Verena; Dell, Anne

2010-01-01

Glycosylation of the S-layer of the crenarchaea Sulfolobus acidocaldarius has been investigated using glycoproteomic methodologies. The mature protein is predicted to contain 31 N-glycosylation consensus sites with approximately one third being found in the C-terminal domain spanning residues L1004-Q1395. Since this domain is rich in Lys and Arg and therefore relatively tractable to glycoproteomic analysis, this study has focused on mapping its N-glycosylation. Our analysis identified nine of the 11 consensus sequence sites, and all were found to be glycosylated. This constitutes a remarkably high glycosylation density in the C-terminal domain averaging one site for each stretch of 30–40 residues. Each of the glycosylation sites observed was shown to be modified with a heterogeneous family of glycans, with the largest having a composition Glc1Man2GlcNAc2 plus 6-sulfoquinovose (QuiS), consistent with the tribranched hexasaccharide previously reported in the cytochrome b558/566 of S. acidocaldarius. S. acidocaldarius is the only archaeal species whose N-glycans are known to be linked via the chitobiose core disaccharide that characterises the N-linked glycans of Eukarya. PMID:20936123

Intra-Articular Cellular Therapy for Osteoarthritis and Focal Cartilage Defects of the Knee: A Systematic Review of the Literature and Study Quality Analysis.

PubMed

Chahla, Jorge; Piuzzi, Nicolas S; Mitchell, Justin J; Dean, Chase S; Pascual-Garrido, Cecilia; LaPrade, Robert F; Muschler, George F

2016-09-21

Intra-articular cellular therapy injections constitute an appealing strategy that may modify the intra-articular milieu or regenerate cartilage in the settings of osteoarthritis and focal cartilage defects. However, little consensus exists regarding the indications for cellular therapies, optimal cell sources, methods of preparation and delivery, or means by which outcomes should be reported. We present a systematic review of the current literature regarding the safety and efficacy of cellular therapy delivered by intra-articular injection in the knee that provided a Level of Evidence of III or higher. A total of 420 papers were screened. Methodological quality was assessed using a modified Coleman methodology score. Only 6 studies (4 Level II and 2 Level III) met the criteria to be included in this review; 3 studies were on treatment of osteoarthritis and 3 were on treatment of focal cartilage defects. These included 4 randomized controlled studies without blinding, 1 prospective cohort study, and 1 retrospective therapeutic case-control study. The studies varied widely with respect to cell sources, cell characterization, adjuvant therapies, and assessment of outcomes. Outcome was reported in a total of 300 knees (124 in the osteoarthritis studies and 176 in the cartilage defect studies). Mean follow-up was 21.0 months (range, 12 to 36 months). All studies reported improved outcomes with intra-articular cellular therapy and no major adverse events. The mean modified Coleman methodology score was 59.1 ± 16 (range, 32 to 82). The studies of intra-articular cellular therapy injections for osteoarthritis and focal cartilage defects in the human knee suggested positive results with respect to clinical improvement and safety. However, the improvement was modest and a placebo effect cannot be disregarded. The overall quality of the literature was poor, and the methodological quality was fair, even among Level-II and III studies. Effective clinical assessment and optimization of injection therapies will demand greater attention to study methodology, including blinding; standardized quantitative methods for cell harvesting, processing, characterization, and delivery; and standardized reporting of clinical and structural outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report

PubMed Central

Salins, Naveen; Gursahani, Roop; Mathur, Roli; Iyer, Shivakumar; Macaden, Stanley; Simha, Nagesh; Mani, Raj Kumar; Rajagopal, M. R.

2018-01-01

Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method. Results: Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice. PMID:29743764

Inflammatory bowel disease and Clostridium difficile infection: contrasting views of international clinical professionals.

PubMed

Stallmach, Andreas; Anttila, Veli-Jukka; Hell, Markus; Gwynn, Simon; Merino-Amador, Paloma; Petrosillo, Nicola; Ráčil, Zdenek; Warren, Tim; Wenisch, Christoph; Wilcox, Mark

2018-02-09

 In patients with inflammatory bowel disease (IBD), Clostridium difficile infection (CDI) is a risk factor for both morbidity and mortality. Currently, appropriate management is unclear. Guidance on best practice in the diagnosis and treatment of CDI in IBD patients is therefore needed.  A multidisciplinary group of clinicians involved in the treatment of patients with IBD and CDI developed 27 consensus statements. Respondents were asked to rate their agreement with each statement using a 4-point Likert scale. A modified Delphi methodology was used to review responses of 442 physicians from different specialties (including infectious disease specialists [n = 104], microbiologists [n = 95], and gastroenterologists [n = 73]). A threshold of 75 % agreement was predefined as consensus.  Consensus was achieved for 17 of the 27 statements. Unprompted recognition of risk factors for CDI was low. Intensification of immunosuppressive therapy in the absence of clinical improvement was controversial. Clear definitions of treatment failure of antibiotic therapy in CDI and recurrence of CDI in IBD are needed. Respondents require further clarity regarding the place of fecal microbiota transplantation in CDI patients with IBD. Differences were observed between the perceptions of microbiologists and gastroenterologists, as well as between countries.  Different perceptions both between specialties and geographical locations complicate the development of an internationally accepted algorithm for the diagnosis and treatment of CDI in patients with IBD. This study highlights the need for future studies in this area. © Georg Thieme Verlag KG Stuttgart · New York.

Guidelines for the conduct of pharmacological clinical trials in hand osteoarthritis: Consensus of a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

PubMed

Reginster, Jean-Yves L; Arden, Nigel K; Haugen, Ida K; Rannou, Francois; Cavalier, Etienne; Bruyère, Olivier; Branco, Jaime; Chapurlat, Roland; Collaud Basset, Sabine; Al-Daghri, Nasser M; Dennison, Elaine M; Herrero-Beaumont, Gabriel; Laslop, Andrea; Leeb, Burkhard F; Maggi, Stefania; Mkinsi, Ouafa; Povzun, Anton S; Prieto-Alhambra, Daniel; Thomas, Thierry; Uebelhart, Daniel; Veronese, Nicola; Cooper, Cyrus

2017-12-07

To gather expert opinion on the conduct of clinical trials that will facilitate regulatory review and approval of appropriate efficacious pharmacological treatments for hand osteoarthritis (OA), an area of high unmet clinical need. The European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) organized a working group under the auspices of the International Osteoporosis Foundation (IOF) and the World Health Organization (WHO). This consensus guideline is intended to provide a reference tool for practice, and should allow for better standardization of the conduct of clinical trials in hand OA. Hand OA is a heterogeneous disease affecting different, and often multiple, joints of the thumb and fingers. It was recognized that the various phenotypes and limitations of diagnostic criteria may make the results of hand OA trials difficult to interpret. Nonetheless, practical recommendations for the conduct of clinical trials of both symptom and structure modifying drugs are outlined in this consensus statement, including guidance on study design, execution, and analysis. While the working group acknowledges that the methodology for performing clinical trials in hand OA will evolve as knowledge of the disease increases, it is hoped that this guidance will support the development of new pharmacological treatments targeting hand OA. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO*

PubMed Central

Xynos, Evaghelos; Gouvas, Nikolaos; Triantopoulou, Charina; Tekkis, Paris; Vini, Louiza; Tzardi, Maria; Boukovinas, Ioannis; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Vassiliou, Vassilios; Xynogalos, Spyridon; Ziras, Nikolaos; Karachaliou, Niki; Zoras, Odysseas; Agalianos, Christos; Souglakos, John

2016-01-01

Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of <60% after both rounds were rejected and not presented. Sixty statements on the management of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized. PMID:26752945

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

PubMed

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Defining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study.

PubMed

Doyen, Bart; Maurel, Blandine; Cole, Jonathan; Maertens, Heidi; Mastracci, Tara; Van Herzeele, Isabelle

2018-02-01

Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus. Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5- point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service. Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies. A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team. Copyright © 2017 European Society for Vascular Surgery. All rights reserved.

Using a Delphi process to establish consensus on emergency medicine clerkship competencies.

PubMed

Penciner, Rick; Langhan, Trevor; Lee, Richard; McEwen, Jill; Woods, Robert A; Bandiera, Glen

2011-01-01

Currently, there is no consensus on the core competencies required for emergency medicine (EM) clerkships in Canada. Existing EM curricula have been developed through informal consensus or local efforts. The Delphi process has been used extensively as a means for establishing consensus. The purpose of this project was to define core competencies for EM clerkships in Canada, to validate a Delphi process in the context of national curriculum development, and to demonstrate the adoption of the CanMEDS physician competency paradigm in the undergraduate medical education realm. Using a modified Delphi process, we developed a consensus amongst a panel of expert emergency physicians from across Canada utilizing the CanMEDS 2005 Physician Competency Framework. Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). This study demonstrated that a modified Delphi process can result in a strong consensus around a realistic number of core competencies for EM clerkships. We propose that such a method could be used by other medical specialties and health professions to develop rotation-specific core competencies.

Defining Pathways for Development of Disease-Modifying Therapies in Children With Type 1 Diabetes: A Consensus Report

PubMed Central

Wherrett, Diane K.; Chiang, Jane L.; Delamater, Alan M.; DiMeglio, Linda A.; Gitelman, Stephen E.; Gottlieb, Peter A.; Herold, Kevan C.; Lovell, Daniel J.; Orchard, Trevor J.; Ryan, Christopher M.; Schatz, Desmond A.; Wendler, David S.

2015-01-01

Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes–modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies. PMID:26404927

[Key points for the management of dermatitis in Latin America. The SLAAI Consensus].

PubMed

Sánchez, Jorge; Páez, Bruno; Macías-Weinmann, Alejandra; De Falco, Alicia

2015-01-01

The incidence of atopic dermatitis in Latin America, as in other regions, has been increasing in recent years. The SLAAI consensus is based on a systematic search for articles related to dermatitis, with focus in the pathophysiology and treatment and its impact on Latin America, and reviewed using the Delphi methodology (Revista Alergia Mexico 2014;61:178-211). In this article we highlight the key points of consensus and particular considerations in Latin America.

Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel

PubMed Central

Allison, Kimberly H; Reisch, Lisa M; Carney, Patricia A; Weaver, Donald L; Schnitt, Stuart J; O’Malley, Frances P; Geller, Berta M; Elmore, Joann G

2015-01-01

Aims To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon. Methods and results In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists’ opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases. Conclusions Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability. PMID:24511905

Development methodology of the novel Endoscopic stone treatment step 1 (EST s1) training/assessment curriculum.

PubMed

Veneziano, Domenico; Ahmed, Kamran; Van Cleynenbreugel, Ben S E P; Gözen, Ali Serdar; Palou, Joan; Sarica, Kemal; Liatsikos, Evangelos N; Sanguedolce, Francesco; Honeck, Patrick; Alvarez-Maestro, Mario; Papatsoris, Athanasios; Kallidonis, Panagiotis; Greco, Francesco; Breda, Alberto; Somani, Bhaskar

2017-07-10

Background Simulation based technical-skill assessment is a core topic of debate, especially in high-risk environments. After the introduction of the E-BLUS exam for basic laparoscopy, no more technical training/assessment urological protocols have been developed in Europe. Objective We describe the methodology used in the development of the novel Endoscopic Stone Treatment step 1 (EST s1) assessment curriculum. Materials and Methods The "full life cycle curriculum development" template was followed for curriculum development. A CTA was run to define the most important steps and details of RIRS, in accordance with EAU Urolithiasis guidelines. Training tasks were created between April 2015 and September 2015. Tasks and metrics were further analyzed by a consensus meeting with the EULIS board in February 2016. A review, aimed to study available simulators and their accordance with task requirements, was subsequently run in London on March 2016. After initial feedback and further tests, content validity of this protocol was achieved during EUREP 2016. Results The EST s1 curriculum development, took 23 months. 72 participants tested the 5 preliminary tasks during EUREP 2015, with sessions of 45 minutes each. Likert-scale questionnaires were filled-out to score the quality of training. The protocol was modified accordingly and 25 participants tested the 4 tasks during the hands-on training sessions of the ESUT 2016 congress. 134 participants finally participated in the validation study in EUREP 2016. During the same event 10 experts confirmed content validity by filling-out a Likert-scale questionnaire. Conclusion We described a reliable and replicable methodology that can be followed to develop training/assessment protocols for surgical procedures. The expert consensus meetings, strict adherence to guidelines and updated literature search towards an Endourology curriculum allowed correct training and assessment protocol development. It is the first step towards standardized simulation training in Endourology with a potential for worldwide adoption.

Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale.

PubMed

Sheu, Bor-Shyang; Wu, Ming-Shiang; Chiu, Cheng-Tang; Lo, Jing-Chuan; Wu, Deng-Chyang; Liou, Jyh-Ming; Wu, Chun-Ying; Cheng, Hsiu-Chi; Lee, Yi-Chia; Hsu, Ping-I; Chang, Chun-Chao; Chang, Wei-Lun; Lin, Jaw-Town

2017-06-01

Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer. This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting. There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer. This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer. © 2017 The Authors. Helicobacter Published by John Wiley & Sons Ltd.

Investigating the Effects of Prompts on Argumentation Style, Consensus and Perceived Efficacy in Collaborative Learning

ERIC Educational Resources Information Center

Harney, Owen M.; Hogan, Michael J.; Broome, Benjamin; Hall, Tony; Ryan, Cormac

2015-01-01

This paper investigates the effects of task-level versus process-level prompts on levels of perceived and objective consensus, perceived efficacy, and argumentation style in the context of a computer-supported collaborative learning session using Interactive Management (IM), a computer facilitated thought and action mapping methodology. Four…

Developing clinical practice guidelines for Chinese herbal treatment of polycystic ovary syndrome: A mixed-methods modified Delphi study.

PubMed

Lai, Lily; Flower, Andrew; Moore, Michael; Lewith, George

2015-06-01

Preliminary evidence suggests Chinese herbal medicine (CHM) could be a viable treatment option for polycystic ovary syndrome (PCOS). Prior to conducting a clinical trial it is important to consider the characteristics of good clinical practice. This study aims to use professional consensus to establish good clinical practice guidelines for the CHM treatment of PCOS. CHM practitioners participated in a mixed-methods modified Delphi study involving three rounds of structured group communication. Round 1 involved qualitative interviews with practitioners to generate statements regarding good clinical practice. In round 2, these statements were distributed online to the same practitioners to rate their agreement using a 7-point Likert scale, where group consensus was defined as a median rating of ≥5. Statements reaching consensus were accepted for consideration onto the guideline whilst those not reaching consensus were re-distributed for consideration in round 3. Statements presented in the guidelines were graded from A (strong consensus) to D (no consensus) determined by median score and interquartile range. 11 CHM practitioners in the UK were recruited. After three Delphi rounds, 91 statement items in total had been considered, of which 89 (97.8%) reached consensus and 2 (2.2%) did not. The concluding set of guidelines consists of 85 items representing key features of CHM prescribing for PCOS. These guidelines can be viewed as an initial framework that captures fundamental principles of good clinical practice for CHM. Copyright © 2015 Elsevier Ltd. All rights reserved.

History and future of the scientific consensus on anthropogenic global warming

NASA Astrophysics Data System (ADS)

Reusswig, Fritz

2013-09-01

The article by Cook et al offers an interesting new methodological approach to the debate about (supposedly lacking) scientific consensus on global warming, showing that contrarian claims that there was no such consensus are clearly misleading. But once the attribution issue can be regarded as settled, new questions and controversies arise. They ultimately result from the different technological and organizational pathways towards a new global society model that takes its adverse climate change effects into account and seeks for new, but also risky solutions.

Medical Students and informed consent: A consensus statement prepared by the Faculties of Medical and Health Science of the Universities of Auckland and Otago, Chief Medical Officers of District Health Boards, New Zealand Medical Students' Association and the Medical Council of New Zealand.

PubMed

Bagg, Warwick; Adams, John; Anderson, Lynley; Malpas, Phillipa; Pidgeon, Grant; Thorn, Michael; Tulloch, David; Zhong, Cathy; Merry, Alan F

2015-05-15

To develop a national consensus statement to promote a pragmatic, appropriate and unified approach to seeking consent for medical student involvement in patient care. A modified Delphi technique was used to develop the consensus statement involving stakeholders. Feedback from consultation and each stakeholder helped to shape the final consensus statement. The consensus statement is a nationally-agreed statement concerning medical student involvement in patient care, which will be useful for medical students, health care professionals and patients.

Creation and Delphi-method refinement of pediatric disaster triage simulations.

PubMed

Cicero, Mark X; Brown, Linda; Overly, Frank; Yarzebski, Jorge; Meckler, Garth; Fuchs, Susan; Tomassoni, Anthony; Aghababian, Richard; Chung, Sarita; Garrett, Andrew; Fagbuyi, Daniel; Adelgais, Kathleen; Goldman, Ran; Parker, James; Auerbach, Marc; Riera, Antonio; Cone, David; Baum, Carl R

2014-01-01

There is a need for rigorously designed pediatric disaster triage (PDT) training simulations for paramedics. First, we sought to design three multiple patient incidents for EMS provider training simulations. Our second objective was to determine the appropriate interventions and triage level for each victim in each of the simulations and develop evaluation instruments for each simulation. The final objective was to ensure that each simulation and evaluation tool was free of bias toward any specific PDT strategy. We created mixed-methods disaster simulation scenarios with pediatric victims: a school shooting, a school bus crash, and a multiple-victim house fire. Standardized patients, high-fidelity manikins, and low-fidelity manikins were used to portray the victims. Each simulation had similar acuity of injuries and 10 victims. Examples include children with special health-care needs, gunshot wounds, and smoke inhalation. Checklist-based evaluation tools and behaviorally anchored global assessments of function were created for each simulation. Eight physicians and paramedics from areas with differing PDT strategies were recruited as Subject Matter Experts (SMEs) for a modified Delphi iterative critique of the simulations and evaluation tools. The modified Delphi was managed with an online survey tool. The SMEs provided an expected triage category for each patient. The target for modified Delphi consensus was ≥85%. Using Likert scales and free text, the SMEs assessed the validity of the simulations, including instances of bias toward a specific PDT strategy, clarity of learning objectives, and the correlation of the evaluation tools to the learning objectives and scenarios. After two rounds of the modified Delphi, consensus for expected triage level was >85% for 28 of 30 victims, with the remaining two achieving >85% consensus after three Delphi iterations. To achieve consensus, we amended 11 instances of bias toward a specific PDT strategy and corrected 10 instances of noncorrelation between evaluations and simulation. The modified Delphi process, used to derive novel PDT simulation and evaluation tools, yielded a high degree of consensus among the SMEs, and eliminated biases toward specific PDT strategies in the evaluations. The simulations and evaluation tools may now be tested for reliability and validity as part of a prehospital PDT curriculum.

The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.

PubMed

Mokkink, Lidwine B; Terwee, Caroline B; Patrick, Donald L; Alonso, Jordi; Stratford, Paul W; Knol, Dirk L; Bouter, Lex M; de Vet, Henrica C W

2010-05-01

Aim of the COSMIN study (COnsensus-based Standards for the selection of health status Measurement INstruments) was to develop a consensus-based checklist to evaluate the methodological quality of studies on measurement properties. We present the COSMIN checklist and the agreement of the panel on the items of the checklist. A four-round Delphi study was performed with international experts (psychologists, epidemiologists, statisticians and clinicians). Of the 91 invited experts, 57 agreed to participate (63%). Panel members were asked to rate their (dis)agreement with each proposal on a five-point scale. Consensus was considered to be reached when at least 67% of the panel members indicated 'agree' or 'strongly agree'. Consensus was reached on the inclusion of the following measurement properties: internal consistency, reliability, measurement error, content validity (including face validity), construct validity (including structural validity, hypotheses testing and cross-cultural validity), criterion validity, responsiveness, and interpretability. The latter was not considered a measurement property. The panel also reached consensus on how these properties should be assessed. The resulting COSMIN checklist could be useful when selecting a measurement instrument, peer-reviewing a manuscript, designing or reporting a study on measurement properties, or for educational purposes.

Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version.

PubMed

Werner, R N; Stockfleth, E; Connolly, S M; Correia, O; Erdmann, R; Foley, P; Gupta, A K; Jacobs, A; Kerl, H; Lim, H W; Martin, G; Paquet, M; Pariser, D M; Rosumeck, S; Röwert-Huber, H-J; Sahota, A; Sangueza, O P; Shumack, S; Sporbeck, B; Swanson, N A; Torezan, L; Nast, A

2015-11-01

Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing. The goal of these evidence- and consensus-based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus-based recommendations for the histopathological definition, diagnosis and the assessment of patients. The guidelines development followed a pre-defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies. Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately. International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments). © 2015 European Academy of Dermatology and Venereology.

Routes of Knowledge: Toward a Methodological Framework for Tracing the Historical Impact of International Organizations

ERIC Educational Resources Information Center

Christensen, Ivan Lind; Ydesen, Christian

2015-01-01

Recent trends in the historiography of international organizations are occupied with tracing their historical impact on national contexts. There is, however, no consensus on how to conduct this type of analysis methodologically. This article examines the methodological challenges arising from this type of research. While a great deal of…

Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

PubMed Central

Mohr, Nicholas M.; Moreno-Walton, Lisa; Mills, Angela M.; Brunett, Patrick H.; Promes, Susan B.

2010-01-01

For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation Xers, and Millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine (SAEM) Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

A consensus definition and core competencies for being an advocate for pharmacy.

PubMed

Bzowyckyj, Andrew S; Janke, Kristin K

2013-03-12

To develop a consensus definition for "advocacy for the profession of pharmacy" and core competencies for doctor of pharmacy (PharmD) graduates to be effective advocates for the profession. A 3-round modified Delphi process was conducted using a panel of 9 experts. Participants revised a definition for "advocacy for the profession" and ultimately rated their agreement using a 5-point Likert scale. Competency statements were developed and subsequently rated for importance for being an advocate and importance to address in PharmD curricula. A consensus-derived definition was developed. Two competency statements achieved consensus for both measures of importance. Four competency statements achieved consensus for only 1 measure and another 4 did not reach consensus for either measure. A consensus-derived definition was developed describing advocacy for the profession of pharmacy and began laying the groundwork for the knowledge and skills necessary to be an effective advocate for the profession of pharmacy.

Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children (Bethesda, Maryland, March 1-3, 1993).

ERIC Educational Resources Information Center

National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

This document compiles abstracts of papers that were presented at a 3-day conference of experts which developed a consensus statement on early identification of hearing impairment in infants and young children. Papers addressed taxonomy; epidemiology; developmental consequences of early hearing impairment; methodology, instrumentation, and…

Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus.

PubMed

Kim, Andrew H; Roberts, Charlotte; Feagan, Brian G; Banerjee, Rupa; Bemelman, Willem; Bodger, Keith; Derieppe, Marc; Dignass, Axel; Driscoll, Richard; Fitzpatrick, Ray; Gaarentstroom-Lunt, Janette; Higgins, Peter D; Kotze, Paulo Gustavo; Meissner, Jillian; O'Connor, Marian; Ran, Zhi-Hua; Siegel, Corey A; Terry, Helen; van Deen, Welmoed K; van der Woude, C Janneke; Weaver, Alandra; Yang, Suk-Kyun; Sands, Bruce E; Vermeire, Séverine; Travis, Simon Pl

2018-03-28

Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease [IBD], for use in different healthcare settings. An international working group [n = 25] representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure [PROM] methodologists participated in a series of teleconferences incorporating a modified Delphi process. Systematic review of existing literature, registry data, patient focus groups and open review periods were used to reach consensus on a minimum set of standard outcome measures and risk adjustment variables. Similar methodology has been used in 21 other disease areas [www.ichom.org]. A minimum Standard Set of outcomes was developed for patients [aged ≥16] with IBD. Outcome domains included survival and disease control [survival, disease activity/remission, colorectal cancer, anaemia], disutility of care [treatment-related complications], healthcare utilization [IBD-related admissions, emergency room visits] and patient-reported outcomes [including quality of life, nutritional status and impact of fistulae] measured at baseline and at 6 or 12 month intervals. A single PROM [IBD-Control questionnaire] was recommended in the Standard Set and minimum risk adjustment data collected at baseline and annually were included: demographics, basic clinical information and treatment factors. A Standard Set of outcome measures for IBD has been developed based on evidence, patient input and specialist consensus. It provides an international template for meaningful, comparable and easy-to-interpret measures as a step towards achieving value-based healthcare in IBD.

PRISMA-Children (C) and PRISMA-Protocol for Children (P-C) Extensions: a study protocol for the development of guidelines for the conduct and reporting of systematic reviews and meta-analyses of newborn and child health research.

PubMed

Kapadia, Mufiza Z; Askie, Lisa; Hartling, Lisa; Contopoulos-Ioannidis, Despina; Bhutta, Zulfiqar A; Soll, Roger; Moher, David; Offringa, Martin

2016-04-18

Paediatric systematic reviews differ from adult systematic reviews in several key aspects such as considerations of child tailored interventions, justifiable comparators, valid outcomes and child sensitive search strategies. Available guidelines, including PRISMA-P (2015) and PRISMA (2009), do not cover all the complexities associated with reporting systematic reviews in the paediatric population. Using a collaborative, multidisciplinary structure, we aim to develop evidence-based and consensus-based PRISMA-P-C (Protocol for Children) and PRISMA-C (Children) Extensions to guide paediatric systematic review protocol and completed review reporting. This project's methodology follows published recommendations for developing reporting guidelines and involves the following six phases; (1) establishment of a steering committee representing key stakeholder groups; (2) a scoping review to identify potential Extension items; (3) three types of consensus activities including meetings of the steering committee to achieve high-level decisions on the content and methodology of the Extensions, a survey of key stakeholders to generate a list of possible items to include in the Extensions and a formal consensus meeting to select the reporting items to add to, or modify for, the Extension; (4) the preliminary checklist items generated in phase III will be evaluated against the existing evidence and reporting practices in paediatric systematic reviews; (5) extension statements and explanation and elaboration documents will provide detailed advice for each item and examples of good reporting; (6) development and implementation of effective knowledge translation of the extension checklist, and an evaluation of the Extensions by key stakeholders. This protocol was considered a quality improvement project by the Hospital for Sick Children's Ethics Committee and did not require ethical review. The resultant checklists, jointly developed with all relevant stakeholders, will be disseminated through peer-reviewed journals as well as national and international conference presentations. Endorsement of the checklist will be sought simultaneously in multiple journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PRISMA-Children (C) and PRISMA-Protocol for Children (P-C) Extensions: a study protocol for the development of guidelines for the conduct and reporting of systematic reviews and meta-analyses of newborn and child health research

PubMed Central

Kapadia, Mufiza Z; Askie, Lisa; Hartling, Lisa; Contopoulos-Ioannidis, Despina; Bhutta, Zulfiqar A; Soll, Roger; Moher, David; Offringa, Martin

2016-01-01

Introduction Paediatric systematic reviews differ from adult systematic reviews in several key aspects such as considerations of child tailored interventions, justifiable comparators, valid outcomes and child sensitive search strategies. Available guidelines, including PRISMA-P (2015) and PRISMA (2009), do not cover all the complexities associated with reporting systematic reviews in the paediatric population. Using a collaborative, multidisciplinary structure, we aim to develop evidence-based and consensus-based PRISMA-P-C (Protocol for Children) and PRISMA-C (Children) Extensions to guide paediatric systematic review protocol and completed review reporting. Methods and analysis This project's methodology follows published recommendations for developing reporting guidelines and involves the following six phases; (1) establishment of a steering committee representing key stakeholder groups; (2) a scoping review to identify potential Extension items; (3) three types of consensus activities including meetings of the steering committee to achieve high-level decisions on the content and methodology of the Extensions, a survey of key stakeholders to generate a list of possible items to include in the Extensions and a formal consensus meeting to select the reporting items to add to, or modify for, the Extension; (4) the preliminary checklist items generated in phase III will be evaluated against the existing evidence and reporting practices in paediatric systematic reviews; (5) extension statements and explanation and elaboration documents will provide detailed advice for each item and examples of good reporting; (6) development and implementation of effective knowledge translation of the extension checklist, and an evaluation of the Extensions by key stakeholders. Ethics and Dissemination This protocol was considered a quality improvement project by the Hospital for Sick Children's Ethics Committee and did not require ethical review. The resultant checklists, jointly developed with all relevant stakeholders, will be disseminated through peer-reviewed journals as well as national and international conference presentations. Endorsement of the checklist will be sought simultaneously in multiple journals. PMID:27091820

Systematic review and consensus guidelines for environmental sampling of Burkholderia pseudomallei.

PubMed

Limmathurotsakul, Direk; Dance, David A B; Wuthiekanun, Vanaporn; Kaestli, Mirjam; Mayo, Mark; Warner, Jeffrey; Wagner, David M; Tuanyok, Apichai; Wertheim, Heiman; Yoke Cheng, Tan; Mukhopadhyay, Chiranjay; Puthucheary, Savithiri; Day, Nicholas P J; Steinmetz, Ivo; Currie, Bart J; Peacock, Sharon J

2013-01-01

Burkholderia pseudomallei, a Tier 1 Select Agent and the cause of melioidosis, is a Gram-negative bacillus present in the environment in many tropical countries. Defining the global pattern of B. pseudomallei distribution underpins efforts to prevent infection, and is dependent upon robust environmental sampling methodology. Our objective was to review the literature on the detection of environmental B. pseudomallei, update the risk map for melioidosis, and propose international consensus guidelines for soil sampling. An international working party (Detection of Environmental Burkholderia pseudomallei Working Party (DEBWorP)) was formed during the VIth World Melioidosis Congress in 2010. PubMed (January 1912 to December 2011) was searched using the following MeSH terms: pseudomallei or melioidosis. Bibliographies were hand-searched for secondary references. The reported geographical distribution of B. pseudomallei in the environment was mapped and categorized as definite, probable, or possible. The methodology used for detecting environmental B. pseudomallei was extracted and collated. We found that global coverage was patchy, with a lack of studies in many areas where melioidosis is suspected to occur. The sampling strategies and bacterial identification methods used were highly variable, and not all were robust. We developed consensus guidelines with the goals of reducing the probability of false-negative results, and the provision of affordable and 'low-tech' methodology that is applicable in both developed and developing countries. The proposed consensus guidelines provide the basis for the development of an accurate and comprehensive global map of environmental B. pseudomallei.

Current Approaches and Clinician Attitudes to the Use of Cerebrospinal Fluid Biomarkers in Diagnostic Evaluation of Dementia in Europe.

PubMed

Miller, Anne-Marie; Balasa, Mircea; Blennow, Kaj; Gardiner, Mary; Rutkowska, Aleksandra; Scheltens, Philip; Teunissen, Charlotte E; Visser, Pieter Jelle; Winblad, Bengt; Waldemar, Gunhild; Lawlor, Brian

2017-01-01

BIOMARKAPD seeks to diminish the barriers associated with the clinical use of cerebrospinal fluid (CSF) biomarker analysis by reducing variation in CSF laboratory methodologies and generating consensus recommendations on their clinical interpretation and application for dementia diagnosis. To examine the disparity in practitioner attitudes and clinical practice relating to the use of CSF biomarkers for dementia diagnosis across Europe. Clinical dementia experts were surveyed on the prevalence of national consensus guidelines and analytical reimbursement across Europe, their biomarker platform preferences, lumbar puncture methodologies and application of reference values and cut-offs for CSF analysis. 74% of respondents (total n = 51) use CSF biomarkers in clinical practice and 69% perform lumbar punctures on an outpatient basis. Most use CSF biomarkers to diagnose atypical (84%) and early-onset cases of cognitive impairment (71%) and for the differential diagnosis of other dementias (69%). 82% state they are sufficiently informed about CSF biomarkers yet 61% report a lack of national consensus guidelines on their use for dementia diagnosis. 48% of countries represented do not reimburse clinical CSF analysis costs. 43% report using normal reference ranges derived from publications. Variations in attitude and practice relating to CSF biomarkers, widely recognised as barriers to their clinical acceptance, remain evident within and between countries across Europe, even in expert centres. These shortcomings must be addressed by developing consensus guidelines on CSF-related methodologies and their clinical application, to further their use for the diagnostic evaluation of dementia.

Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review.

PubMed

Kenny, Sarah J; Whittaker, Jackie L; Emery, Carolyn A

2016-08-01

Preprofessional dancers partake in rigorous training and have high injury prevalence. Attempts to identify risk factors for dance injuries have focused on a diversity of intrinsic and extrinsic factors. To identify and evaluate the evidence examining risk factors for musculoskeletal injury in preprofessional ballet and modern dancers. Fifteen electronic databases were systematically searched to October 2015. Studies selected met a priori inclusion criteria and investigated musculoskeletal injury risk factors in preprofessional (elite adolescent, student, young adult) ballet and modern dancers. Two reviewers independently assessed the quality and level of evidence using the Downs and Black (DB) criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Of 1364 potentially relevant studies, 47 were included and scored. Inconsistent injury definition and methodology precluded meta-analysis. The most common modifiable risk factors investigated were anthropometrics (ie, body mass index, adiposity), joint range of motion (ie, lower extremity), dance exposure (ie, years training, exposure hours) and age. The median DB score across studies was 8/33 (range 2-16). The majority of studies were classified as level 3 evidence and few considered risk factor inter-relationships. There is some level 2 evidence that previous injury and poor psychological coping skills are associated with increased injury risk. Because of the lack of high-quality studies, consensus regarding risk factors for musculoskeletal injury in preprofessional dancers remains difficult. There is a need for injury definition consensus and high-quality prospective studies examining the multifactorial relationship between risk factors and injury in preprofessional dance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cross-continental comparison of national food consumption survey methods--a narrative review

USDA-ARS?s Scientific Manuscript database

Food consumption surveys are performed in many countries. Comparison of results from those surveys across nations is difficult because of differences in methodological approaches. While consensus about the preferred methodology associated with national food consumption surveys is increasing, no in...

A modified Delphi study of structures and processes related to medicines management for elderly hospitalised patients in the United Arab Emirates.

PubMed

Al Shemeili, Saeed; Klein, Susan; Strath, Alison; Fares, Saleh; Stewart, Derek

2016-10-01

The structures and processes around the management of medicines for elderly, hospitalized patients are ill defined. This study aimed to determine consensus related to strategic and operational approaches in the United Arab Emirates. A modified Delphi technique, consensus study with first round statements developed from systematic reviews related to medicines management. Normalization process theory and the theoretical domains framework were applied in the construction of statements, organized into key elements of medicines management: guidelines for medicines management, medicines reconciliation, medicines selection, prescribing and review, medicines adherence, medicines counselling, health professional training and evaluation research. Seventy per cent (summative agree and strongly agree) was set as the target for consensus. Thirty panellists were recruited, representing senior physicians working within geriatrics, hospital pharmacy and nursing directors, chief health professionals (including social workers) and policy makers within the Health Authority of Abu Dhabi and academics. A high level of consensus was obtained for most statements relating to the structures and processes of medicines management. While consensus was not achieved for targeting only those patients with medicines related issues, it was achieved for focusing on all elderly admissions. Similarly, consensus was not achieved for which professions were most suited to roles but was achieved for trained and competent staff. High levels of consensus were obtained for structures and processes of medicines management relating to elderly hospitalized patients. Trained and competent health professionals were preferred to specific professions for any tasks and that all elderly patients and not targeted patients should be the focus for medicines management. © 2016 John Wiley & Sons, Ltd.

Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies.

PubMed

Diamond, Ivan R; Grant, Robert C; Feldman, Brian M; Pencharz, Paul B; Ling, Simon C; Moore, Aideen M; Wales, Paul W

2014-04-01

To investigate how consensus is operationalized in Delphi studies and to explore the role of consensus in determining the results of these studies. Systematic review of a random sample of 100 English language Delphi studies, from two large multidisciplinary databases [ISI Web of Science (Thompson Reuters, New York, NY) and Scopus (Elsevier, Amsterdam, NL)], published between 2000 and 2009. About 98 of the Delphi studies purported to assess consensus, although a definition for consensus was only provided in 72 of the studies (64 a priori). The most common definition for consensus was percent agreement (25 studies), with 75% being the median threshold to define consensus. Although the authors concluded in 86 of the studies that consensus was achieved, consensus was only specified a priori (with a threshold value) in 42 of these studies. Achievement of consensus was related to the decision to stop the Delphi study in only 23 studies, with 70 studies terminating after a specified number of rounds. Although consensus generally is felt to be of primary importance to the Delphi process, definitions of consensus vary widely and are poorly reported. Improved criteria for reporting of methods of Delphi studies are required. Copyright © 2014 Elsevier Inc. All rights reserved.

Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting.

PubMed

Chappell, Phillip B; Stewart, Michelle; Alphs, Larry; DiCesare, Franco; DuBrava, Sarah; Harkavy-Friedman, Jill; Lim, Pilar; Ratcliffe, Sian; Silverman, Morton M; Targum, Steven D; Marder, Stephen R

2017-06-01

To develop consensus recommendations for assessment of suicidal ideation/suicidal behavior (SI/SB) in clinical trials. Stakeholders from academia, industry, regulatory agencies, National Institutes of Health, National Institute of Mental Health, and patient advocacy organizations participated in a consensus meeting that was sponsored by the International Society for CNS Clinical Trials and Methodology and held November 17-18, 2015. Prior to the meeting, teams of experts identified key areas of consensus and dissent related to SI/SB. The most critical issues were presented and discussed in the consensus meeting. Literature reviews and a pre-meeting survey were conducted. Findings were discussed in pre-meeting working group sessions and at the consensus meeting. Five pre-meeting working groups reviewed (1) nomenclature and classification schemes for SI/SB, (2) detection and assessment of SI/SB, (3) analysis of SI/SB data, (4) design of clinical trials for new treatments of SI/SB, and (5) public health approaches to SI/SB. A modification of the RAND/UCLA Appropriateness Method was used to combine review of scientific evidence with the collective views of experts and stakeholders to reach the final consensus statements. After discussion, all attendees voted using an electronic interactive audience response system. Areas of agreement and areas of continuing dissent were recorded. All 5 working groups agreed that a major barrier to advancement of the field of SI/SB research and the development of new treatments for SI/SB remains the lack of a universally accepted standardized nomenclature and classification system. Achieving alignment on definitions and classification of suicide-related phenomena is critical to improving the detection and assessment of SI/SB, the design of clinical trials for new treatments, and effective public health interventions. © Copyright 2017 Physicians Postgraduate Press, Inc.

Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting.

PubMed

Donaldson, Ian A; Alonzi, Roberto; Barratt, Dean; Barret, Eric; Berge, Viktor; Bott, Simon; Bottomley, David; Eggener, Scott; Ehdaie, Behfar; Emberton, Mark; Hindley, Richard; Leslie, Tom; Miners, Alec; McCartan, Neil; Moore, Caroline M; Pinto, Peter; Polascik, Thomas J; Simmons, Lucy; van der Meulen, Jan; Villers, Arnauld; Willis, Sarah; Ahmed, Hashim U

2015-04-01

Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field. To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design. Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health. Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level. Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging-targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3+3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus. The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy. In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Focal Therapy: Patients, Interventions, and Outcomes—A Report from a Consensus Meeting

PubMed Central

Donaldson, Ian A.; Alonzi, Roberto; Barratt, Dean; Barret, Eric; Berge, Viktor; Bott, Simon; Bottomley, David; Eggener, Scott; Ehdaie, Behfar; Emberton, Mark; Hindley, Richard; Leslie, Tom; Miners, Alec; McCartan, Neil; Moore, Caroline M.; Pinto, Peter; Polascik, Thomas J.; Simmons, Lucy; van der Meulen, Jan; Villers, Arnauld; Willis, Sarah; Ahmed, Hashim U.

2015-01-01

Background Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field. Objective To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design. Design, setting, and participants Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health. Outcome measurements and statistical analysis Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level. Results and limitations Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging–targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5 mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3 + 3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus. Conclusions The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy. Patient summary In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer. PMID:25281389

Designing a Standardized Laparoscopy Curriculum for Gynecology Residents: A Delphi Approach

PubMed Central

Shore, Eliane M.; Lefebvre, Guylaine G.; Husslein, Heinrich; Bjerrum, Flemming; Sorensen, Jette Led; Grantcharov, Teodor P.

2015-01-01

Background Evidence suggests that simulation leads to improved operative skill, shorter operating room time, and better patient outcomes. Currently, no standardized laparoscopy curriculum exists for gynecology residents. Objective To design a structured laparoscopy curriculum for gynecology residents using Delphi consensus methodology. Methods This study began with Delphi methodology to determine expert consensus on the components of a gynecology laparoscopic skills curriculum. We generated a list of cognitive content, technical skills, and nontechnical skills for training in laparoscopic surgery, and asked 39 experts in gynecologic education to rate the items on a Likert scale (1–5) for inclusion in the curriculum. Consensus was predefined as Cronbach α of ≥ 0.80. We then conducted another Delphi survey with 9 experienced users of laparoscopic virtual reality simulators to delineate relevant curricular tasks. Finally, a cross-sectional design defined benchmark scores for all identified tasks, with 10 experienced gynecologic surgeons performing the identified tasks at basic, intermediate, and advanced levels. Results Consensus (Cronbach α = 0.85) was achieved in the first round of the curriculum Delphi, and after 2 rounds (Cronbach α = 0.80) in the virtual reality curriculum Delphi. Consensus was reached for cognitive, technical, and nontechnical skills as well as for 6 virtual reality tasks. Median time and economy of movement scores defined benchmarks for all tasks. Conclusions This study used Delphi consensus to develop a comprehensive curriculum for teaching gynecologic laparoscopy. The curriculum conforms to current educational standards of proficiency-based training, and is suggested as a standard in residency programs. PMID:26221434

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials.

PubMed

Flynn, Angela C; Dalrymple, Kathryn; Barr, Suzanne; Poston, Lucilla; Goff, Louise M; Rogozińska, Ewelina; van Poppel, Mireille N M; Rayanagoudar, Girish; Yeo, SeonAe; Barakat Carballo, Ruben; Perales, Maria; Bogaerts, Annick; Cecatti, Jose G; Dodd, Jodie; Owens, Julie; Devlieger, Roland; Teede, Helena; Haakstad, Lene; Motahari-Tabari, Narges; Tonstad, Serena; Luoto, Riitta; Guelfi, Kym; Petrella, Elisabetta; Phelan, Suzanne; Scudeller, Tânia T; Hauner, Hans; Renault, Kristina; Sagedal, Linda Reme; Stafne, Signe N; Vinter, Christina; Astrup, Arne; Geiker, Nina R W; McAuliffe, Fionnuala M; Mol, Ben W; Thangaratinam, Shakila

2016-05-01

Interventions targeting maternal obesity are a healthcare and public health priority. The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

[Priority research agendas: a strategic resource for health in Latin America].

PubMed

Becerra-Posada, Francisco; de Snyder, Nelly Salgado; Cuervo, Luis Gabriel; Montorzi, Gabriela

2014-12-01

Understand and analyze procedures used to create national integrated research agendas from 2007 to 2011 in Argentina, Guatemala, Mexico, Panama, and Paraguay. Descriptive, cross-sectional study using an online survey of agenda preparation processes; specifically, development, integration, implementation, and use and dissemination of the agenda. The 45 respondents reported following specific methodologies for agenda construction and had a good opinion of organizational aspects with regard to prior information provided and balance among disciplines and stakeholders. Some 60% considered the coordinators impartial, although 25% mentioned biases favoring some subject; 42% received technical support from consultants, reading matter, and methodological guidelines; 40% engaged in subject-matter priority-setting; and 55% confirmed dissemination and communication of the agenda. However, only 22% reported inclusion of agenda topics in national calls for research proposals. In the countries studied, development of the health research agenda was characterized by prior planning and appropriate organization to achieve - consensus-based outcomes. Nevertheless, the agendas were not used in national calls for research proposals, reflecting lack of coordination in national health research systems and lack of connection between funders and researchers. It is recommended that stakeholders strengthen integration and advocacy efforts to modify processes and structures of agenda-based calls for research proposals.

Delphi Research Methodology Applied to Place-Based Watershed Education

ERIC Educational Resources Information Center

Vallor, Rosanna R.; Yates, Kimberly A.; Brody, Michael

2016-01-01

This research focuses on the results of the Flathead Watershed Delphi survey, a consensus-building methodology used to establish foundational knowledge, skills and dispositions for the Flathead Watershed Educators Guide, a place-based watershed curriculum for middle school grades based on the Flathead Watershed Sourcebook. Survey participants (n =…

Cell-based therapeutic strategies for multiple sclerosis

PubMed Central

Scolding, Neil J; Pasquini, Marcelo; Reingold, Stephen C; Cohen, Jeffrey A; Atkins, Harold; Banwell, Brenda; Bar-Or, Amit; Bebo, Bruce; Bowen, James; Burt, Richard; Calabresi, Peter; Cohen, Jeffrey; Comi, Giancarlo; Connick, Peter; Cross, Anne; Cutter, Gary; Derfuss, Tobias; Ffrench-Constant, Charles; Freedman, Mark; Galipeau, Jacques; Goldman, Myla; Goldman, Steven; Goodman, Andrew; Green, Ari; Griffith, Linda; Hartung, Hans-Peter; Hemmer, Bernhard; Hyun, Insoo; Iacobaeus, Ellen; Inglese, Matilde; Jubelt, Burk; Karussis, Dimitrios; Küry, Patrick; Landsman, Douglas; Laule, Cornelia; Liblau, Roland; Mancardi, Giovanni; Ann Marrie, Ruth; Miller, Aaron; Miller, Robert; Miller, David; Mowry, Ellen; Muraro, Paolo; Nash, Richard; Ontaneda, Daniel; Pasquini, Marcelo; Pelletier, Daniel; Peruzzotti-Jametti, Luca; Pluchino, Stefano; Racke, Michael; Reingold, Stephen; Rice, Claire; Ringdén, Olle; Rovira, Alex; Saccardi, Riccardo; Sadiq, Saud; Sarantopoulos, Stefanie; Savitz, Sean; Scolding, Neil; Soelberg Sorensen, Per; Pia Sormani, Maria; Stuve, Olaf; Tesar, Paul; Thompson, Alan; Trojano, Maria; Uccelli, Antonio; Uitdehaag, Bernard; Utz, Ursula; Vukusic, Sandra; Waubant, Emmanuelle; Wilkins, Alastair

2017-01-01

Abstract The availability of multiple disease-modifying medications with regulatory approval to treat multiple sclerosis illustrates the substantial progress made in therapy of the disease. However, all are only partially effective in preventing inflammatory tissue damage in the central nervous system and none directly promotes repair. Cell-based therapies, including immunoablation followed by autologous haematopoietic stem cell transplantation, mesenchymal and related stem cell transplantation, pharmacologic manipulation of endogenous stem cells to enhance their reparative capabilities, and transplantation of oligodendrocyte progenitor cells, have generated substantial interest as novel therapeutic strategies for immune modulation, neuroprotection, or repair of the damaged central nervous system in multiple sclerosis. Each approach has potential advantages but also safety concerns and unresolved questions. Moreover, clinical trials of cell-based therapies present several unique methodological and ethical issues. We summarize here the status of cell-based therapies to treat multiple sclerosis and make consensus recommendations for future research and clinical trials. PMID:29053779

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology.

PubMed

Eubank, Breda H; Mohtadi, Nicholas G; Lafave, Mark R; Wiley, J Preston; Bois, Aaron J; Boorman, Richard S; Sheps, David M

2016-05-20

Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm. A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting. In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways) for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic. This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

Design of a consensus-derived synoptic operative report for lung cancer surgery.

PubMed

Schneider, Laura; Shargall, Yaron; Schieman, Colin; Seely, Andrew J; Srinathan, Sadeesh; Malthaner, Richard A; Pierre, Andrew F; Safieddine, Najib; Vaillancourt, Rosaire; Plourde, Madelaine; Bond, James; Johnson, Scott; Smith, Shona E; Finley, Christian J

2014-04-01

For lung cancer surgery, a narrative operative report is the standard reporting procedure, whereas a synoptic-style report is increasingly utilized by healthcare professionals in various specialties with great success. A synoptic operative report more succinctly and accurately captures vital information and is rapidly generated with good intraobserver reliability. The objective of this study was to systematically develop a synoptic operative report for lung cancer surgery following a modified Delphi consensus model with the support of the Canadian thoracic surgery community. Using online survey software, thoracic surgeons and related physicians were asked to suggest and rate data elements for a synoptic report following the modified Delphi consensus model. The consensus exercise-derived template was forwarded to a small working group, who further refined the definition and priority designation of elements until the working group had reached a satisfactory consensus. In all, 139 physicians were invited to participate in the consensus exercise, with 36.7%, 44.6%, and 19.5% response rates, respectively, in the three rounds. Eighty-nine elements were agreed upon at the conclusion of the exercise, but 141 elements were forwarded to the working group. The working group agreed upon a final data set of 180 independently defined data elements, with 72 mandatory and 108 optional elements for implementation in the final report. This study demonstrates the process involved in developing a multidisciplinary, consensus-based synoptic lung cancer operative report. This novel report style is a quality improvement initiative to improve the capture, dissemination, readability, and potential utility of critical surgical information. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Systematic Review and Consensus Guidelines for Environmental Sampling of Burkholderia pseudomallei

PubMed Central

Limmathurotsakul, Direk; Dance, David A. B.; Wuthiekanun, Vanaporn; Kaestli, Mirjam; Mayo, Mark; Warner, Jeffrey; Wagner, David M.; Tuanyok, Apichai; Wertheim, Heiman; Yoke Cheng, Tan; Mukhopadhyay, Chiranjay; Puthucheary, Savithiri; Day, Nicholas P. J.; Steinmetz, Ivo; Currie, Bart J.; Peacock, Sharon J.

2013-01-01

Background Burkholderia pseudomallei, a Tier 1 Select Agent and the cause of melioidosis, is a Gram-negative bacillus present in the environment in many tropical countries. Defining the global pattern of B. pseudomallei distribution underpins efforts to prevent infection, and is dependent upon robust environmental sampling methodology. Our objective was to review the literature on the detection of environmental B. pseudomallei, update the risk map for melioidosis, and propose international consensus guidelines for soil sampling. Methods/Principal Findings An international working party (Detection of Environmental Burkholderia pseudomallei Working Party (DEBWorP)) was formed during the VIth World Melioidosis Congress in 2010. PubMed (January 1912 to December 2011) was searched using the following MeSH terms: pseudomallei or melioidosis. Bibliographies were hand-searched for secondary references. The reported geographical distribution of B. pseudomallei in the environment was mapped and categorized as definite, probable, or possible. The methodology used for detecting environmental B. pseudomallei was extracted and collated. We found that global coverage was patchy, with a lack of studies in many areas where melioidosis is suspected to occur. The sampling strategies and bacterial identification methods used were highly variable, and not all were robust. We developed consensus guidelines with the goals of reducing the probability of false-negative results, and the provision of affordable and ‘low-tech’ methodology that is applicable in both developed and developing countries. Conclusions/Significance The proposed consensus guidelines provide the basis for the development of an accurate and comprehensive global map of environmental B. pseudomallei. PMID:23556010

Development of a standardized training course for laparoscopic procedures using Delphi methodology.

PubMed

Bethlehem, Martijn S; Kramp, Kelvin H; van Det, Marc J; ten Cate Hoedemaker, Henk O; Veeger, Nicolaas J G M; Pierie, Jean Pierre E N

2014-01-01

Content, evaluation, and certification of laparoscopic skills and procedure training lack uniformity among different hospitals in The Netherlands. Within the process of developing a new regional laparoscopic training curriculum, a uniform and transferrable curriculum was constructed for a series of laparoscopic procedures. The aim of this study was to determine regional expert consensus regarding the key steps for laparoscopic appendectomy and cholecystectomy using Delphi methodology. Lists of suggested key steps for laparoscopic appendectomy and cholecystectomy were created using surgical textbooks, available guidelines, and local practice. A total of 22 experts, working for teaching hospitals throughout the region, were asked to rate the suggested key steps for both procedures on a Likert scale from 1-5. Consensus was reached with Crohnbach's α ≥ 0.90. Of the 22 experts, 21 completed and returned the survey (95%). Data analysis already showed consensus after the first round of Delphi on the key steps for laparoscopic appendectomy (Crohnbach's α = 0.92) and laparoscopic cholecystectomy (Crohnbach's α = 0.90). After the second round, 15 proposed key steps for laparoscopic appendectomy and 30 proposed key steps for laparoscopic cholecystectomy were rated as important (≥4 by at least 80% of the expert panel). These key steps were used for the further development of the training curriculum. By using the Delphi methodology, regional consensus was reached on the key steps for laparoscopic appendectomy and cholecystectomy. These key steps are going to be used for standardized training and evaluation purposes in a new regional laparoscopic curriculum. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A Survey Examining Photopatch Test and Phototest Methodologies of Contact Dermatologists in the United States: Platform for Developing A Consensus.

PubMed

Asemota, Eseosa; Crawford, Glen; Kovarik, Carrie; Brod, Bruce A

There is currently no standardized protocol for photopatch testing and phototesting in the United States. Certain testing paramaters (such as chemicals tested, time between test application and irradiation, and time of final interpretation) vary from provider to provider. These variations may impact comparability and consistency of test results. The goal of our survey-based study was to outline the photopatch test and phototest protocols used by US contact dermatologists. The information obtained will aid in the development of a national consensus on testing methodologies. Based on a literature search conducted on differences in testing methodologies, we constructed a questionnaire. The survey was distributed at the American Contact Dermatitis Society annual meeting and via the American Contact Dermatitis Society Web site. Standard descriptive analysis was performed on data obtained. Of the 800 dermatologists contacted, 117 agreed to participate in the survey. Among these respondents, 64 (54.8%) conduct photopatch testing. Results of the survey are presented, and they confirm that a variety of techniques and testing materials are used. It would be beneficial to enlist a panel of expert contact dermatologists to create by formal consensus, using these research findings, a standard photopatch test protocol for use in this country.

Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation

PubMed Central

Grogl, Max; Boni, Marina; Carvalho, Edgar M.; Chebli, Houda; Cisse, Mamoudou; Diro, Ermias; Fernandes Cota, Gláucia; Erber, Astrid C.; Gadisa, Endalamaw; Handjani, Farhad; Khamesipour, Ali; Llanos-Cuentas, Alejandro; López Carvajal, Liliana; Grout, Lise; Lmimouni, Badre Eddine; Mokni, Mourad; Nahzat, Mohammad Sami; Ben Salah, Afif; Ozbel, Yusuf; Pascale, Juan Miguel; Rizzo Molina, Nidia; Rode, Joelle; Romero, Gustavo; Ruiz-Postigo, José Antonio; Gore Saravia, Nancy; Soto, Jaime; Uzun, Soner; Mashayekhi, Vahid; Vélez, Ivan Dario; Vogt, Florian; Zerpa, Olga; Arana, Byron

2018-01-01

Introduction Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL). Materials and methods Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings. Results Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized. Conclusions The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments. PMID:29329311

3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management.

PubMed

Gomollón, Fernando; Dignass, Axel; Annese, Vito; Tilg, Herbert; Van Assche, Gert; Lindsay, James O; Peyrin-Biroulet, Laurent; Cullen, Garret J; Daperno, Marco; Kucharzik, Torsten; Rieder, Florian; Almer, Sven; Armuzzi, Alessandro; Harbord, Marcus; Langhorst, Jost; Sans, Miquel; Chowers, Yehuda; Fiorino, Gionata; Juillerat, Pascal; Mantzaris, Gerassimos J; Rizzello, Fernando; Vavricka, Stephan; Gionchetti, Paolo

2017-01-01

This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Exploring consensus in 21st century projections of climatically suitable areas for African vertebrates

PubMed Central

Garcia, Raquel A; Burgess, Neil D; Cabeza, Mar; Rahbek, Carsten; Araújo, Miguel B

2012-01-01

Africa is predicted to be highly vulnerable to 21st century climatic changes. Assessing the impacts of these changes on Africa's biodiversity is, however, plagued by uncertainties, and markedly different results can be obtained from alternative bioclimatic envelope models or future climate projections. Using an ensemble forecasting framework, we examine projections of future shifts in climatic suitability, and their methodological uncertainties, for over 2500 species of mammals, birds, amphibians and snakes in sub-Saharan Africa. To summarize a priori the variability in the ensemble of 17 general circulation models, we introduce a consensus methodology that combines co-varying models. Thus, we quantify and map the relative contribution to uncertainty of seven bioclimatic envelope models, three multi-model climate projections and three emissions scenarios, and explore the resulting variability in species turnover estimates. We show that bioclimatic envelope models contribute most to variability, particularly in projected novel climatic conditions over Sahelian and southern Saharan Africa. To summarize agreements among projections from the bioclimatic envelope models we compare five consensus methodologies, which generally increase or retain projection accuracy and provide consistent estimates of species turnover. Variability from emissions scenarios increases towards late-century and affects southern regions of high species turnover centred in arid Namibia. Twofold differences in median species turnover across the study area emerge among alternative climate projections and emissions scenarios. Our ensemble of projections underscores the potential bias when using a single algorithm or climate projection for Africa, and provides a cautious first approximation of the potential exposure of sub-Saharan African vertebrates to climatic changes. The future use and further development of bioclimatic envelope modelling will hinge on the interpretation of results in the light of methodological as well as biological uncertainties. Here, we provide a framework to address methodological uncertainties and contextualize results.

A practical guideline for examining a uterine niche using ultrasonography in non-pregnant women: a modified Delphi method amongst European experts.

PubMed

Jordans, I P M; de Leeuw, R; Stegwee, S I; Amso, N N; Barri-Soldevila, P N; van den Bosch, T; Bourne, T; Brolmann, H A M; Donnez, O; Dueholm, M; Hehenkamp, W J K; Jastrow, N; Jurkovic, D; Mashiach, R; Naji, O; Streuli, I; Timmerman, D; Vd Voet, L F; Huirne, J A F

2018-03-14

To generate a uniform, internationally recognized guideline for detailed uterine niche evaluation by ultrasonography in non-pregnant women using a modified Delphi method amongst international experts. Fifteen international gynecological experts were recruited by their membership of the European niche taskforce group. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche studies. Relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group. Two online questionnaires were sent to the expert panel and one group meeting was organized. Consensus was predefined as a consensus rate of at least 70%. In total 15 experts participated in this study. Consensus was reached for a total of 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. All experts agreed on the proposed guideline for niche evaluation in non-pregnant women as presented in this paper. Consensus between niche experts was achieved on all items regarding ultrasonographic niche measurement. This article is protected by copyright. All rights reserved.

Defining a Bobath clinical framework - A modified e-Delphi study.

PubMed

Vaughan-Graham, Julie; Cott, Cheryl

2016-11-01

To gain consensus within the expert International Bobath Instructors Training Association (IBITA) on a Bobath clinical framework on which future efficacy studies can be based. A three-round modified e-Delphi approach was used with 204 full members of the IBITA. Twenty-one initial statements were generated from the literature. Consensus was defined a priori as at least 80% of the respondents with a level of agreement on a Likert scale of 4 or 5. The Delphi questionnaire for each round was available online for two weeks. Summary reports and subsequent questionnaires were posted within four weeks. Ninety-four IBITA members responded, forming the Delphi panel, of which 68 and 66 responded to Rounds Two and Three, respectively. The 21 initial statements were revised to 17 statements and five new statements in Round Two in which eight statements were accepted and two statements were eliminated. Round Three presented 12 revised statements, all reaching consensus. The Delphi was successful in gaining consensus on a Bobath clinical framework in a geographically diverse expert association, identifying the unique components of Bobath clinical practice. Discussion throughout all three Rounds revolved primarily around the terminology of atypical and compensatory motor behavior and balance.

Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement.

PubMed

Slade, Susan C; Dionne, Clermont E; Underwood, Martin; Buchbinder, Rachelle

2016-10-05

Exercise is effective for prevention and management of acute and chronic health conditions. However, trial descriptions of exercise interventions are often suboptimal, leaving readers unclear about the content of effective programmes. To address this, the 16-item internationally endorsed Consensus on Exercise Reporting Template (CERT) was developed. The aim is to present the final template and provide an Explanation and Elaboration Statement to operationalise the CERT. Development of the CERT was based on the EQUATOR Network methodological framework for developing reporting guidelines. We used a modified Delphi technique to gain consensus of international exercise experts and conducted 3 sequential rounds of anonymous online questionnaires and a Delphi workshop. The 16-item CERT is the minimum data set considered necessary to report exercise interventions. The contents may be included in online supplementary material, published as a protocol or located on websites and other electronic repositories. The Explanation and Elaboration Statement is intended to enhance the use, understanding and dissemination of the CERT and presents the meaning and rationale for each item, together with examples of good reporting. The CERT is designed specifically for the reporting of exercise programmes across all evaluative study designs for exercise research. The CERT can be used by authors to structure intervention reports, by reviewers and editors to assess completeness of exercise descriptions and by readers to facilitate the use of the published information. The CERT has the potential to increase clinical uptake of effective exercise programmes, enable research replication, reduce research waste and improve patient outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A consensus definition of running-related injury in recreational runners: a modified Delphi approach.

PubMed

Yamato, Tiê Parma; Saragiotto, Bruno Tirotti; Lopes, Alexandre Dias

2015-05-01

Delphi study. To reach a consensus definition of running-related injury in recreational runners through a modified Delphi approach. Many studies have suggested the need for a standardized definition of running-related injury to provide uniformity to injury surveillance in running. We invited 112 researchers from running-related injury studies identified in a previous systematic review to classify words and terms frequently used in definitions of running-related injury in an online form during 3 rounds of study. In the last round, participants were asked to approve or disapprove the consensus definition. We considered an agreement level of at least 75% to be a consensus. Thirty-eight participants agreed to participate in the study. The response rates were 94.7% (n = 36) for the first round, 83.3% (n = 30) for the second round, and 86.7% (n = 26) for the third round. A consensus definition of running-related injury was reached, with 80% of participants approving the following: "Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional." The proposed standardized definition of running-related injury could assist in standardizing the definitions used in sport science research and facilitate between-study comparisons. Future studies testing the validity of the proposed consensus definition, as well as its accurate translation to other languages, are also needed.

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference.

PubMed

Benedetti, Maria Grazia; Beghi, Ettore; De Tanti, Antonio; Cappozzo, Aurelio; Basaglia, Nino; Cutti, Andrea Giovanni; Cereatti, Andrea; Stagni, Rita; Verdini, Federica; Manca, Mario; Fantozzi, Silvia; Mazzà, Claudia; Camomilla, Valentina; Campanini, Isabella; Castagna, Anna; Cavazzuti, Lorenzo; Del Maestro, Martina; Croce, Ugo Della; Gasperi, Marco; Leo, Tommaso; Marchi, Pia; Petrarca, Maurizio; Piccinini, Luigi; Rabuffetti, Marco; Ravaschio, Andrea; Sawacha, Zimi; Spolaor, Fabiola; Tesio, Luigi; Vannozzi, Giuseppe; Visintin, Isabella; Ferrarin, Maurizio

2017-10-01

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

An Overview of Recent Advances in Event-Triggered Consensus of Multiagent Systems.

PubMed

Ding, Lei; Han, Qing-Long; Ge, Xiaohua; Zhang, Xian-Ming

2018-04-01

Event-triggered consensus of multiagent systems (MASs) has attracted tremendous attention from both theoretical and practical perspectives due to the fact that it enables all agents eventually to reach an agreement upon a common quantity of interest while significantly alleviating utilization of communication and computation resources. This paper aims to provide an overview of recent advances in event-triggered consensus of MASs. First, a basic framework of multiagent event-triggered operational mechanisms is established. Second, representative results and methodologies reported in the literature are reviewed and some in-depth analysis is made on several event-triggered schemes, including event-based sampling schemes, model-based event-triggered schemes, sampled-data-based event-triggered schemes, and self-triggered sampling schemes. Third, two examples are outlined to show applicability of event-triggered consensus in power sharing of microgrids and formation control of multirobot systems, respectively. Finally, some challenging issues on event-triggered consensus are proposed for future research.

DXA in the assessment of subchondral bone mineral density in knee osteoarthritis--A semi-standardized protocol after systematic review.

PubMed

Sepriano, Alexandre; Roman-Blas, Jorge A; Little, Robert D; Pimentel-Santos, Fernando; Arribas, Jose María; Largo, Raquel; Branco, Jaime C; Herrero-Beaumont, Gabriel

2015-12-01

Subchondral bone mineral density (sBMD) contributes to the initiation and progression of knee osteoarthritis (OA). Reliable methods to assess sBMD status may predict the response of specific OA phenotypes to targeted therapies. While dual-energy X-ray absorptiometry (DXA) of the knee can determine sBMD, no consensus exists regarding its methodology. Construct a semi-standardized protocol for knee DXA to measure sBMD in patients with OA of the knee by evaluating the varying methodologies present in existing literature. We performed a systematic review of original papers published in PubMed and Web of Science from their inception to July 2014 using the following search terms: subchondral bone, osteoarthritis, and bone mineral density. DXA of the knee can be performed with similar reproducibility values to those proposed by the International Society for Clinical Densitometry for the hip and spine. We identified acquisition view, hip rotation, knee positioning and stabilization, ROI location and definition, and the type of analysis software as important sources of variation. A proposed knee DXA protocol was constructed taking into consideration the results of the review. DXA of the knee can be reliably performed in patients with knee OA. Nevertheless, we found substantial methodological variation across previous studies. Methodological standardization may provide a foundation from which to establish DXA of the knee as a valid tool for identification of SB changes and as an outcome measure in clinical trials of disease modifying osteoarthritic drugs. Copyright © 2015 Elsevier Inc. All rights reserved.

The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes.

PubMed

Bond, William F; Hui, Joshua; Fernandez, Rosemarie

2018-02-01

Over the past decade, emergency medicine (EM) took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso-, and macrosystems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome" was conceived to foster discussion among experts in EM, engineering, and social sciences, focusing on key barriers and opportunities in simulation-based research. This executive summary describes the overall rationale for the conference, conference planning, and consensus-building approaches and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodologic and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare. © 2017 by the Society for Academic Emergency Medicine.

Family Medicine Global Health Fellowship Competencies: A Modified Delphi Study.

PubMed

Rayess, Fadya El; Filip, Anna; Doubeni, Anna; Wilson, Calvin; Haq, Cynthia; Debay, Marc; Anandarajah, Gowri; Heffron, Warren; Jayasekera, Neil; Larson, Paul; Dahlman, Bruce; Valdman, Olga; Hunt, Vince

2017-02-01

Many US medical schools and family medicine departments have responded to a growing interest in global health by developing global health fellowships. However, there are no guidelines or consensus statements outlining competencies for global health fellows. Our objective was to develop a mission and core competencies for Family Medicine Global Health Fellowships. A modified Delphi technique was used to develop consensus on fellowship competencies. A panel, comprised of 13 members with dual expertise in global health and medical education, undertook an iterative consensus process, followed by peer review, from April to December 2014. The panel developed a mission statement and identified six domains for family medicine global health fellowships: patient care, medical knowledge, professionalism, communication and leadership, teaching, and scholarship. Each domain includes a set of core and program-specific competencies. The family medicine global health competencies are intended to serve as an educational framework for the design, implementation, and evaluation of individual family medicine global health fellowship programs.

Defining pathways for development of disease-modifying therapies in children with type 1 diabetes: a consensus report.

PubMed

Wherrett, Diane K; Chiang, Jane L; Delamater, Alan M; DiMeglio, Linda A; Gitelman, Stephen E; Gottlieb, Peter A; Herold, Kevan C; Lovell, Daniel J; Orchard, Trevor J; Ryan, Christopher M; Schatz, Desmond A; Wendler, David S; Greenbaum, Carla J

2015-10-01

Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes-modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study.

PubMed

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Rushton, Alison

2016-09-14

To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. Online international survey. A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

EAU guidelines on surgical treatment of urinary incontinence.

PubMed

Lucas, M G; Bosch, R J L; Burkhard, F C; Cruz, F; Madden, T B; Nambiar, A K; Neisius, A; de Ridder, D J M K; Tubaro, A; Turner, W H; Pickard, R S

2013-09-01

The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology. We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience. Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report. These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

Design and validation of key text messages (Tonsil-Text-To-Me) to improve parent and child perioperative tonsillectomy experience: A modified Delphi study.

PubMed

Song, Jin Soo A; Wozney, Lori; Chorney, Jill; Ishman, Stacey L; Hong, Paul

2017-11-01

Parents can struggle while providing perioperative tonsillectomy care for their children at home. Short message service (SMS) technology is an accessible and direct modality to communicate timely, evidence-based recommendations to parents across the perioperative period. This study focused on validating a SMS protocol, Tonsil-Text-To-Me (TTTM), for parents of children undergoing tonsillectomy. This study used a modified Delphi expert consensus method. Participants were an international sample of 27 clinicians/researchers. Participants rated level of agreement with recommendations across seven perioperative domains, derived systematically from scientific and lay literature. A priori consensus analysis was conducted using threshold criterion. A multidisciplinary team of local clinicians were also individually interviewed to consolidate text messages and implement recurrent suggestions. In the modified Delphi panel, 30 statements reached threshold agreement (>3.0 of 4.0); recommendations surrounding diet (3.87) and hygiene (3.83) had the highest level of consensus, while recommendations regarding activity (3.42) and non-pharmacologic pain management (3.55) had the lowest consensus. The 30 statements reconfigured into 12 concise text messages. After further interviews with local clinicians, 14 final text messages were included in the SMS protocol to be sent two weeks preoperatively to one week postoperatively. This study illustrates the development of TTTM which is designed to deliver key sequential text messages at the optimal time during the perioperative setting to parents caring for their children who are undergoing tonsillectomy. Copyright © 2017 Elsevier B.V. All rights reserved.

[The guideline for the treatment of mood disorders in USA and Japan].

PubMed

Higuchi, T

2001-08-01

Recently, the number of available antidepressants has increased dramatically and psychopharmacological treatment is becoming complex. It is important to present some guideline for supporting clinical decision making. Three different kinds of guideline for the treatment of mood disorders, that is, the APA style guideline, the algorithm and the consensus guideline, have been developed in our country. The APA style guideline and the algorithm are basically evidence based and the consensus guideline is developed through the consensus panel format. These guidelines should be used as 'a starting point' for specifying decisions that will be modified occasionally.

Pelvic-floor-muscle-training adherence "modifiers": A review of primary qualitative studies-2011 ICS State-of-the-Science Seminar research paper III of IV.

PubMed

Hay-Smith, Jean; Dean, Sarah; Burgio, Kathryn; McClurg, Doreen; Frawley, Helena; Dumoulin, Chantale

2015-09-01

This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing "modifiers" of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six "modifiers" of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the "modifiers" of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence. © 2015 Wiley Periodicals, Inc.

Methodology for Evaluating a Novel Education Technology: A Case Study of Handheld Video Games in Chile

ERIC Educational Resources Information Center

Margolis, Jesse L.; Nussbaum, Miguel; Rodriguez, Patricio; Rosas, Ricardo

2006-01-01

Many school systems, in both the developed and developing world, are implementing educational technology to assist in student learning. However, there is no clear consensus on how to evaluate these new technologies. This paper proposes a comprehensive methodology for estimating the value of a new educational technology in three steps: benefit…

Speeding up the Consensus Clustering methodology for microarray data analysis

PubMed Central

2011-01-01

Background The inference of the number of clusters in a dataset, a fundamental problem in Statistics, Data Analysis and Classification, is usually addressed via internal validation measures. The stated problem is quite difficult, in particular for microarrays, since the inferred prediction must be sensible enough to capture the inherent biological structure in a dataset, e.g., functionally related genes. Despite the rich literature present in that area, the identification of an internal validation measure that is both fast and precise has proved to be elusive. In order to partially fill this gap, we propose a speed-up of Consensus (Consensus Clustering), a methodology whose purpose is the provision of a prediction of the number of clusters in a dataset, together with a dissimilarity matrix (the consensus matrix) that can be used by clustering algorithms. As detailed in the remainder of the paper, Consensus is a natural candidate for a speed-up. Results Since the time-precision performance of Consensus depends on two parameters, our first task is to show that a simple adjustment of the parameters is not enough to obtain a good precision-time trade-off. Our second task is to provide a fast approximation algorithm for Consensus. That is, the closely related algorithm FC (Fast Consensus) that would have the same precision as Consensus with a substantially better time performance. The performance of FC has been assessed via extensive experiments on twelve benchmark datasets that summarize key features of microarray applications, such as cancer studies, gene expression with up and down patterns, and a full spectrum of dimensionality up to over a thousand. Based on their outcome, compared with previous benchmarking results available in the literature, FC turns out to be among the fastest internal validation methods, while retaining the same outstanding precision of Consensus. Moreover, it also provides a consensus matrix that can be used as a dissimilarity matrix, guaranteeing the same performance as the corresponding matrix produced by Consensus. We have also experimented with the use of Consensus and FC in conjunction with NMF (Nonnegative Matrix Factorization), in order to identify the correct number of clusters in a dataset. Although NMF is an increasingly popular technique for biological data mining, our results are somewhat disappointing and complement quite well the state of the art about NMF, shedding further light on its merits and limitations. Conclusions In summary, FC with a parameter setting that makes it robust with respect to small and medium-sized datasets, i.e, number of items to cluster in the hundreds and number of conditions up to a thousand, seems to be the internal validation measure of choice. Moreover, the technique we have developed here can be used in other contexts, in particular for the speed-up of stability-based validation measures. PMID:21235792

[Curricular design of health postgraduate programs: the case of Masters in epidemiology].

PubMed

Bobadilla, J L; Lozano, R; Bobadilla, C

1991-01-01

This paper discusses the need to create specific programs for the training of researchers in epidemiology, a field that has traditionally been ignored by the graduate programs in public health. This is due, in part, to the emphasis that has been placed on the training of professionals in other areas of public health. The paper also includes the results of a consensus exercise developed during the curricular design of the Masters Program in Epidemiology of the School of Medicine of the National Autonomous University of Mexico. The technique used during the consensus exercise was the TKJ, which allows the presentation of ideas and possible solutions for a specific problem. This is probably the first published experience in the use of such a technique for the design of an academic curriculum. Taking as a base the general characteristics of the students, the substantive, disciplinary and methodological subjects were chosen. The results showed a need for a multidisciplinary approach based on modern methodologies of statistics and epidemiology. The usefulness of the results of the curricular design and the superiority of this method to reach consensus is also discussed.

Consensus Seasonal Flood Forecasts and Warning Response System (FFWRS): an alternate for nonstructural flood management in Bangladesh.

PubMed

Chowdhury, Rashed

2005-06-01

Despite advances in short-range flood forecasting and information dissemination systems in Bangladesh, the present system is less than satisfactory. This is because of short lead-time products, outdated dissemination networks, and lack of direct feedback from the end-user. One viable solution is to produce long-lead seasonal forecasts--the demand for which is significantly increasing in Bangladesh--and disseminate these products through the appropriate channels. As observed in other regions, the success of seasonal forecasts, in contrast to short-term forecast, depends on consensus among the participating institutions. The Flood Forecasting and Warning Response System (henceforth, FFWRS) has been found to be an important component in a comprehensive and participatory approach to seasonal flood management. A general consensus in producing seasonal forecasts can thus be achieved by enhancing the existing FFWRS. Therefore, the primary objective of this paper is to revisit and modify the framework of an ideal warning response system for issuance of consensus seasonal flood forecasts in Bangladesh. The five-stage FFWRS-i) Flood forecasting, ii) Forecast interpretation and message formulation, iii) Warning preparation and dissemination, iv) Responses, and v) Review and analysis-has been modified. To apply the concept of consensus forecast, a framework similar to that of the Southern African Regional Climate Outlook Forum (SARCOF) has been discussed. Finally, the need for a climate Outlook Fora has been emphasized for a comprehensive and participatory approach to seasonal flood hazard management in Bangladesh.

Administration and leadership competencies: establishment of a national consensus for emergency medicine.

PubMed

Thoma, Brent; Poitras, Julien; Penciner, Rick; Sherbino, Jonathan; Holroyd, Brian R; Woods, Robert A

2015-03-01

The Royal College of Physicians and Surgeons of Canada requires emergency medicine (EM) residency programs to meet training objectives relating to administration and leadership. The purpose of this study was to establish a national consensus on the competencies for inclusion in an EM administration and leadership curriculum. A modified Delphi process involving two iterative rounds of an electronic survey was used to achieve consensus on competencies for inclusion in an EM administration and leadership curriculum. An initial list of competencies was compiled using peer-reviewed and grey literature. The participants included 14 EM residency program directors and 43 leadership and administration experts from across Canada who were recruited using a snowball technique. The proposed competencies were organized using the CanMEDS Physician Competency Framework and presented in English or French. Consensus was defined a priori as >70% agreement. Nearly all (13 of 14) of the institutions with an FRCPC EM program had at least one participant complete both surveys. Thirty-five of 57 (61%) participants completed round 1, and 30 (53%) participants completed both rounds. Participants suggested an additional 16 competencies in round 1. The results of round 1 informed the decisions in round 2. Fifty-nine of 109 (54.1%) competencies achieved consensus for inclusion. Based on a national modified Delphi process, we describe 59 competencies for inclusion in an EM administration and leadership curriculum that was arranged by CanMEDS Role. EM educators may consider these competencies when designing local curricula.

Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale.

PubMed

Tate, Robyn L; McDonald, Skye; Perdices, Michael; Togher, Leanne; Schultz, Regina; Savage, Sharon

2008-08-01

Rating scales that assess methodological quality of clinical trials provide a means to critically appraise the literature. Scales are currently available to rate randomised and non-randomised controlled trials, but there are none that assess single-subject designs. The Single-Case Experimental Design (SCED) Scale was developed for this purpose and evaluated for reliability. Six clinical researchers who were trained and experienced in rating methodological quality of clinical trials developed the scale and participated in reliability studies. The SCED Scale is an 11-item rating scale for single-subject designs, of which 10 items are used to assess methodological quality and use of statistical analysis. The scale was developed and refined over a 3-year period. Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field, which were empirically tested against 85 published reports. Inter-rater reliability was assessed using a random sample of 20/312 single-subject reports archived in the Psychological Database of Brain Impairment Treatment Efficacy (PsycBITE). Inter-rater reliability for the total score was excellent, both for individual raters (overall ICC = 0.84; 95% confidence interval 0.73-0.92) and for consensus ratings between pairs of raters (overall ICC = 0.88; 95% confidence interval 0.78-0.95). Item reliability was fair to excellent for consensus ratings between pairs of raters (range k = 0.48 to 1.00). The results were replicated with two independent novice raters who were trained in the use of the scale (ICC = 0.88, 95% confidence interval 0.73-0.95). The SCED Scale thus provides a brief and valid evaluation of methodological quality of single-subject designs, with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings. Items from the scale can also be used as a checklist in the design, reporting and critical appraisal of single-subject designs, thereby assisting to improve standards of single-case methodology.

Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group.

PubMed

Lee, Mathew J; Bhangu, A; Blencowe, Natalie S; Nepogodiev, D; Gokani, Vimal J; Harries, Rhiannon L; Akinfala, M; Ali, O; Allum, W; Bosanquet, D C; Boyce, K; Bradburn, M; Chapman, S J; Christopher, E; Coulter, I; Dean, B J F; Dickfos, M; El Boghdady, M; Elmasry, M; Fleming, S; Glasbey, J; Healy, C; Kasivisvanathan, V; Khan, K S; Kolias, A G; Lee, S M; Morton, D; O'Beirne, J; Sinclair, P; Sutton, P A

2016-11-01

Surgical trainees are expected to demonstrate academic achievement in order to obtain their certificate of completion of training (CCT). These standards are set by the Joint Committee on Surgical Training (JCST) and specialty advisory committees (SAC). The standards are not equivalent across all surgical specialties and recognise different achievements as evidence. They do not recognise changes in models of research and focus on outcomes rather than process. The Association of Surgeons in Training (ASiT) and National Research Collaborative (NRC) set out to develop progressive, consistent and flexible evidence set for academic requirements at CCT. A modified-Delphi approach was used. An expert group consisting of representatives from the ASiT and the NRC undertook iterative review of a document proposing changes to requirements. This was circulated amongst wider stakeholders. After ten iterations, an open meeting was held to discuss these proposals. Voting on statements was performed using a 5-point Likert Scale. Each statement was voted on twice, with ≥80% of votes in agreement meaning the statement was approved. The results of this vote were used to propose core and optional academic requirements for CCT. Online discussion concluded after ten rounds. At the consensus meeting, statements were voted on by 25 delegates from across surgical specialties and training-grades. The group strongly favoured acquisition of 'Good Clinical Practice' training and research methodology training as CCT requirements. The group agreed that higher degrees, publications in any author position (including collaborative authorship), recruiting patients to a study or multicentre audit and presentation at a national or international meeting could be used as evidence for the purpose of CCT. The group agreed on two essential 'core' requirements (GCP and methodology training) and two of a menu of four 'additional' requirements (publication with any authorship position, presentation, recruitment of patients to a multicentre study and completion of a higher degree), which should be completed in order to attain CCT. This approach has engaged stakeholders to produce a progressive set of academic requirements for CCT, which are applicable across surgical specialties. Flexibility in requirements whilst retaining a high standard of evidence is desirable. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

PubMed

Delahunt, Eamonn; Bleakley, Chris M; Bossard, Daniela S; Caulfield, Brian M; Docherty, Carrie L; Doherty, Cailbhe; Fourchet, François; Fong, Daniel T; Hertel, Jay; Hiller, Claire E; Kaminski, Thomas W; McKeon, Patrick O; Refshauge, Kathryn M; Remus, Alexandria; Verhagen, Evert; Vicenzino, Bill T; Wikstrom, Erik A; Gribble, Phillip A

2018-06-09

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach.

PubMed

Fernandes, Olavo; Gorman, Sean K; Slavik, Richard S; Semchuk, William M; Shalansky, Steve; Bussières, Jean-François; Doucette, Douglas; Bannerman, Heather; Lo, Jennifer; Shukla, Simone; Chan, Winnie W Y; Benninger, Natalie; MacKinnon, Neil J; Bell, Chaim M; Slobodan, Jeremy; Lyder, Catherine; Zed, Peter J; Toombs, Kent

2015-06-01

Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care. © The Author(s) 2015.

Seeking consensus on universal health coverage indicators in the sustainable development goals.

PubMed

Reddock, Jennifer

2017-01-01

There is optimism that the inclusion of universal health coverage in the Sustainable Development Goals advances its prominence in global and national health policy. However, formulating indicators for Target 3.8 through the Inter-Agency Expert Group on Sustainable Development Indicators has been challenging. Achieving consensus on the conceptual and methodological aspects of universal health coverage is likely to take some time in multi-stakeholder fora compared with national efforts to select indicators.

Standards should be applied in the prevention and handling of missing data for patient-centered outcomes research: a systematic review and expert consensus.

PubMed

Li, Tianjing; Hutfless, Susan; Scharfstein, Daniel O; Daniels, Michael J; Hogan, Joseph W; Little, Roderick J A; Roy, Jason A; Law, Andrew H; Dickersin, Kay

2014-01-01

To recommend methodological standards in the prevention and handling of missing data for primary patient-centered outcomes research (PCOR). We searched National Library of Medicine Bookshelf and Catalog as well as regulatory agencies' and organizations' Web sites in January 2012 for guidance documents that had formal recommendations regarding missing data. We extracted the characteristics of included guidance documents and recommendations. Using a two-round modified Delphi survey, a multidisciplinary panel proposed mandatory standards on the prevention and handling of missing data for PCOR. We identified 1,790 records and assessed 30 as having relevant recommendations. We proposed 10 standards as mandatory, covering three domains. First, the single best approach is to prospectively prevent missing data occurrence. Second, use of valid statistical methods that properly reflect multiple sources of uncertainty is critical when analyzing missing data. Third, transparent and thorough reporting of missing data allows readers to judge the validity of the findings. We urge researchers to adopt rigorous methodology and promote good science by applying best practices to the prevention and handling of missing data. Developing guidance on the prevention and handling of missing data for observational studies and studies that use existing records is a priority for future research. Copyright © 2014 Elsevier Inc. All rights reserved.

Methodology for AACT evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning.

PubMed

Gosselin, Sophie; Morris, Martin; Miller-Nesbitt, Andrea; Hoffman, Robert S; Hayes, Bryan D; Turgeon, Alexis F; Gilfix, Brian M; Grunbaum, Ami M; Bania, Theodore C; Thomas, Simon H L; Morais, José A; Graudins, Andis; Bailey, Benoit; Mégarbane, Bruno; Calello, Diane P; Levine, Michael; Stellpflug, Samuel J; Hoegberg, Lotte C G; Chuang, Ryan; Stork, Christine; Bhalla, Ashish; Rollins, Carol J; Lavergne, Valéry

2015-07-01

Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.

Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique.

PubMed

Lin, Yen-Ko; Chen, Chao-Wen; Lee, Wei-Che; Lin, Tsung-Ying; Kuo, Liang-Chi; Lin, Chia-Ju; Shi, Leiyu; Tien, Yin-Chun; Cheng, Yuan-Chia

2017-11-29

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients' knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department (ED) were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts' opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480 . The date of registration was April 18, 2011 (retrospectively registered).

A proposed adaptation of the European Foundation for Quality Management Excellence Model to physical activity programmes for the elderly - development of a quality self-assessment tool using a modified Delphi process

PubMed Central

2011-01-01

Background There has been a growing concern in designing physical activity (PA) programmes for elderly people, since evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Complete programme evaluations are a necessary prerequisite to continuous quality improvements. Being able to refine, adapt and create tools that are suited to the realities and contexts of PA programmes for the elderly in order to support its continuous improvement is, therefore, crucial. Thus, the aim of this study was to develop a self-assessment tool for PA programmes for the elderly. Methods A 3-round Delphi process was conducted via the Internet with 43 national experts in PA for the elderly, management and delivery of PA programmes for the elderly, sports management, quality management and gerontology, asking experts to identify the propositions that they considered relevant for inclusion in the self-assessment tool. Experts reviewed a list of proposed statements, based on the criteria and sub-criteria from the European Foundation for Quality Management Excellence Model (EFQM) and PA guidelines for older adults and rated each proposition from 1 to 8 (disagree to agree) and modified and/or added propositions. Propositions receiving either bottom or top scores of greater than 70% were considered to have achieved consensus to drop or retain, respectively. Results In round 1, of the 196 originally-proposed statements (best practice principles), the experts modified 41, added 1 and achieved consensus on 93. In round 2, a total of 104 propositions were presented, of which experts modified 39 and achieved consensus on 53. In the last round, of 51 proposed statements, the experts achieved consensus on 19. After 3 rounds of rating, experts had not achieved consensus on 32 propositions. The resulting tool consisted of 165 statements that assess nine management areas involved in the development of PA programmes for the elderly. Conclusion Based on experts' opinions, a self-assessment tool was found in order to access quality of PA programmes for the elderly. Information obtained with evaluations would be useful to organizations seeking to improve their services, customer satisfaction and, consequently, adherence to PA programmes, targeting the ageing population. PMID:21958203

Scandinavian guidelines for initial management of minor and moderate head trauma in children.

PubMed

Astrand, Ramona; Rosenlund, Christina; Undén, Johan

2016-02-18

The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim. General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used. Systematic evidence-based review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and based upon relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders. The guidelines include criteria for selecting children for CT scans, in-hospital observation or early discharge, and suggestions for monitoring routines and discharge advice for children and guardians. The guidelines separate mild head trauma patients into high-, medium- and low-risk categories, favouring observation for mild, low-risk patients as an attempt to reduce CT scans in children. We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new diagnostic tools within paediatric neurotrauma.

Gaining consensus on family carer needs when caring for someone dying at home to develop the Carers' Alert Thermometer (CAT): a modified Delphi study.

PubMed

Knighting, Katherine; O'Brien, Mary R; Roe, Brenda; Gandy, Rob; Lloyd-Williams, Mari; Nolan, Mike; Jack, Barbara A

2016-01-01

To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Multi-phase modified Delphi study and instrument development. Qualitative and quantitative data collection took place between 2011-2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of 'the current caring situation' and 'the carer's own health and well-being' were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method. © 2015 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique.

PubMed

Bleijlevens, Michel H C; Wagner, Laura M; Capezuti, Elizabeth; Hamers, Jan P H

2016-11-01

To develop an internationally accepted research definition of physical restraint. Comprehensive literature search followed by a web-based, three-round, modified Delphi technique comprising reviews and feedback. Clinical care settings. An international group of 48 experts consisting of researchers and clinicians from 14 countries who have made sustained contribution to research and clinical application in the field of physical restraint in clinical care. Data were collected using an online survey program and one in-person meeting. Results of the online survey and the in-person meeting were used for distribution in subsequent rounds until consensus on a definition was reached. Consensus was defined as 90% of the participating experts agreeing with the proposed definition of physical restraint. Thirty-four different definitions were identified during the literature search and served as a starting point for the modified Delphi technique. After three rounds, 45 (95.7%) of 47 remaining experts agreed with the newly proposed definition: "Physical restraint is defined as any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily." A multidisciplinary, internationally representative panel of experts reached consensus on a research definition for physical restraints in older persons. This is a necessary step toward improved comparisons of the prevalence of physical restraint use across studies and countries. This definition can further guide research interventions aimed at reducing use of physical restraints. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A consensus-based gold standard for the evaluation of mass casualty triage systems.

PubMed

Lerner, E Brooke; McKee, Courtney H; Cady, Charles E; Cone, David C; Colella, M Riccardo; Cooper, Arthur; Coule, Phillip L; Lairet, Julio R; Liu, J Marc; Pirrallo, Ronald G; Sasser, Scott M; Schwartz, Richard; Shepherd, Greene; Swienton, Raymond E

2015-01-01

Accuracy and effectiveness analyses of mass casualty triage systems are limited because there are no gold standard definitions for each of the triage categories. Until there is agreement on which patients should be identified by each triage category, it will be impossible to calculate sensitivity and specificity or to compare accuracy between triage systems. To develop a consensus-based, functional gold standard definition for each mass casualty triage category. National experts were recruited through the lead investigators' contacts and their suggested contacts. Key informant interviews were conducted to develop a list of potential criteria for defining each triage category. Panelists were interviewed in order of their availability until redundancy of themes was achieved. Panelists were blinded to each other's responses during the interviews. A modified Delphi survey was developed with the potential criteria identified during the interview and delivered to all recruited experts. In the early rounds, panelists could add, remove, or modify criteria. In the final rounds edits were made to the criteria until at least 80% agreement was achieved. Thirteen national and local experts were recruited to participate in the project. Six interviews were conducted. Three rounds of voting were performed, with 12 panelists participating in the first round, 12 in the second round, and 13 in the third round. After the first two rounds, the criteria were modified according to respondent suggestions. In the final round, over 90% agreement was achieved for all but one criterion. A single e-mail vote was conducted on edits to the final criterion and consensus was achieved. A consensus-based, functional gold standard definition for each mass casualty triage category was developed. These gold standard definitions can be used to evaluate the accuracy of mass casualty triage systems after an actual incident, during training, or for research.

Use of a Computer-Mediated Delphi Process to Validate a Mass Casualty Conceptual Model

PubMed Central

CULLEY, JOAN M.

2012-01-01

Since the original work on the Delphi technique, multiple versions have been developed and used in research and industry; however, very little empirical research has been conducted that evaluates the efficacy of using online computer, Internet, and e-mail applications to facilitate a Delphi method that can be used to validate theoretical models. The purpose of this research was to develop computer, Internet, and e-mail applications to facilitate a modified Delphi technique through which experts provide validation for a proposed conceptual model that describes the information needs for a mass-casualty continuum of care. Extant literature and existing theoretical models provided the basis for model development. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships, and indicators in the model. The majority of experts rated the online processes favorably (mean of 6.1 on a seven-point scale). Using online Internet and computer applications to facilitate a modified Delphi process offers much promise for future research involving model building or validation. The online Delphi process provided an effective methodology for identifying and describing the complex series of events and contextual factors that influence the way we respond to disasters. PMID:21076283

Use of a computer-mediated Delphi process to validate a mass casualty conceptual model.

PubMed

Culley, Joan M

2011-05-01

Since the original work on the Delphi technique, multiple versions have been developed and used in research and industry; however, very little empirical research has been conducted that evaluates the efficacy of using online computer, Internet, and e-mail applications to facilitate a Delphi method that can be used to validate theoretical models. The purpose of this research was to develop computer, Internet, and e-mail applications to facilitate a modified Delphi technique through which experts provide validation for a proposed conceptual model that describes the information needs for a mass-casualty continuum of care. Extant literature and existing theoretical models provided the basis for model development. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships, and indicators in the model. The majority of experts rated the online processes favorably (mean of 6.1 on a seven-point scale). Using online Internet and computer applications to facilitate a modified Delphi process offers much promise for future research involving model building or validation. The online Delphi process provided an effective methodology for identifying and describing the complex series of events and contextual factors that influence the way we respond to disasters.

Selective mutism: a consensus based care pathway of good practice.

PubMed

Keen, D V; Fonseca, S; Wintgens, A

2008-10-01

Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was reached as to what constitutes clinical progress, intervals for monitoring progress, criteria for referral onwards for multidisciplinary specialist assessment and the role of selective serotonin reuptake inhibitor (SSRI) medication. A consensus methodology has been successfully used to compensate for the lack of evidence base and harness the expertise of a relatively small number of experienced professionals in order to provide a basis for the future development of services.

Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Biddison, Lee Daugherty; Berkowitz, Kenneth A; Courtney, Brooke; De Jong, Col Marla J; Devereaux, Asha V; Kissoon, Niranjan; Roxland, Beth E; Sprung, Charles L; Dichter, Jeffrey R; Christian, Michael D; Powell, Tia

2014-10-01

Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable to support evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. We report the suggestions that focus on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. Ethics issues permeate virtually all aspects of pandemic and disaster response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. Our suggestions reflect the consensus of the Task Force. We recognize, however, that some suggestions, including those related to end-of-life care, may be controversial. We highlight the need for additional research and dialogue in articulating values to guide health-care decisions during disasters.

Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes.

PubMed

2013-07-01

The management of primary rectal cancer beyond total mesorectal excision planes (PRC-bTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional total mesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized web-based voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. The consensus process has provided guidance for the management of patients with PRC-bTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

Lexical Testing and the Reliability of the Modified Vocabulary Knowledge Scale

ERIC Educational Resources Information Center

Tan, Debbita; Pandian, Ambigapathy; Jaganathan, Paramaswari

2016-01-01

This paper highlights some of the vocabulary tests available, and reports the reliability of the modified Vocabulary Knowledge Scale (VKS) (Rosszell, 2007). Although there is no consensus as to what actually constitutes vocabulary knowledge, the notion that it is made up of receptive knowledge (words recognised or known when seen or heard) and…

Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative.

PubMed

Penciner, Rick; Woods, Robert A; McEwen, Jill; Lee, Richard; Langhan, Trevor; Bandiera, Glen

2013-01-01

There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators. We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada. Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided. This study established a national consensus defining the core competencies for EM clerkship in Canada.

Cell-based therapeutic strategies for multiple sclerosis.

PubMed

Scolding, Neil J; Pasquini, Marcelo; Reingold, Stephen C; Cohen, Jeffrey A

2017-11-01

The availability of multiple disease-modifying medications with regulatory approval to treat multiple sclerosis illustrates the substantial progress made in therapy of the disease. However, all are only partially effective in preventing inflammatory tissue damage in the central nervous system and none directly promotes repair. Cell-based therapies, including immunoablation followed by autologous haematopoietic stem cell transplantation, mesenchymal and related stem cell transplantation, pharmacologic manipulation of endogenous stem cells to enhance their reparative capabilities, and transplantation of oligodendrocyte progenitor cells, have generated substantial interest as novel therapeutic strategies for immune modulation, neuroprotection, or repair of the damaged central nervous system in multiple sclerosis. Each approach has potential advantages but also safety concerns and unresolved questions. Moreover, clinical trials of cell-based therapies present several unique methodological and ethical issues. We summarize here the status of cell-based therapies to treat multiple sclerosis and make consensus recommendations for future research and clinical trials. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain.

Perceptual aspects of reproduced sound in car cabin acoustics.

PubMed

Kaplanis, Neofytos; Bech, Søren; Tervo, Sakari; Pätynen, Jukka; Lokki, Tapio; van Waterschoot, Toon; Jensen, Søren Holdt

2017-03-01

An experiment was conducted to determine the perceptual effects of car cabin acoustics on the reproduced sound field. In-car measurements were conducted whilst the cabin's interior was physically modified. The captured sound fields were recreated in the laboratory using a three-dimensional loudspeaker array. A panel of expert assessors followed a rapid sensory analysis protocol, the flash profile, to perceptually characterize and evaluate 12 acoustical conditions of the car cabin using individually elicited attributes. A multivariate analysis revealed the panel's consensus and the identified perceptual constructs. Six perceptual constructs characterize the differences between the acoustical conditions of the cabin, related to bass, ambience, transparency, width and envelopment, brightness, and image focus. The current results indicate the importance of several acoustical properties of a car's interior on the perceived sound qualities. Moreover, they signify the capacity of the applied methodology in assessing spectral and spatial properties of automotive environments in laboratory settings using a time-efficient and flexible protocol.

[Reflection of the evidence-based medicine's principles in the Russian consensus documents on angiology and vascular surgery].

PubMed

Pokrovskiĭ, A V; Sapelkin, S V

2009-01-01

Analysed herein are the consensus documents concerning angiology and vascular surgery worked out and adopted in Russia. This is followed by a detailed description of the methodology used while their development, underlying their significance for medical practice and pointing out their strict compliance with the principles of evidence-based medicine. Emphasis is laid on the thesis that the consensus guidelines worked out by the leading specialists, like any rules and norms, contribute favourably to making appropriate decisions by the practicing clinical physicians and may serve as a basis for creation of the branch standards. Also shown are advantages and shortcomings of the adopted documents in angiology, including phlebology, and finally announced is a forthcoming meeting of the Russian experts, devoted to the development of the consensus document entitled "Russian Clinical Guidelines on Diagnosis and Treatment of Chronic Venous Diseases".

Consensus statement on the treatment of multiple sclerosis by the Spanish Society of Neurology in 2016.

PubMed

García Merino, A; Ramón Ara Callizo, J; Fernández Fernández, O; Landete Pascual, L; Moral Torres, E; Rodríguez-Antigüedad Zarrantz, A

2017-03-01

With the advent of new disease-modifying drugs, the treatment of multiple sclerosis is becoming increasingly complex. Using consensus statements is therefore advisable. The present consensus statement, which was drawn up by the Spanish Society of Neurology's study group for demyelinating diseases, updates previous consensus statements on the disease. The present study lists the medications currently approved for multiple sclerosis and their official indications, and analyses such treatment-related aspects as activity, early treatment, maintenance, follow-up, treatment failure, changes in medication, and special therapeutic situations. This consensus statement includes treatment recommendations for a wide range of demyelinating diseases, from isolated demyelinating syndromes to the different forms of multiple sclerosis, as well as recommendations for initial therapy and changes in drug medication, and additional comments on induction and combined therapy and practical aspects of the use of these drugs. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Effects of heterogeneous convergence rate on consensus in opinion dynamics

NASA Astrophysics Data System (ADS)

Huang, Changwei; Dai, Qionglin; Han, Wenchen; Feng, Yuee; Cheng, Hongyan; Li, Haihong

2018-06-01

The Deffuant model has attracted much attention in the study of opinion dynamics. Here, we propose a modified version by introducing into the model a heterogeneous convergence rate which is dependent on the opinion difference between interacting agents and a tunable parameter κ. We study the effects of heterogeneous convergence rate on consensus by investigating the probability of complete consensus, the size of the largest opinion cluster, the number of opinion clusters, and the relaxation time. We find that the decrease of the convergence rate is favorable to decreasing the confidence threshold for the population to always reach complete consensus, and there exists optimal κ resulting in the minimal bounded confidence threshold. Moreover, we find that there exists a window before the threshold of confidence in which complete consensus may be reached with a nonzero probability when κ is not too large. We also find that, within a certain confidence range, decreasing the convergence rate will reduce the relaxation time, which is somewhat counterintuitive.

Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process.

PubMed

Bunch, K J; Allin, B; Jolly, M; Hardie, T; Knight, M

2018-05-16

To develop a core metric set to monitor the quality of maternity care. Delphi process followed by a face-to-face consensus meeting. English maternity units. Three representative expert panels: service designers, providers and users. Maternity care metrics judged important by participants. Participants were asked to complete a two-phase Delphi process, scoring metrics from existing local maternity dashboards. A consensus meeting discussed the results and re-scored the metrics. In all, 125 distinct metrics across six domains were identified from existing dashboards. Following the consensus meeting, 14 metrics met the inclusion criteria for the final core set: smoking rate at booking; rate of birth without intervention; caesarean section delivery rate in Robson group 1 women; caesarean section delivery rate in Robson group 2 women; caesarean section delivery rate in Robson group 5 women; third- and fourth-degree tear rate among women delivering vaginally; rate of postpartum haemorrhage of ≥1500 ml; rate of successful vaginal birth after a single previous caesarean section; smoking rate at delivery; proportion of babies born at term with an Apgar score <7 at 5 minutes; proportion of babies born at term admitted to the neonatal intensive care unit; proportion of babies readmitted to hospital at <30 days of age; breastfeeding initiation rate; and breastfeeding rate at 6-8 weeks. Core outcome set methodology can be used to incorporate the views of key stakeholders in developing a core metric set to monitor the quality of care in maternity units, thus enabling improvement. Achieving consensus on core metrics for monitoring the quality of maternity care. © 2018 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

10-Minute Delayed Recall from the Modified Mini-Mental State Test Predicts Alzheimer’s Disease Pathology

PubMed Central

Lyness, Scott A.; Lee, Ae Young; Zarow, Chris; Teng, Evelyn L.; Chui, Helena C.

2014-01-01

We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer’s disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0–9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation. PMID:24240637

10-minute delayed recall from the modified mini-mental state test predicts Alzheimer's disease pathology.

PubMed

Lyness, Scott A; Lee, Ae Young; Zarow, Chris; Teng, Evelyn L; Chui, Helena C

2014-01-01

We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer's disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0-9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation.

Consensus-based methodology for detection communities in multilayered networks

NASA Astrophysics Data System (ADS)

Karimi-Majd, Amir-Mohsen; Fathian, Mohammad; Makrehchi, Masoud

2018-03-01

Finding groups of network users who are densely related with each other has emerged as an interesting problem in the area of social network analysis. These groups or so-called communities would be hidden behind the behavior of users. Most studies assume that such behavior could be understood by focusing on user interfaces, their behavioral attributes or a combination of these network layers (i.e., interfaces with their attributes). They also assume that all network layers refer to the same behavior. However, in real-life networks, users' behavior in one layer may differ from their behavior in another one. In order to cope with these issues, this article proposes a consensus-based community detection approach (CBC). CBC finds communities among nodes at each layer, in parallel. Then, the results of layers should be aggregated using a consensus clustering method. This means that different behavior could be detected and used in the analysis. As for other significant advantages, the methodology would be able to handle missing values. Three experiments on real-life and computer-generated datasets have been conducted in order to evaluate the performance of CBC. The results indicate superiority and stability of CBC in comparison to other approaches.

Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care.

PubMed

Milligan, James; Lee, Joseph; Hillier, Loretta M; Slonim, Karen; Craven, Catharine

2018-05-07

To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. Modified Delphi consensus process; survey methodology. Primary care. Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys. Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited. There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care. This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.

Consensus statement on essential patient characteristics in systemic treatment trials for metastatic colorectal cancer: Supported by the ARCAD Group.

PubMed

Goey, Kaitlyn K H; Sørbye, Halfdan; Glimelius, Bengt; Adams, Richard A; André, Thierry; Arnold, Dirk; Berlin, Jordan D; Bodoky, György; de Gramont, Aimery; Díaz-Rubio, Eduardo; Eng, Cathy; Falcone, Alfredo; Grothey, Axel; Heinemann, Volker; Hochster, Howard S; Kaplan, Richard S; Kopetz, Scott; Labianca, Roberto; Lieu, Christopher H; Meropol, Neal J; Price, Timothy J; Schilsky, Richard L; Schmoll, Hans-Joachim; Shacham-Shmueli, Einat; Shi, Qian; Sobrero, Alberto F; Souglakos, John; Van Cutsem, Eric; Zalcberg, John; van Oijen, Martijn G H; Punt, Cornelis J A; Koopman, Miriam

2018-06-21

Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous metastases, (K)RAS and BRAF mutation status, microsatellite instability/mismatch repair status and number of prior treatment lines. A total of five patient characteristics were considered the most relevant stratification factors: RAS/BRAF mutation status, performance status, primary tumour sidedness and liver-only disease. This survey provides a minimum set of essential baseline patient characteristics and stratification factors to include in phase 3 trials of systemic treatment of mCRC. Inclusion of these patient characteristics and strata in study protocols and final study reports will improve interpretation of trial results and facilitate cross-study comparisons. Copyright © 2018 Elsevier Ltd. All rights reserved.

Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations

PubMed Central

Groskreutz, Derek; Grinbergs-Saull, Anna; Howard, Rob; O’Brien, John T.; Mountain, Gail; Woods, Bob; Perneczky, Robert; McCleery, Jenny; Pickett, James; Challis, David; Charlesworth, Georgina; Featherstone, Katie; Jones, Roy; Schneider, Justine; Shepperd, Sasha; Thompson-Coon, Jo; Ballard, Clive; Burns, Alistair; Garrard, Peter; Kehoe, Patrick; Passmore, Peter; Robinson, Louise

2017-01-01

Background There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia. Methods and findings We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer’s disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer’s society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification. Limitations Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties. Interpretation This is the first review to identify the 81 outcome measures the research community uses for disease-modifying trials in mild-to-moderate dementia. Our recommendations will facilitate designing, comparing and meta-analysing disease modification trials in mild-to-moderate dementia, increasing their value. Trial registration PROSPERO no. CRD42015027346. PMID:28662127

Instruments to assess patients with rotator cuff pathology: a systematic review of measurement properties.

PubMed

Longo, Umile Giuseppe; Saris, Daniël; Poolman, Rudolf W; Berton, Alessandra; Denaro, Vincenzo

2012-10-01

The aims of this study were to obtain an overview of the methodological quality of studies on the measurement properties of rotator cuff questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed. A systematic review of published studies on the measurement properties of rotator cuff questionnaires was performed. Two investigators independently rated the quality of the studies using the Consensus-based Standards for the selection of health Measurement Instruments checklist. This checklist was developed in an international Delphi consensus study. Sixteen studies were included, in which two measurement instruments were evaluated, namely the Western Ontario Rotator Cuff Index and the Rotator Cuff Quality-of-Life Measure. The methodological quality of the included studies was adequate on some properties (construct validity, reliability, responsiveness, internal consistency, and translation) but need to be improved on other aspects. The most important methodological aspects that need to be developed are as follows: measurement error, content validity, structural validity, cross-cultural validity, criterion validity, and interpretability. Considering the importance of adequate measurement properties, it is concluded that, in the field of rotator cuff pathology, there is room for improvement in the methodological quality of studies measurement properties. II.

Research in assessment: consensus statement and recommendations from the Ottawa 2010 Conference.

PubMed

Schuwirth, Lambert; Colliver, Jerry; Gruppen, Larry; Kreiter, Clarence; Mennin, Stewart; Onishi, Hirotaka; Pangaro, Louis; Ringsted, Charlotte; Swanson, David; Van Der Vleuten, Cees; Wagner-Menghin, Michaela

2011-01-01

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

Core Competencies in Natural Health Products for Canadian Pharmacy Students

PubMed Central

Byrne, Ani; Austin, Zubin; Jurgens, Tannis; Raman-Wilms, Lalitha

2010-01-01

Objective To reach consensus on core competency statements for natural health products (NHPs) for Canadian pharmacy students. Methods Four rounds of a modified Delphi method were used to achieve consensus on core competency statements for NHPs. Pharmacy educators from Canada and the United States, and representatives from Canadian pharmacy organizations ranked their agreement using a 5-point Likert scale. Results Consensus was achieved on 3 NHP-related core competency statements: (1) to incorporate NHP knowledge when providing pharmaceutical care; (2) to access and critically appraise NHP-related information sources; and (3) to provide appropriate education to patients and other health care providers on the effectiveness, potential adverse effects, and drug interactions of NHPs. Conclusions Consensus was reached among leaders in NHP education on 3 NHP-related core competency statements. Implementation of these competencies would ensure that graduating Canadian pharmacists would be able to fulfill their professional responsibilities related to NHPs. PMID:20498738

[Medical expert consensus in AH on the clinical use of triple fixed-dose antihypertensive therapy in Spain].

PubMed

Mazón, P; Galve, E; Gómez, J; Gorostidi, M; Górriz, J L; Mediavilla, J D

The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations.

PubMed

Oddo, Mauro; Poole, Daniele; Helbok, Raimund; Meyfroidt, Geert; Stocchetti, Nino; Bouzat, Pierre; Cecconi, Maurizio; Geeraerts, Thomas; Martin-Loeches, Ignacio; Quintard, Hervé; Taccone, Fabio Silvio; Geocadin, Romergryko G; Hemphill, Claude; Ichai, Carole; Menon, David; Payen, Jean-François; Perner, Anders; Smith, Martin; Suarez, José; Videtta, Walter; Zanier, Elisa R; Citerio, Giuseppe

2018-04-01

To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients. A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions-using a sequential approach to avoid biases and misinterpretations-was used to generate the final consensus statement. The final consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements. We present a consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients.

Young age as a modifying factor in sports concussion management: what is the evidence?

PubMed

Foley, Cassidy; Gregory, Andrew; Solomon, Gary

2014-01-01

In 2008, the Concussion in Sport Group (CISG) published its third consensus statement and introduced 10 'modifying' factors that were presumed clinically to influence the investigation and management of concussions in sports. Young age was listed as one of the modifying factors. In some cases, these modifiers were thought to be predictive of prolonged or persistent symptoms. These same modifying factors were retained in the fourth iteration of the CISG consensus statement (2013), although mention was made of possible limitations of their efficacy. The CISG statements provided several empirical references regarding young age as a modifying factor. We reviewed the published sports concussion literature with the purpose of determining empirical studies that support or refute the inclusion of young age as a modifier of concussive injury in sports. We performed a systematic review of the PubMed database utilizing the keywords concussion, sports, mild traumatic brain injury, youth, adolescents, and children. English language studies were extracted by the authors and summarized for review. Multiple empirical studies were found indicating that younger athletes may take longer to recover from a sports-related concussion (SRC) than their older peers. However, studies did not indicate that younger athletes were at more risk for prolonged recovery (>4 wk). Empirical evidence supports the inclusion of young age as a modifying factor in sports concussion. However, the difference in recovery time seems relatively small (a few days) and young age does not predict prolonged recovery (>4 wk). The findings support the inclusion of young age as a specific modifier in the treatment of SRC and have implications for the clinical management of this common injury.

Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group.

PubMed

Gariepy, Cheryl E; Heyman, Melvin B; Lowe, Mark E; Pohl, John F; Werlin, Steven L; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S; Freedman, Steven D; Giefer, Matthew J; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z; Morinville, Veronique D; Ooi, Chee Y; Schwarzenberg, Sarah J; Troendle, David M; Yen, Elizabeth; Uc, Aliye

2017-01-01

Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.

The Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group

PubMed Central

Gariepy, Cheryl E.; Heyman, Melvin B.; Lowe, Mark E.; Pohl, John F.; Werlin, Steven L.; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S.; Freedman, Steven D.; Giefer, Matthew J.; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z.; Morinville, Veronique D.; Ooi, Chee Y.; Schwarzenberg, Sarah Jane; Troendle, David M.; Yen, Elizabeth; Uc, Aliye

2016-01-01

Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates over the past decade. However, as pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. Objectives: To review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. Methods: A systematic review of the literature was performed and scored for quality, then consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. Results: The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. Conclusion: This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting. PMID:27782962

Modified international e-Delphi survey to define healthcare professional competencies for working with teenagers and young adults with cancer

PubMed Central

Taylor, Rachel M; Feltbower, Richard G; Aslam, Natasha; Raine, Rosalind; Whelan, Jeremy S; Gibson, Faith

2016-01-01

Objectives To provide international consensus on the competencies required by healthcare professionals in order to provide specialist care for teenagers and young adults (TYA) with cancer. Design Modified e-Delphi survey. Setting International, multicentre study. Participants Experts were defined as professionals having worked in TYA cancer care for more than 12 months. They were identified through publications and professional organisations. Methods Round 1, developed from a previous qualitative study, included 87 closed-ended questions with responses on a nine-point Likert scale and further open-ended responses to identify other skills, knowledge and attitudes. Round 2 contained only items with no consensus in round 1 and suggestions of additional items of competency. Consensus was defined as a median score ranging from 7 to 9 and strength of agreement using mean absolute deviation of the median. Results A total of 179 registered to be members of the expert panel; valid responses were available from 158 (88%) in round 1 and 136/158 (86%) in round 2. The majority of participants were nurses (35%) or doctors (39%) from Europe (55%) or North America (35%). All 87 items in round 1 reached consensus with an additional 15 items identified for round 2, which also reached consensus. The strength of agreement was mostly high for statements. The areas of competence rated most important were agreed to be: ‘Identify the impact of disease on young people's life’ (skill), ‘Know about side effects of treatment and how this might be different to those experienced by children or older adults’ (knowledge), ‘Honesty’ (attitude) and ‘Listen to young people's concerns’ (aspect of communication). Conclusions Given the high degree of consensus, this list of competencies should influence education curriculum, professional development and inform workforce planning. Variation in strength of agreement for some competencies between professional groups should be explored further in pursuit of effective multidisciplinary team working. PMID:27142859

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Devereaux, Asha V; Tosh, Pritish K; Hick, John L; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M; Shah, Umair A; Fagbuyi, Daniel B; Skippen, Peter; Dichter, Jeffrey R; Kissoon, Niranjan; Christian, Michael D; Upperman, Jeffrey S

2014-10-01

Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.

Diagnosis of Cystic Fibrosis in Nonscreened Populations.

PubMed

Sosnay, Patrick R; White, Terry B; Farrell, Philip M; Ren, Clement L; Derichs, Nico; Howenstine, Michelle S; Nick, Jerry A; De Boeck, Kris

2017-02-01

Although the majority of cases of cystic fibrosis (CF) are now diagnosed through newborn screening, there is still a need to standardize the diagnostic criteria for those diagnosed outside of the neonatal period. This is because newborn screening started relatively recently, it is not performed everywhere, and even for individuals who were screened, there is the possibility of a false negative. To limit irreversible organ pathology, a timely diagnosis of CF and institution of CF therapies can greatly benefit these patients. Experts on CF diagnosis were convened at the 2015 CF Foundation Diagnosis Consensus Conference. The participants reviewed and discussed published works and instructive cases of CF diagnosis in individuals presenting with signs, symptoms, or a family history of CF. Through a modified Delphi methodology, several consensus statements were agreed upon. These consensus statements were updates of prior CF diagnosis conferences and recommendations. CF diagnosis in individuals outside of newborn screening relies on the clinical evidence and on evidence of CF transmembrane conductance regulator (CFTR) dysfunction. Clinical evidence can include typical organ pathologies seen in CF such as bronchiectasis or pancreatic insufficiency but often represent a broad range of severity including mild cases. CFTR dysfunction can be demonstrated using sweat chloride testing, CFTR molecular genetic analysis, or CFTR physiologic tests. On the basis of the large number of patients with bona fide CF currently followed in registries with sweat chloride levels between 30 and 40 mmol/L, the threshold considered "intermediate" was lowered from 40 mmol/L in the prior diagnostic guidelines to 30 mmol/L. The CF diagnosis was also discussed in the context of CFTR-related disorders in which CFTR dysfunction may be present, but the individual does not meet criteria for CF. CF diagnosis remains a rare but important condition that can be diagnosed when characteristic clinical features are seen in an individual with demonstrated CFTR dysfunction. Copyright © 2016 Elsevier Inc. All rights reserved.

Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India.

PubMed

Mahajan, Prashant; Batra, Prerna; Thakur, Neha; Patel, Reena; Rai, Narendra; Trivedi, Nitin; Fassl, Bernhard; Shah, Binita; Lozon, Marie; Oteng, Rockerfeller A; Saha, Abhijeet; Shah, Dheeraj; Galwankar, Sagar

2017-08-15

India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.

Chartered Society of Physiotherapy's identification of national research priorities for physiotherapy using a modified Delphi technique.

PubMed

Rankin, Gabrielle; Rushton, Alison; Olver, Pat; Moore, Ann

2012-09-01

To define research priorities to strategically inform the evidence base for physiotherapy practice. A modified Delphi method using SurveyMonkey software identified priorities for physiotherapy research through national consensus. An iterative process of three rounds provided feedback. Round 1 requested five priorities using pre-defined prioritisation criteria. Content analysis identified research themes and topics. Round 2 requested rating of the importance of the research topics using a 1-5 Likert scale. Round 3 requested a further process of rating. Quantitative and qualitative data informed decision-making. Level of consensus was established as mean rating ≥ 3.5, coefficient of variation ≤ 30%, and ≥ 55% agreement. Consensus across participants was evaluated using Kendall's W. Four expert panels (n=40-61) encompassing a range of stakeholders and reflecting four core areas of physiotherapy practice were established by steering groups (n=204 participants overall). Response rates of 53-78% across three rounds were good. The identification of 24/185 topics for musculoskeletal, 43/174 for neurology, 30/120 for cardiorespiratory and medical rehabilitation, and 30/113 for mental and physical health and wellbeing as priorities demonstrated discrimination of the process. Consensus between participants was good for most topics. Measurement validity of the research topics was good. The involvement of multiple stakeholders as participants ensured the current context of the intended use of the priorities. From a process of national consensus involving key stakeholders, including service users, physiotherapy research topics have been identified and prioritised. Setting priorities provides a vision of how research can contribute to the developing research base in physiotherapy to maximise focus. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Consensus-based guidelines for Video EEG monitoring in the pre-surgical evaluation of children with epilepsy in the UK.

PubMed

Pressler, Ronit M; Seri, Stefano; Kane, Nick; Martland, Tim; Goyal, Sushma; Iyer, Anand; Warren, Elliott; Notghi, Lesley; Bill, Peter; Thornton, Rachel; Appleton, Richard; Doyle, Sarah; Rushton, Sarah; Worley, Alan; Boyd, Stewart G

2017-08-01

Paediatric Epilepsy surgery in the UK has recently been centralised in order to improve expertise and quality of service available to children. Video EEG monitoring or telemetry is a highly specialised and a crucial component of the pre-surgical evaluation. Although many Epilepsy Monitoring Units work to certain standards, there is no national or international guideline for paediatric video telemetry. Due to lack of evidence we used a modified Delphi process utilizing the clinical and academic expertise of the clinical neurophysiology sub-specialty group of Children's Epilepsy Surgical Service (CESS) centres in England and Wales. This process consisted of the following stages I: Identification of the consensus working group, II: Identification of key areas for guidelines, III: Consensus practice points and IV: Final review. Statements that gained consensus (median score of either 4 or 5 using a five-point Likerttype scale) were included in the guideline. Two rounds of feedback and amendments were undertaken. The consensus guidelines includes the following topics: referral pathways, neurophysiological equipment standards, standards of recording techniques, with specific emphasis on safety of video EEG monitoring both with and without drug withdrawal, a protocol for testing patient's behaviours, data storage and guidelines for writing factual reports and conclusions. All statements developed received a median score of 5 and were adopted by the group. Using a modified Delphi process we were able to develop universally-accepted video EEG guidelines for the UK CESS. Although these recommendations have been specifically developed for the pre-surgical evaluation of children with epilepsy, it is assumed that most components are transferable to any paediatric video EEG monitoring setting. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery.

PubMed

van Vliet, Daphne C R; van der Meij, Eva; Bouwsma, Esther V A; Vonk Noordegraaf, Antonie; van den Heuvel, Baukje; Meijerink, Wilhelmus J H J; van Baal, W Marchien; Huirne, Judith A F; Anema, Johannes R

2016-12-01

Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.

Recommended Skill Requirements of Recent Management Information Systems Graduates for Employment: A Modified Delphi Study

ERIC Educational Resources Information Center

Strnad, Michael A., Sr.

2013-01-01

The purpose of this Modified Delphi study was to achieve a consensus and forecast a prediction from expert IT hiring managers on what skills are required of MIS graduates for employment. In doing so, guidance could be provided to academic leaders who design curricula for MIS students on the required skills for employment. This study was conducted…

Reaching consensus on communication of critical laboratory results using a collective intelligence method.

PubMed

Llovet, Maria Isabel; Biosca, Carmen; Martínez-Iribarren, Alicia; Blanco, Aurora; Busquets, Glòria; Castro, María José; Llopis, Maria Antonia; Montesinos, Mercè; Minchinela, Joana; Perich, Carme; Prieto, Judith; Ruiz, Rosa; Serrat, Núria; Simón, Margarita; Trejo, Alex; Monguet, Josep Maria; López-Pablo, Carlos; Ibarz, Mercè

2018-02-23

There is no consensus in the literature about what analytes or values should be informed as critical results and how they should be communicated. The main aim of this project is to establish consensual standards of critical results for the laboratories participating in the study. Among the project's secondary objectives, establishing consensual procedures for communication can be highlighted. Consensus was reached among all participating laboratories establishing the basis for the construction of the initial model put forward for consensus in conjunction with the clinicians. A real-time Delphi, methodology "health consensus" (HC), with motivating and participative questions was applied. The physician was expected to choose a numeric value within a scale designed for each analyte. The medians of critical results obtained represent the consensus on critical results for outpatient and inpatient care. Both in primary care and in hospital care a high degree of consensus was observed for critical values proposed in the analysis of creatinine, digoxin, phosphorus, glucose, international normalized ratio (INR), leukocytes, magnesium, neutrophils, chloride, sodium, calcium and lithium. For the rest of critical results the degree of consensus obtained was "medium high". The results obtained showed that in 72% of cases the consensual critical value coincided with the medians initially proposed by the laboratories. The real-time Delphi has allowed obtaining consensual standards for communication of critical results among the laboratories participating in the study, which can serve as a basis for other organizations.

Homeland Security Collaboration: Catch Phrase or Preeminent Organizational Construct?

DTIC Science & Technology

2009-09-01

collaborative effort? C. RESEARCH METHODOLOGY This research project utilized a modified case study methodology. The traditional case study method ...discussing the research method , offering smart practices and culminate with findings and recommendations. Chapter II Homeland Security Collaboration...41 Centers for Regional Excellence, “Building Models.” 16 Chapter III Research Methodology:  Modified Case Study Method is

Oral health in children with physical (Cerebral Palsy) and intellectual (Down Syndrome) disabilities: Systematic review I.

PubMed

Diéguez-Pérez, Montserrat; de Nova-García, Manuel-Joaquín; Mourelle-Martínez, M Rosa; Bartolomé-Villar, Begona

2016-07-01

Traditionally, patients with physical and/or intellectual disabilities presented greater oral pathology, owing to their condition and to other external factors. Improved social and health conditions make it necessary to update knowledge on their oral and dental health. For this purpose, a bibliographic review was done regarding the state of oral health of children with these two types of disability, in comparison with a control group. Some of the guidelines of the PRISMA statement were taken into account. The ranking of the articles found is based on the modified Newcastle-Ottawa Quality Assessment Scale. The final number of articles evaluated was 14. Parameters such as dental caries, oral hygiene, gingival health, dental traumas, malocclusion and habits were considered. There is no consensus among authors regarding dental caries, oral hygiene and gingival health. The different results obtained are due in part to the fact that the methodologies used were not the same. However, it has been noted that, when studying other parameters and regardless of the methodology employed, the results obtained are similar. Children with physical and intellectual disabilities constitute a group that needs early and regular dental care in order to prevent and limit the severity of the pathologies observed. Oral health, dental caries, malocclusion, oral habits, dental trauma, oral hygiene, disabled child, cerebral palsy and Down syndrome.

Oral health in children with physical (Cerebral Palsy) and intellectual (Down Syndrome) disabilities: Systematic review I

PubMed Central

de Nova-García, Manuel-Joaquín; Mourelle-Martínez, Mª Rosa; Bartolomé-Villar, Begona

2016-01-01

Introduction Traditionally, patients with physical and/or intellectual disabilities presented greater oral pathology, owing to their condition and to other external factors. Improved social and health conditions make it necessary to update knowledge on their oral and dental health. Material and Methods For this purpose, a bibliographic review was done regarding the state of oral health of children with these two types of disability, in comparison with a control group. Some of the guidelines of the PRISMA statement were taken into account. The ranking of the articles found is based on the modified Newcastle-Ottawa Quality Assessment Scale. The final number of articles evaluated was 14. Parameters such as dental caries, oral hygiene, gingival health, dental traumas, malocclusion and habits were considered. Results There is no consensus among authors regarding dental caries, oral hygiene and gingival health. The different results obtained are due in part to the fact that the methodologies used were not the same. However, it has been noted that, when studying other parameters and regardless of the methodology employed, the results obtained are similar. Conclusions Children with physical and intellectual disabilities constitute a group that needs early and regular dental care in order to prevent and limit the severity of the pathologies observed. Key words:Oral health, dental caries, malocclusion, oral habits, dental trauma, oral hygiene, disabled child, cerebral palsy and Down syndrome. PMID:27398187

Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice.

PubMed

Cooney, Lewis; Loke, Yoon K; Golder, Su; Kirkham, Jamie; Jorgensen, Andrea; Sinha, Ian; Hawcutt, Daniel

2017-06-02

Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. There is no consensus on the optimal methodology for systematic reviews of therapeutic ranges. An overview of systematic reviews of therapeutic ranges was undertaken. The following databases were used: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts and Reviews of Effects (DARE) and MEDLINE. The published methodologies used when systematically reviewing the therapeutic range of a drug were analyzed. Step by step recommendations to optimize such systematic reviews are proposed. Ten systematic reviews that investigated the correlation between serum concentrations and clinical outcomes encompassing a variety of medicines and indications were assessed. There were significant variations in the methodologies used (including the search terms used, data extraction methods, assessment of bias, and statistical analyses undertaken). Therapeutic ranges should be population and indication specific and based on clinically relevant outcomes. Recommendations for future systematic reviews based on these findings have been developed. Evidence based therapeutic ranges have the potential to improve TDM practice. Current systematic reviews investigating therapeutic ranges have highly variable methodologies and there is no consensus of best practice when undertaking systematic reviews in this field. These recommendations meet a need not addressed by standard protocols.

Correlation between the Modified Systemic Lupus Erythematosus Disease Activity Index 2000 and the European Consensus Lupus Activity Measurement in juvenile systemic lupus erythematosus.

PubMed

Sato, J O; Corrente, J E; Saad-Magalhães, C

2016-11-01

Objective The objective of this study was to assess Modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and European Consensus Lupus Activity Measurement (ECLAM) disease activity correlation in addition to their respective correlation to Pediatric Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (Ped-SDI), in juvenile systemic lupus erythematosus (JSLE). Methods The activity indices were scored retrospectively and summarized by adjusted means during follow-up. The Ped-SDI was scored during the last visit for those with more than six months follow-up. Pearson correlation between the Modified SLEDAI-2K and ECLAM, as well as Spearman correlations between the Modified SLEDAI-2K, ECLAM, and Ped-SDI were calculated. The receiver operating characteristic (ROC) curve was calculated for both activity indices discriminating damage measured by Ped-SDI. Results Thirty-seven patients with mean age at diagnosis 11 ± 2.9 years and mean follow-up time 3.2 ± 2.4 years were studied. The Modified SLEDAI-2K and ECLAM adjusted means were highly correlated ( r = 0.78, p < 0.001). Similarly, Spearman correlation between the activity indices was also high ( r s  > 0.7, p < 0.001), but Modified SLEDAI-2K and ECLAM correlation with Ped-SDI was only moderate. ROC analysis discriminant performance for both activity indices resulted in area under curve (AUC) of 0.74 and 0.73 for Modified SLEDAI-2K and ECLAM, respectively. Conclusion The high correlation found between the Modified SLEDAI-2K and ECLAM adjusted means indicated that both tools can be equally useful for longitudinal estimates of JSLE activity.

Expert validation of a teamwork assessment rubric: A modified Delphi study.

PubMed

Parratt, Jenny A; Fahy, Kathleen M; Hutchinson, Marie; Lohmann, Gui; Hastie, Carolyn R; Chaseling, Marilyn; O'Brien, Kylie

2016-01-01

Teamwork is a 'soft skill' employability competence desired by employers. Poor teamwork skills in healthcare have an impact on adverse outcomes. Teamwork skills are rarely the focus of teaching and assessment in undergraduate courses. The TeamUP Rubric is a tool used to teach and evaluate undergraduate students' teamwork skills. Students also use the rubric to give anonymised peer feedback during team-based academic assignments. The rubric's five domains focus on planning, environment, facilitation, conflict management and individual contribution; each domain is grounded in relevant theory. Students earn marks for their teamwork skills; validity of the assessment rubric is critical. To what extent do experts agree that the TeamUP Rubric is a valid assessment of 'teamwork skills'? Modified Delphi technique incorporating Feminist Collaborative Conversations. A heterogeneous panel of 35 professionals with recognised expertise in communications and/or teamwork. Three Delphi rounds using a survey that included the rubric were conducted either face-to-face, by telephone or online. Quantitative analysis yielded item content validity indices (I-CVI); minimum consensus was pre-set at 70%. An average of the I-CVI also yielded sub-scale (domain) (D-CVI/Ave) and scale content validity indices (S-CVI/Ave). After each Delphi round, qualitative data were analysed and interpreted; Feminist Collaborative Conversations by the research team aimed to clarify and confirm consensus about the wording of items on the rubric. Consensus (at 70%) was obtained for all but one behavioural descriptor of the rubric. We modified that descriptor to address expert concerns. The TeamUP Rubric (Version 4) can be considered to be well validated at that level of consensus. The final rubric reflects underpinning theory, with no areas of conceptual overlap between rubric domains. The final TeamUP Rubric arising from this study validly measures individual student teamwork skills and can be used with confidence in the university setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

PubMed Central

Dervenis, Christos; Xynos, Evaghelos; Sotiropoulos, George; Gouvas, Nikolaos; Boukovinas, Ioannis; Agalianos, Christos; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Emmanouilidis, Christos; Georgiou, Panagiotis; Karachaliou, Niki; Katopodi, Ourania; Kountourakis, Panteleimon; Kyriazanos, Ioannis; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pechlivanides, George; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Tekkis, Paris; Triantopoulou, Charina; Tzardi, Maria; Vassiliou, Vassilis; Vini, Louiza; Xynogalos, Spyridon; Ziras, Nikolaos; Souglakos, John

2016-01-01

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes. PMID:27708505

Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials

PubMed Central

2012-01-01

Background There is a need for more Comparative Effectiveness Research (CER) to strengthen the evidence base for clinical and policy decision-making. Effectiveness Guidance Documents (EGD) are targeted to clinical researchers. The aim of this EGD is to provide specific recommendations for the design of prospective acupuncture studies to support optimal use of resources for generating evidence that will inform stakeholder decision-making. Methods Document development based on multiple systematic consensus procedures (written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders including patients, clinicians and payers were involved. Results Recommendations focused mainly on randomized studies and were developed for the following areas: overall research strategy, treatment protocol, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. Conclusion The present EGD, based on an international consensus developed with multiple stakeholder involvement, provides the first systematic methodological guidance for future CER on acupuncture. PMID:22953730

Critical appraisal of the Vienna consensus: performance indicators for assisted reproductive technology laboratories.

PubMed

Lopez-Regalado, María Luisa; Martínez-Granados, Luis; González-Utor, Antonio; Ortiz, Nereyda; Iglesias, Miriam; Ardoy, Manuel; Castilla, Jose A

2018-05-24

The Vienna consensus, based on the recommendations of an expert panel, has identified 19 performance indicators for assisted reproductive technology (ART) laboratories. Two levels of reference values are established for these performance indicators: competence and benchmark. For over 10 years, the Spanish embryology association (ASEBIR) has participated in the definition and design of ART performance indicators, seeking to establish specific guidelines for ART laboratories to enhance quality, safety and patient welfare. Four years ago, ASEBIR took part in an initiative by AENOR, the Spanish Association for Standardization and Certification, to develop a national standard in this field (UNE 17900:2013 System of quality management for assisted reproduction laboratories), extending the former requirements, based on ISO 9001, to include performance indicators. Considering the experience acquired, we discuss various aspects of the Vienna consensus and consider certain discrepancies in performance indicators between the consensus and UNE 179007:2013, and analyse the definitions, methodology and reference values used. Copyright © 2018. Published by Elsevier Ltd.

Minimal-Approximation-Based Distributed Consensus Tracking of a Class of Uncertain Nonlinear Multiagent Systems With Unknown Control Directions.

PubMed

Choi, Yun Ho; Yoo, Sung Jin

2017-03-28

A minimal-approximation-based distributed adaptive consensus tracking approach is presented for strict-feedback multiagent systems with unknown heterogeneous nonlinearities and control directions under a directed network. Existing approximation-based consensus results for uncertain nonlinear multiagent systems in lower-triangular form have used multiple function approximators in each local controller to approximate unmatched nonlinearities of each follower. Thus, as the follower's order increases, the number of the approximators used in its local controller increases. However, the proposed approach employs only one function approximator to construct the local controller of each follower regardless of the order of the follower. The recursive design methodology using a new error transformation is derived for the proposed minimal-approximation-based design. Furthermore, a bounding lemma on parameters of Nussbaum functions is presented to handle the unknown control direction problem in the minimal-approximation-based distributed consensus tracking framework and the stability of the overall closed-loop system is rigorously analyzed in the Lyapunov sense.

A Qualitative Assessment of the Parenting Challenges and Treatment Needs of Mothers with Borderline Personality Disorder

PubMed Central

Zalewski, Maureen; Stepp, Stephanie D.; Whalen, Diana J.; Scott, Lori N.

2014-01-01

There are currently no empirically supported interventions to target parenting among mothers who have Borderline Personality Disorder (BPD). The current study uses Consensus Qualitative Research (CQR) methodology to: I) learn about mothers’ experiences of parenting with BPD, and II) identify treatment modifications to Dialectical Behavior Therapy (DBT) as suggested by mothers with BPD who are currently engaged in DBT skills training. Twenty-three mothers were recruited from intensive outpatient and partial hospitalization programs that teach DBT skills. A total of 9 focus groups that met one time were conducted asking women a series of questions regarding their experiences of parenting with BPD and how they would modify DBT to address parenting issues. Using the CQR approach, we coded domains and categories that were discussed by mothers in the focus groups. Coding revealed that mothers with BPD wished parenting was integrated more in their current DBT skills groups. In addition, one of the most prominent themes to emerge was that parenting is particularly stressful to mothers with BPD and is associated with guilt, uncertainty, and worry. Finally, mothers offered many ideas for how to integrate parenting-focused interventions into DBT. The CQR method revealed gaps in current treatment for mothers with BPD and provided useful ideas for how to modify DBT to target parenting and integrate these modifications into other approaches for treating mothers with BPD. PMID:26257507

Nutrition management guideline for maple syrup urine disease: an evidence- and consensus-based approach.

PubMed

Frazier, Dianne M; Allgeier, Courtney; Homer, Caroline; Marriage, Barbara J; Ogata, Beth; Rohr, Frances; Splett, Patricia L; Stembridge, Adrya; Singh, Rani H

2014-07-01

In an effort to increase harmonization of care and enable outcome studies, the Genetic Metabolic Dietitians International (GMDI) and the Southeast Regional Newborn Screening and Genetics Collaborative (SERC) are partnering to develop nutrition management guidelines for inherited metabolic disorders (IMD) using a model combining both evidence- and consensus-based methodology. The first guideline to be completed is for maple syrup urine disease (MSUD). This report describes the methodology used in its development: formulation of five research questions; review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; and expert input through Delphi surveys and a nominal group process. This report includes the summary statements for each research question and the nutrition management recommendations they generated. Each recommendation is followed by a standardized rating based on the strength of the evidence and consensus used. The application of technology to build the infrastructure for this project allowed transparency during development of this guideline and will be a foundation for future guidelines. Online open access of the full, published guideline allows utilization by health care providers, researchers, and collaborators who advise, advocate and care for individuals with MSUD and their families. There will be future updates as warranted by developments in research and clinical practice. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 1: Evidence analysis and consensus process: collaborative path toward small animal CPR guidelines.

PubMed

Boller, Manuel; Fletcher, Daniel J

2012-06-01

To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to evaluate the scientific evidence relevant to small animal CPR and to compose consensus-based clinical CPR guidelines for dogs and cats. This report is part of a series of 7 articles on the RECOVER evidence and knowledge gap analysis and consensus-based small animal CPR guidelines. It describes the organizational structure of RECOVER, the evaluation process employed, consisting of standardized literature searches, the analysis of relevant articles according to study design, species and predefined quality markers, and the drafting of clinical CPR guidelines based on these data. Therefore, this article serves as the methodology section for the subsequent 6 RECOVER articles. Academia, referral practice. RECOVER is a collaborative initiative that systematically evaluated the evidence on 74 topics relevant to small animal CPR and generated 101 clinical CPR guidelines from this analysis. All primary contributors were veterinary specialists, approximately evenly split between academic institutions and private referral practices. The evidence evaluation and guideline drafting processes were conducted according to a predefined sequence of steps designed to reduce bias and increase the repeatability of the findings, including multiple levels of review, culminating in a consensus process. Many knowledge gaps were identified that will allow prioritization of research efforts in veterinary CPR. Collaborative systematic evidence review is organizationally challenging but feasible and effective in veterinary medicine. More experience is needed to refine the process. © Veterinary Emergency and Critical Care Society 2012.

Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review.

PubMed

Snijders, Thom E; Willemsen, Koen; van Gaalen, Steven M; Castelein, Rene M; Weinans, Harrie; de Gast, Arthur

2018-05-01

Dislocation is one of the main reasons for revision of total hip arthroplasty but dislocation rates have not changed in the past decades, compromising patients' well-being. Acetabular cup orientation plays a key role in implant stability and has been widely studied. This article investigates whether there is a consensus on optimal cup orientation, which is necessary when using a navigation system. A systematic search of the literature in the PubMed, Embase and Cochrane databases was performed (March 2017) to identify articles that investigated the direct relationship between cup orientation and dislocation, including a thorough evaluation of postoperative cup orientation assessment methods. Twenty eight relevant articles evaluating a direct relation between dislocation and cup orientation could not come to a consensus. The key reason is a lack of uniformity in the assessment of cup orientation. Cup orientation is assessed with different imaging modalities, different methodologies, different definitions for inclination and anteversion, several reference planes and distinct patient positions. All available studies lack uniformity in cup orientation assessment; therefore it is impossible to reach consensus on optimal cup orientation. Using navigation systems for placement of the cup is inevitably flawed when using different definitions in the preoperative planning, peroperative placement and postoperative evaluation. Further methodological development is required to assess cup orientation. Consequently, the postoperative assessment should be uniform, thus differentiating between anterior and posterior dislocation, use the same definitions for inclination and anteversion with the same reference plane and with the patient in the same position.

Cost-Utility Analysis: Current Methodological Issues and Future Perspectives

PubMed Central

Nuijten, Mark J. C.; Dubois, Dominique J.

2011-01-01

The use of cost–effectiveness as final criterion in the reimbursement process for listing of new pharmaceuticals can be questioned from a scientific and policy point of view. There is a lack of consensus on main methodological issues and consequently we may question the appropriateness of the use of cost–effectiveness data in health care decision-making. Another concern is the appropriateness of the selection and use of an incremental cost–effectiveness threshold (Cost/QALY). In this review, we focus mainly on only some key methodological concerns relating to discounting, the utility concept, cost assessment, and modeling methodologies. Finally we will consider the relevance of some other important decision criteria, like social values and equity. PMID:21713127

Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving.

PubMed

Czeisler, Charles A; Wickwire, Emerson M; Barger, Laura K; Dement, William C; Gamble, Karen; Hartenbaum, Natalie; Ohayon, Maurice M; Pelayo, Rafael; Phillips, Barbara; Strohl, Kingman; Tefft, Brian; Rajaratnam, Shantha M W; Malhotra, Raman; Whiton, Kaitlyn; Hirshkowitz, Max

2016-06-01

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed. Copyright © 2016. Published by Elsevier Inc.

Asian Consensus Report on Functional Dyspepsia

PubMed Central

Miwa, Hiroto; Ghoshal, Uday C; Gonlachanvit, Sutep; Gwee, Kok-Ann; Ang, Tiing-Leong; Chang, Full-Young; Fock, Kwong Ming; Hongo, Michio; Hou, Xiaohua; Kachintorn, Udom; Ke, Meiyun; Lai, Kwok-Hung; Lee, Kwang Jae; Lu, Ching-Liang; Mahadeva, Sanjiv; Miura, Soichiro; Park, Hyojin; Rhee, Poong-Lyul; Sugano, Kentaro; Vilaichone, Ratha-korn; Wong, Benjamin CY

2012-01-01

Background/Aims Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians. PMID:22523724

Unintended Effects in Genetically Modified Food/Feed Safety: A Way Forward.

PubMed

Fernandez, Antonio; Paoletti, Claudia

2018-04-20

Identifying and assessing unintended effects in genetically modified food and feed are considered paramount by the Food and Agricultural Organization (FAO), World Health Organization (WHO), and Codex Alimentarius, despite heated debate. This paper addresses outstanding needs: building consensus on the history-of-safe-use concept, harmonizing criteria to select appropriate conventional counterparts, and improving endpoint selection to identify unintended effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

Application of systematic review methodology to the field of nutrition

USDA-ARS?s Scientific Manuscript database

Systematic reviews represent a rigorous and transparent approach of synthesizing scientific evidence that minimizes bias. They evolved within the medical community to support development of clinical and public health practice guidelines, set research agendas and formulate scientific consensus state...

Accountability in public health units: using a modified nominal group technique to develop a balanced scorecard for performance measurement.

PubMed

Robinson, Victoria A; Hunter, Duncan; Shortt, Samuel E D

2003-01-01

Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units. A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18). 73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8). The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.

PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain.

PubMed

Neugebauer, E A M; Wilkinson, R C; Kehlet, H; Schug, S A

2007-07-01

Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

Definition of a COPD self-management intervention: International Expert Group consensus.

PubMed

Effing, Tanja W; Vercoulen, Jan H; Bourbeau, Jean; Trappenburg, Jaap; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W M A; Bucknall, Christine; Dewan, Naresh A; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J A; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L; Singh, Sally; Zuwallack, Richard; Benzo, Roberto; Goldstein, Roger; Partridge, Martyn R; van der Palen, Job

2016-07-01

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step. The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.

Priorities for research in child maltreatment, intimate partner violence and resilience to violence exposures: results of an international Delphi consensus development process.

PubMed

Wathen, C Nadine; MacGregor, Jennifer C D; Hammerton, Joanne; Coben, Jeffrey H; Herrman, Helen; Stewart, Donna E; MacMillan, Harriet L

2012-08-21

Intimate partner violence (IPV) and child maltreatment (CM) are major global public health problems. The Preventing Violence Across the Lifespan (PreVAiL) Research Network, an international group of over 60 researchers and national and international knowledge-user partners in CM and IPV, sought to identify evidence-based research priorities in IPV and CM, with a focus on resilience, using a modified Delphi consensus development process. Review of existing empirical evidence, PreVAiL documents and team discussion identified a starting list of 20 priorities in the following categories: resilience to violence exposure (RES), CM, and IPV, as well as priorities that cross-cut the content areas (CC), and others specific to research methodologies (RM) in violence research. PreVAiL members (N = 47) completed two online survey rounds, and one round of discussions via three teleconference calls to rate, rank and refine research priorities. Research priorities were: to examine key elements of promising or successful programmes in RES/CM/IPV to build intervention pilot work; CC: to integrate violence questions into national and international surveys, and RM: to investigate methods for collecting and collating datasets to link data and to conduct pooled, meta and sub-group analyses to identify promising interventions for particular groups. These evidence-based research priorities, developed by an international team of violence, gender and mental health researchers and knowledge-user partners, are of relevance for prevention and resilience-oriented research in the areas of IPV and CM.

Management of congenital quantitative fibrinogen disorders: a Delphi consensus.

PubMed

Casini, A; de Moerloose, P

2016-11-01

No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available. The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management. The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0.5 g L -1 ; (iii) if an adaptation of dosage is required, the frequency of infusions rather than the fibrinogen amount should be modified; (iv) afibrinogenaemic patients undergoing a surgery at high bleeding risk should receive fibrinogen concentrates regardless of the personal or family history of bleeding; (v) moderate hypofibrinogenaemic patients (i.e. ≥0.5 g L -1 ) without previous bleeding (despite haemostatic challenges) undergoing a surgery at low bleeding risk may not receive fibrinogen concentrates as prophylaxis; (vi) monitoring the trough fibrinogen levels should be performed at least once a month throughout the pregnancy and a foetal growth and placenta development close monitoring by ultrasound is recommended; (vii) fibrinogen replacement should be started concomitantly to the introduction of anticoagulation in afibrinogenaemic patients suffering from a venous thromboembolic event; and (viii) low-molecular-weight heparin is the anticoagulant of choice in case of venous thromboembolism. The results of this initiative should help clinicians in the difficult management of patients with congenital fibrinogen disorders. © 2016 John Wiley & Sons Ltd.

Priorities for research in child maltreatment, intimate partner violence and resilience to violence exposures: results of an international Delphi consensus development process

PubMed Central

2012-01-01

Background Intimate partner violence (IPV) and child maltreatment (CM) are major global public health problems. The Preventing Violence Across the Lifespan (PreVAiL) Research Network, an international group of over 60 researchers and national and international knowledge-user partners in CM and IPV, sought to identify evidence-based research priorities in IPV and CM, with a focus on resilience, using a modified Delphi consensus development process. Methods Review of existing empirical evidence, PreVAiL documents and team discussion identified a starting list of 20 priorities in the following categories: resilience to violence exposure (RES), CM, and IPV, as well as priorities that cross-cut the content areas (CC), and others specific to research methodologies (RM) in violence research. PreVAiL members (N = 47) completed two online survey rounds, and one round of discussions via three teleconference calls to rate, rank and refine research priorities. Results Research priorities were: to examine key elements of promising or successful programmes in RES/CM/IPV to build intervention pilot work; CC: to integrate violence questions into national and international surveys, and RM: to investigate methods for collecting and collating datasets to link data and to conduct pooled, meta and sub-group analyses to identify promising interventions for particular groups. Conclusions These evidence-based research priorities, developed by an international team of violence, gender and mental health researchers and knowledge-user partners, are of relevance for prevention and resilience-oriented research in the areas of IPV and CM. PMID:22908894

[Part II: basic hemodynamic monitoring and the use of pulmonary artery catheter].

PubMed

Dias, Fernando Suparregui; Rezende, Ederlon; Mendes, Ciro Leite; Réa-Neto, Alvaro; David, Cid Marcos; Schettino, Guilherme; Lobo, Suzana Margareth Ajeje; Barros, Alberto; Silva, Eliézer; Friedman, Gilberto; Amaral, José Luiz Gomes do; Park, Marcelo; Monachini, Maristela; Oliveira, Mirella Cristine de; Assunção, Murillo Santucci César; Akamine, Nelson; Mello, Patrícia Veiga C; Pereira, Renata Andréa Pietro; Costa Filho, Rubens; Araújo, Sebastião; Félix Pinto, Sérgio; Ferreira, Sérgio; Mitushima, Simone Mattoso; Agareno, Sydney; Brilhante, Yuzeth Nóbrega de Assis

2006-03-01

Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.

Sentinel node biopsy for prostate cancer: report from a consensus panel meeting.

PubMed

van der Poel, Henk G; Wit, Esther M; Acar, Cenk; van den Berg, Nynke S; van Leeuwen, Fijs W B; Valdes Olmos, Renato A; Winter, Alexander; Wawroschek, Friedhelm; Liedberg, Fredrik; Maclennan, Steven; Lam, Thomas

2017-08-01

To explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer through a consensus panel of experts. A two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the research and development project/University of California, Los Angeles Appropriateness Methodology on 150 statements in nine domains. The disagreement index based on the interpercentile range, adjusted for symmetry score, was used to assess consensus and non-consensus among panel members. Consensus was obtained on 91 of 150 statements (61%). The main outcomes were: (1) the results from an extended lymph node dissection (eLND) are still considered the 'gold standard', and sentinel node (SN) detection should be combined with eLND, at least in patients with intermediate- and high-risk prostate cancer; (2) the role of SN detection in low-risk prostate cancer is unclear; and (3) future studies should contain oncological endpoints as number of positive nodes outside the eLND template, false-negative and false-positive SN procedures, and recurrence-free survival. A high rate of consensus was obtained regarding outcome measures of future clinical trials on SNB (89%). Consensus on tracer technology was only obtained in 47% of statements, reflecting a need for further research and standardization in this area. The low-level evidence in the available literature and the composition of mainly SNB users in the panel constitute the major limitations of the study. Consensus on a majority of elementary statements on SN detection in prostate cancer was obtained.; therefore, the results from this consensus report will provide a basis for the design of further studies in the field. A group of experts identified evidence and knowledge gaps on SN detection in prostate cancer and its application in daily practice. Information from the consensus statements can be used to direct further studies. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

PubMed

Lis, Rebecca; Sakata, Vicki; Lien, Onora

2017-08-01

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

Quantitative application of the primary progressive aphasia consensus criteria.

PubMed

Wicklund, Meredith R; Duffy, Joseph R; Strand, Edythe A; Machulda, Mary M; Whitwell, Jennifer L; Josephs, Keith A

2014-04-01

To determine how well the consensus criteria could classify subjects with primary progressive aphasia (PPA) using a quantitative speech and language battery that matches the test descriptions provided by the consensus criteria. A total of 105 participants with a neurodegenerative speech and language disorder were prospectively recruited and underwent neurologic, neuropsychological, and speech and language testing and MRI in this case-control study. Twenty-one participants with apraxia of speech without aphasia served as controls. Select tests from the speech and language battery were chosen for application of consensus criteria and cutoffs were employed to determine syndromic classification. Hierarchical cluster analysis was used to examine participants who could not be classified. Of the 84 participants, 58 (69%) could be classified as agrammatic (27%), semantic (7%), or logopenic (35%) variants of PPA. The remaining 31% of participants could not be classified. Of the unclassifiable participants, 2 clusters were identified. The speech and language profile of the first cluster resembled mild logopenic PPA and the second cluster semantic PPA. Gray matter patterns of loss of these 2 clusters of unclassified participants also resembled mild logopenic and semantic variants. Quantitative application of consensus PPA criteria yields the 3 syndromic variants but leaves a large proportion unclassified. Therefore, the current consensus criteria need to be modified in order to improve sensitivity.

Bias, belief, and consensus: Collective opinion formation on fluctuating networks

NASA Astrophysics Data System (ADS)

Ngampruetikorn, Vudtiwat; Stephens, Greg J.

2016-11-01

With the advent of online networks, societies have become substantially more interconnected with individual members able to easily both maintain and modify their own social links. Here, we show that active network maintenance exposes agents to confirmation bias, the tendency to confirm one's beliefs, and we explore how this bias affects collective opinion formation. We introduce a model of binary opinion dynamics on a complex, fluctuating network with stochastic rewiring and we analyze these dynamics in the mean-field limit of large networks and fast link rewiring. We show that confirmation bias induces a segregation of individuals with different opinions and stabilizes the consensus state. We further show that bias can have an unusual, nonmonotonic effect on the time to consensus and this suggests a novel avenue for large-scale opinion manipulation.

Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine

PubMed Central

Paruthi, Shalini; Brooks, Lee J.; D'Ambrosio, Carolyn; Hall, Wendy A.; Kotagal, Suresh; Lloyd, Robin M.; Malow, Beth A.; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F.; Rosen, Carol L.; Troester, Matthew M.; Wise, Merrill S.

2016-01-01

Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine. Citation: Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12(6):785–786. PMID:27250809

Bias, belief, and consensus: Collective opinion formation on fluctuating networks.

PubMed

Ngampruetikorn, Vudtiwat; Stephens, Greg J

2016-11-01

With the advent of online networks, societies have become substantially more interconnected with individual members able to easily both maintain and modify their own social links. Here, we show that active network maintenance exposes agents to confirmation bias, the tendency to confirm one's beliefs, and we explore how this bias affects collective opinion formation. We introduce a model of binary opinion dynamics on a complex, fluctuating network with stochastic rewiring and we analyze these dynamics in the mean-field limit of large networks and fast link rewiring. We show that confirmation bias induces a segregation of individuals with different opinions and stabilizes the consensus state. We further show that bias can have an unusual, nonmonotonic effect on the time to consensus and this suggests a novel avenue for large-scale opinion manipulation.

Influence of Parameters of a Reactive Interatomic Potential on the Properties of Saturated Hydrocarbons

DTIC Science & Technology

2017-01-01

Methodology 3 2.1 Modified Embedded-Atom Method Theory 3 2.1.1 Embedding Energy Function 3 2.1.2 Screening Factor 8 2.1.3 Modified Embedded-Atom...Simulation Methodology 2.1 Modified Embedded-Atom Method Theory In the EAM and MEAM formalisms1,2,5 the total energy of a system of atoms (Etot) is...An interatomic potential for saturated hydrocarbons using the modified embedded-atom method (MEAM), a semiempirical many-body potential based on

Development of Impact Assessment Methodologies for Environmental Sustainability

EPA Science Inventory

Sustainability has been discussed for many years, with no consensus on how to ensure that environmental sustainability is reached or even that progress is made in the right direction. The Brundtland Commission statement that sustainability “meets the needs of the present without...

International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.

PubMed

Goldstein, Brahm; Giroir, Brett; Randolph, Adrienne

2005-01-01

Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Consensus conference. This document describes the issues surrounding consensus on four major questions addressed at the meeting: a) How should the pediatric age groups affected by sepsis be delineated? b) What are the specific definitions of pediatric SIRS, infection, sepsis, severe sepsis, and septic shock? c) What are the specific definitions of pediatric organ failure and the validity of pediatric organ failure scores? d) What are the appropriate study populations and study end points required to successfully conduct clinical trials in pediatric sepsis? Five subgroups first met separately and then together to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiological data, and coagulation variables. All conference participants approved the final draft of the proceedings of the meeting. Conference attendees modified the current criteria used to define SIRS and sepsis in adults to incorporate pediatric physiologic variables appropriate for the following subcategories of children: newborn, neonate, infant, child, and adolescent. In addition, the SIRS definition was modified so that either criteria for fever or white blood count had to be met. We also defined various organ dysfunction categories, severe sepsis, and septic shock specifically for children. Although no firm conclusion was made regarding a single appropriate study end point, a novel nonmortality end point, organ failure-free days, was considered optimal for pediatric clinical trials given the relatively low incidence of mortality in pediatric sepsis compared with adult populations. We modified the adult SIRS criteria for children. In addition, we revised definitions of severe sepsis and septic shock for the pediatric population. Our goal is for these first-generation pediatric definitions and criteria to facilitate the performance of successful clinical studies in children with sepsis.

Evolutionary speed limited by water in arid Australia

PubMed Central

Goldie, Xavier; Gillman, Len; Crisp, Mike; Wright, Shane

2010-01-01

The covariation of biodiversity with climate is a fundamental pattern in nature. However, despite the ubiquity of this relationship, a consensus on the ultimate cause remains elusive. The evolutionary speed hypothesis posits direct mechanistic links between ambient temperature, the tempo of micro-evolution and, ultimately, species richness. Previous research has demonstrated faster rates of molecular evolution in warmer climates for a broad range of poikilothermic and homeothermic organisms, in both terrestrial and aquatic environments. In terrestrial systems, species richness increases with both temperature and water availability and the interaction of those terms: productivity. However, the influence of water availability as an independent variable on micro-evolutionary processes has not been examined previously. Here, using methodology that limits the potentially confounding role of cladogenetic and demographic processes, we report, to our knowledge, the first evidence that woody plants living in the arid Australian Outback are evolving more slowly than related species growing at similar latitudes in moist habitats on the mesic continental margins. These results support a modified evolutionary speed explanation for the relationship between the water-energy balance and plant diversity patterns. PMID:20410038

Evolutionary speed limited by water in arid Australia.

PubMed

Goldie, Xavier; Gillman, Len; Crisp, Mike; Wright, Shane

2010-09-07

The covariation of biodiversity with climate is a fundamental pattern in nature. However, despite the ubiquity of this relationship, a consensus on the ultimate cause remains elusive. The evolutionary speed hypothesis posits direct mechanistic links between ambient temperature, the tempo of micro-evolution and, ultimately, species richness. Previous research has demonstrated faster rates of molecular evolution in warmer climates for a broad range of poikilothermic and homeothermic organisms, in both terrestrial and aquatic environments. In terrestrial systems, species richness increases with both temperature and water availability and the interaction of those terms: productivity. However, the influence of water availability as an independent variable on micro-evolutionary processes has not been examined previously. Here, using methodology that limits the potentially confounding role of cladogenetic and demographic processes, we report, to our knowledge, the first evidence that woody plants living in the arid Australian Outback are evolving more slowly than related species growing at similar latitudes in moist habitats on the mesic continental margins. These results support a modified evolutionary speed explanation for the relationship between the water-energy balance and plant diversity patterns.

The competencies of Registered Nurses working in care homes: a modified Delphi study.

PubMed

Stanyon, Miriam Ruth; Goldberg, Sarah Elizabeth; Astle, Anita; Griffiths, Amanda; Gordon, Adam Lee

2017-07-01

registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. a two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further 10 competencies did not reach consensus. the output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

Cornell Alliance for Science Evaluation of Consensus on Genetically Modified Food Safety: Weaknesses in Study Design

PubMed Central

Antoniou, Michael N.; Robinson, Claire J.

2017-01-01

Cornell Alliance for Science has launched an initiative in which “citizen scientists” are called upon to evaluate studies on health risks of genetically modified (GM) crops and foods. The purpose is to establish whether the consensus on GM food safety claimed by the American Association for the Advancement of Science (AAAS) is supported by a review of the scientific literature. The Alliance’s citizen scientists are examining more than 12,000 publication abstracts to quantify how far the scientific literature supports the AAAS’s statement. We identify a number of fundamental weaknesses in the Alliance’s study design, including evaluation is based only on information provided in the publication abstract; there is a lack of clarity as to what material is included in the 12,000 study abstracts to be reviewed, since the number of appropriately designed investigations addressing GM food safety are few; there is uncertainty as to whether studies of toxic effects arising from GM crop-associated pesticides will be included; there is a lack of clarity regarding whether divergent yet equally valid interpretations of the same study will be taken into account; and there is no definition of the cutoff point for consensus or non-consensus on GM food safety. In addition, vital industry proprietary biosafety data on GM crops and associated pesticides are not publicly available and is thus cannot inform this project. Based on these weaknesses in the study design, we believe it is questionable as to whether any objective or meaningful conclusion can be drawn from the Alliance’s initiative. PMID:28447029

Rating scale for the assessment of competence in ultrasound-guided peripheral vascular access - a Delphi Consensus Study.

PubMed

Primdahl, Stine C; Todsen, Tobias; Clemmesen, Louise; Knudsen, Lars; Weile, Jesper

2016-09-21

Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study. We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale. Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure. We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.

Cornell Alliance for Science Evaluation of Consensus on Genetically Modified Food Safety: Weaknesses in Study Design.

PubMed

Antoniou, Michael N; Robinson, Claire J

2017-01-01

Cornell Alliance for Science has launched an initiative in which "citizen scientists" are called upon to evaluate studies on health risks of genetically modified (GM) crops and foods. The purpose is to establish whether the consensus on GM food safety claimed by the American Association for the Advancement of Science (AAAS) is supported by a review of the scientific literature. The Alliance's citizen scientists are examining more than 12,000 publication abstracts to quantify how far the scientific literature supports the AAAS's statement. We identify a number of fundamental weaknesses in the Alliance's study design, including evaluation is based only on information provided in the publication abstract; there is a lack of clarity as to what material is included in the 12,000 study abstracts to be reviewed, since the number of appropriately designed investigations addressing GM food safety are few; there is uncertainty as to whether studies of toxic effects arising from GM crop-associated pesticides will be included; there is a lack of clarity regarding whether divergent yet equally valid interpretations of the same study will be taken into account; and there is no definition of the cutoff point for consensus or non-consensus on GM food safety. In addition, vital industry proprietary biosafety data on GM crops and associated pesticides are not publicly available and is thus cannot inform this project. Based on these weaknesses in the study design, we believe it is questionable as to whether any objective or meaningful conclusion can be drawn from the Alliance's initiative.

Anthropogenic ``Global Warming'' Alarmism: Illuminating some Scientific and Methodological Flaws

NASA Astrophysics Data System (ADS)

Gould, Larry

2009-10-01

There continues to be an increasing number of scientists and public figures around the world who are challenging the dominant political- and mediadriven claims that have been bolstered by so-called ``consensus'' scientific views -- that dangerous ``global warming/climate change'' is caused primarily by human-produced carbon dioxide. This general talk will show that the weight of scientific evidence strongly contradicts the alarmist claims. It will also explain what are some of the methodological flaws that continue to threaten the scientific method.

Modified Method of Simplest Equation Applied to the Nonlinear Schrödinger Equation

NASA Astrophysics Data System (ADS)

Vitanov, Nikolay K.; Dimitrova, Zlatinka I.

2018-03-01

We consider an extension of the methodology of the modified method of simplest equation to the case of use of two simplest equations. The extended methodology is applied for obtaining exact solutions of model nonlinear partial differential equations for deep water waves: the nonlinear Schrödinger equation. It is shown that the methodology works also for other equations of the nonlinear Schrödinger kind.

Optimizing the assessment of pediatric injury severity in low-resource settings: Consensus generation through a modified Delphi analysis.

PubMed

St-Louis, Etienne; Deckelbaum, Dan Leon; Baird, Robert; Razek, Tarek

2017-06-01

Although a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings. A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. Qualitative data was extracted from the systematic review, including scoring parameters, settings and outcomes. In order to establish consensus regarding which of these elements are most adapted to pediatric patients in low-resource settings, they were subjected to a modified Delphi survey for external validation. The Delphi process is a structured communication technique that relies on a panel of experts to develop a systematic, interactive consensus method. We invited a group of 38 experts, including adult and pediatric surgeons, emergency physicians and anesthesiologists trauma team leaders from a level 1 trauma center in Montreal, Canada, and a pediatric referral trauma hospital in Santiago, Chile to participate in two successive rounds of our survey. Consensus was reached regarding various features of an ideal pediatric trauma score. Specifically, our experts agreed pediatric trauma scoring tool should differ from its adult counterpart, that it can be derived from point of care data available at first assessment, that blood pressure is an important variable to include in a predictive model for pediatric trauma outcomes, that blood pressure is a late but specific marker of shock in pediatric patients, that pulse rate is a more sensitive marker of hemodynamic instability than blood pressure, that an assessment of airway status should be included as a predictive variable for pediatric trauma outcomes, that the AVPU classification of neurologic status is simple and reliable in the acute setting, and more so than GCS at all ages. Therefore, we conclude that an opportunity exists to develop a new pediatric trauma score, combining the above consensus-generating ideas, that would be best adapted for use in low-resource settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment.

PubMed

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management.

PubMed

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment

PubMed Central

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S.

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment. PMID:29422793

ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis.

PubMed

Montalban, X; Gold, R; Thompson, A J; Otero-Romero, S; Amato, M P; Chandraratna, D; Clanet, M; Comi, G; Derfuss, T; Fazekas, F; Hartung, H P; Havrdova, E; Hemmer, B; Kappos, L; Liblau, R; Lubetzki, C; Marcus, E; Miller, D H; Olsson, T; Pilling, S; Selmaj, K; Siva, A; Sorensen, P S; Sormani, M P; Thalheim, C; Wiendl, H; Zipp, F

2018-02-01

Multiple sclerosis (MS) is a complex disease of the central nervous system. As new drugs are becoming available, knowledge on diagnosis and treatment must continuously evolve. There is therefore a need for a reference tool compiling current data on benefit and safety, to aid professionals in treatment decisions and use of resources across Europe. The European Committee of Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN) have joined forces to meet this need. The objective was to develop an evidence-based clinical practice guideline for the pharmacological treatment of people with MS to guide healthcare professionals in the decision-making process. This guideline has been developed using the GRADE methodology and following the recently updated EAN recommendations for guideline development. Clinical questions were formulated in PICO format (patient, intervention, comparator, outcome) and outcomes were prioritized according to their relevance to clinical practice. An exhaustive literature search up to December 2016 was performed for each question and the evidence is presented narratively and, when possible, combined in a meta-analysis using a random-effects model. The quality of evidence for each outcome was rated into four categories - very high, high, low and very low - according to the risk of bias. GRADE evidence profiles were created using GRADEprofiler (GRADEpro) software (Version 3.6). The recommendations with assigned strength (strong, weak) were formulated based on the quality of evidence and the risk-benefit balance. Consensus between the panellists was reached by use of the modified nominal group technique. A total of 10 questions have been agreed, encompassing treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and treatment strategies in MS and pregnancy. The guideline takes into account all disease-modifying drugs approved by the European Medicine Agency at the time of publication. A total of 20 recommendations were agreed by the guideline working group members after three rounds of consensus. © 2018 European Academy of Neurology and European Committee of Treatment of Research in Multiple Sclerosis.

A consensus process on management of major burns accidents: lessons learned from the café fire in Volendam, The Netherlands.

PubMed

Welling, L; Boers, M; Mackie, D P; Patka, P; Bierens, J J L M; Luitse, J S K; Kreis, R W

2006-01-01

The optimum response to the different stages of a major burns incident is still not established. The fire in a café in Volendam on New Year's Eve 2000 was the worst incident in recent Dutch history and resulted in mass burn casualties. The fire has been the subject of several investigations concerned with organisational and medical aspects. Based on the findings in these investigations, a multidisciplinary research group started a consensus study. The aim of this study was to further identify areas of improvement in the care after mass burns incidents. The consensus process comprised three postal rounds (Delphi Method) and a consensus conference (modified nominal group technique). The multidisciplinary panel consisted of 26 Dutch-speaking experts, working in influential positions within the sphere of disaster management and healthcare. In response to the postal questionnaires, consensus was reached for 66 per cent of the statements. Six topics were subsequently discussed during the consensus conference; three topics were discussed within the plenary session and three during subgroup meetings. During the conference, consensus was reached for seven statements (one subject generated two statements). In total, the panel agreed on 21 statements. These covered the following topics: registration and evaluation of disaster care, capacity planning for disasters, pre hospital care of victims of burns disasters, treatment and transportation priorities, distribution of casualties (including interhospital transports), diagnosis and treatment and education and training. In disaster medicine, the paper shows how a consensus process is a suitable tool to identify areas of improvement of care after mass burns incidents.

Study of consensus-based time synchronization in wireless sensor networks.

PubMed

He, Jianping; Li, Hao; Chen, Jiming; Cheng, Peng

2014-03-01

Recently, various consensus-based protocols have been developed for time synchronization in wireless sensor networks. However, due to the uncertainties lying in both the hardware fabrication and network communication processes, it is not clear how most of the protocols will perform in real implementations. In order to reduce such gap, this paper investigates whether and how the typical consensus-based time synchronization protocols can tolerate the uncertainties in practical sensor networks through extensive testbed experiments. For two typical protocols, i.e., Average Time Synchronization (ATS) and Maximum Time Synchronization (MTS), we first analyze how the time synchronization accuracy will be affected by various uncertainties in the system. Then, we implement both protocols on our sensor network testbed consisted of Micaz nodes, and investigate the time synchronization performance and robustness under various network settings. Noticing that the synchronized clocks under MTS may be slightly faster than the desirable clock, by adopting both maximum consensus and minimum consensus, we propose a modified protocol, MMTS, which is able to drive the synchronized clocks closer to the desirable clock while maintaining the convergence rate and synchronization accuracy of MTS. © 2013 ISA. Published by ISA. All rights reserved.

Methodology for the systematic reviews on an adjacent segment pathology.

PubMed

Norvell, Daniel C; Dettori, Joseph R; Skelly, Andrea C; Riew, K Daniel; Chapman, Jens R; Anderson, Paul A

2012-10-15

A systematic review. To provide a detailed description of the methods undertaken in the systematic search and analytical summary of adjacent segment pathology (ASP) issues and to describe the process used to develop consensus statements and clinical recommendations regarding factors associated with the prevention and treatment of ASP. We present methods used in conducting the systematic, evidence-based reviews and development of expert panel consensus statements and clinical recommendations on the classification, natural history, risk factors, and treatment of radiographical and clinical ASP. Our intent is that clinicians will combine the information from these reviews with an understanding of their own capacities and experience to better manage patients at risk of ASP and consider future research for the prevention and treatment of ASP. A systematic search and critical review of the English-language literature was undertaken for articles published on the classification, risk, risk factors, and treatment of radiographical and clinical ASP. Articles were screened for relevance using a priori criteria, and relevant articles were critically reviewed. Whether an article was included for review depended on whether the study question was descriptive, one of therapy, or one of prognosis. The strength of evidence for the overall body of literature in each topic area was determined by 2 independent reviewers considering risk of bias, consistency, directness, and precision of results using a modification of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Disagreements were resolved by consensus. Findings from articles meeting inclusion criteria were summarized. From these summaries, consensus statements or clinical recommendations were formulated among subject experts through a modified Delphi process using the GRADE approach. A total of 3382 articles were identified and screened on 14 topics relating to the classification, risks, risk factors, and treatment of radiographical and clinical ASP. Of these, 127 met our predetermined inclusion criteria and were used to answer specific clinical questions within each topic. Lack of precision in the terminology related to adjacent segment disease and critical evaluation of definitions used across included articles led to a consensus to use ASP and suggest it as a standard. No validated comprehensive classification system for ASP currently exists. The expert panel developed a consensus definition of radiographical and clinical ASP (RASP and CASP). Some of the highlights from the analyses included the annual, 5- and 10-year risks of developing cervical and lumbar ASP after surgery, several important risk factors associated with the development of cervical and lumbar ASP, and the possibility that some motion sparing procedures may be associated with a lower risk of ASP compared with fusion despite kinematic studies demonstrating similar adjacent segment mobility following these procedures. Other highlights included a high risk of proximal junctional kyphosis (PJK) following long fusions for deformity correction, postsurgical malalignment as a potential risk factor for RASP and the paucity of studies on treatment of cervical and lumbar ASP. Systematic reviews were undertaken to understand the classification, risks, risk factors, and treatment of RASP and CASP and to provide consensus statements and clinical recommendations. This article reports the methods used in the reviews.

Caries preventive measures in orthodontic practice: the development of a clinical practice guideline.

PubMed

Oosterkamp, B C M; van der Sanden, W J M; Frencken, J E F M; Kuijpers-Jagtman, A M

2016-02-01

White spot lesions (WSLs) are a side effect of orthodontic treatment, causing esthetic problems and a risk of deeper enamel and dentine lesions. Many strategies have been developed for preventing WSLs, but great variability exists in preventive measures between orthodontists. This study developed statements on which a clinical practice guideline (CPG) can be developed in order to help orthodontists select preventive measures based on the best available evidence. A nominal group technique (RAND-e modified Delphi procedure) was used. A multidisciplinary expert panel rated 264 practice- and evidence-based statements related to the management of WSLs. To provide panel members with the same knowledge, a total of six articles obtained from a systematic review of the literature were read by the panel in preparation of three consensus rounds. According to the technique, a threshold of 75% of all ratings within any 3-point section of the 9-point scale regarding a specific statement was accepted as consensus. After the first and second consensus rounds, consensus was reached on 37.5 and 31.1% of statements, respectively. For the remaining 31.4% of statements, consensus was reached during a 4-h consensus meeting. Statements on the management of WSLs derived from a systematic literature review combined with expert opinion were formally integrated toward consensus through a nominal group technique. These statements formed the basis for developing a CPG on the management of WSLs before and during orthodontic treatment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Moving forward through consensus: protocol for a modified Delphi approach to determine the top research priorities in the field of orthopaedic oncology.

PubMed

Schneider, Patricia; Evaniew, Nathan; Rendon, Juan Sebastian; McKay, Paula; Randall, R Lor; Turcotte, Robert; Vélez, Roberto; Bhandari, Mohit; Ghert, Michelle

2016-05-24

Orthopaedic oncology researchers face several obstacles in the design and execution of randomised controlled trials, including finite fiscal resources to support the rising costs of clinical research and insufficient patient volume at individual sites. As a result, high-quality research to guide clinical practice has lagged behind other surgical subspecialties. A focused approach is imperative to design a research programme that is economical, streamlined and addresses clinically relevant endpoints. The primary objective of this study will be to use a consensus-based approach to identify research priorities for international clinical trials in orthopaedic oncology. We will conduct a 3-phase modified Delphi method consisting of 2 sequential rounds of anonymous web-based questionnaires (phases I and II), and an in-person consensus meeting (phase III). Participants will suggest research questions that they believe are of particular importance to the field (phase I), and individually rate each proposed question on 5 criteria (phase II). Research questions that meet predetermined consensus thresholds will be brought forward to the consensus meeting (phase III) for discussion by an expert panel. Following these discussions, the expert panel will be asked to assign scores for each research question, and research questions meeting predetermined criteria will be brought forward for final ranking. The expert panel will then be asked to rank the top 3 research questions, and these 3 research questions will be distributed to the initial group of participants for validation. An ethics application is currently under review with the Hamilton Integrated Research Ethics Board in Hamilton, Ontario, Canada. The results of this initiative will be disseminated through peer-reviewed publications and conference presentations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Determination of Relevant Goals and Criteria Used to Select an Automated Patient Care Information System

PubMed Central

Chocholik, Joan K.; Bouchard, Susan E.; Tan, Joseph K. H.; Ostrow, David N.

1999-01-01

Objectives: To determine the relevant weighted goals and criteria for use in the selection of an automated patient care information system (PCIS) using a modified Delphi technique to achieve consensus. Design: A three-phase, six-round modified Delphi process was implemented by a ten-member PCIS selection task force. The first phase consisted of an exploratory round. It was followed by the second phase, of two rounds, to determine the selection goals and finally the third phase, of three rounds, to finalize the selection criteria. Results: Consensus on the goals and criteria for selecting a PCIS was measured during the Delphi process by reviewing the mean and standard deviation of the previous round's responses. After the study was completed, the results were analyzed using a limits-of-agreement indicator that showed strong agreement of each individual's responses between each of the goal determination rounds. Further analysis for variability in the group's response showed a significant movement to consensus after the first goal-determination iteration, with consensus reached on all goals by the end of the second iteration. Conclusion: The results indicated that the relevant weighted goals and criteria used to make the final decision for an automated PCIS were developed as a result of strong agreement among members of the PCIS selection task force. It is therefore recognized that the use of the Delphi process was beneficial in achieving consensus among clinical and nonclinical members in a relatively short time while avoiding a decision based on political biases and the “groupthink” of traditional committee meetings. The results suggest that improvements could be made in lessening the number of rounds by having information available through side conversations, by having other statistical indicators besides the mean and standard deviation available between rounds, and by having a content expert address questions between rounds. PMID:10332655

Contemporary management of paraesophaegeal hernias: establishing a European expert consensus.

PubMed

Bonrath, E M; Grantcharov, T P

2015-08-01

The surgical treatment of paraesophageal hernias remains a challenge due to the lack of consensus regarding principles of operative treatment. The objectives of this study were to achieve consensus on key topics through expert opinion using a Delphi methodology. A Delphi survey combined with a face-to-face meeting was conducted. A panel of European experts in foregut surgery from high-volume centres generated items in the first survey round. In subsequent rounds, the panel rated agreement with statements on a 5-point Likert-type scale. Internal consistency (consensus) was predefined as Cronbach's α > .80. Items that >70 % of the panel either rated as irrelevant/unimportant, or relevant/important were selected as consensus items, while topics that did not reach this cut-off were termed "undecided/controversial". Three survey rounds were completed: 19 experts from 10 countries completed round one, 18 continued through rounds two and three. Internal consistency was high in rounds two and three (α > .90). Fifty-eight additional/revised items derived from comments and free-text entries were included in round three. In total, 118 items were rated; consensus agreement was achieved for 70 of these. Examples of consensus topics are the relevance of the disease profile for assessing surgical urgency and complexity, the role of clinical history as the mainstay of patient follow-up, indications for revision surgery, and training and credentialing recommendations. Topics with the most "undecided/controversial" items were follow-up, postoperative care and surgical technique. This Delphi study achieved expert consensus on key topics in the operative management of paraesophageal hernias, providing an overview of the current opinion among European foregut surgeons. Moreover, areas with substantial variability in opinions were identified reflecting the current lack of empirical evidence and opportunities for future research.

The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part II: Tactics. Attention-Deficit/Hyperactivity Disorder.

PubMed

Pliszka, S R; Greenhill, L L; Crismon, M L; Sedillo, A; Carlson, C; Conners, C K; McCracken, J T; Swanson, J M; Hughes, C W; Llana, M E; Lopez, M; Toprac, M G

2000-07-01

Expert consensus methodology was used to develop a medication treatment algorithm for attention-deficit/hyperactivity disorder (ADHD). The algorithm broadly outlined the choice of medication for ADHD and some of its most common comorbid conditions. Specific tactical recommendations were developed with regard to medication dosage, assessment of drug response, management of side effects, and long-term medication management. The consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families developed evidence-based tactics for the pharmacotherapy of childhood ADHD and its common comorbid disorders. The panel discussed specifics of treatment of ADHD and its comorbid conditions with stimulants, antidepressants, mood stabilizers, alpha-agonists, and (when appropriate) antipsychotics. Specific tactics for the use of each of the above agents are outlined. The tactics are designed to be practical for implementation in the public mental health sector, but they may have utility in many practice settings, including the private practice environment. Tactics for psychopharmacological management of ADHD can be developed with consensus.

Measuring STEM Students' Mathematical Identities

ERIC Educational Resources Information Center

Kaspersen, Eivind; Pepin, Birgit; Sikko, Svein Arne

2017-01-01

Studies on identity in general and mathematical identity in particular have gained much interest over the last decades. However, although measurements have been proven to be potent tools in many scientific fields, a lack of consensus on ontological, epistemological, and methodological issues has complicated measurements of mathematical identities.…

Cognitive Efficiency: A Conceptual and Methodological Comparison

ERIC Educational Resources Information Center

Hoffman, Bobby

2012-01-01

Cognitive efficiency (CE) is generally defined as qualitative increases in knowledge gained in relation to the time and effort invested in knowledge acquisition. Across disciplines, limited consensus exists concerning the conceptual and measurement properties of CE partly because some researchers indiscriminately use the construct of CE to…

Achieving Graduate Employability through Consensus in the South Pacific Island Nation

ERIC Educational Resources Information Center

Bhanugopan, Ramudu; Fish, Alan

2009-01-01

Purpose: The purpose of this paper is to recognise the important technical and business skills and personal attributes necessary to support the "employability" of undergraduate business students. Design/methodology/approach: Senior-level undergraduate business students and employers were surveyed regarding their perceptions on the…

The hospital incident command system: modified model for hospitals in iran.

PubMed

Djalali, Ahmadreza; Hosseinijenab, Vahid; Peyravi, Mahmoudreza; Nekoei-Moghadam, Mahmood; Hosseini, Bashir; Schoenthal, Lisa; Koenig, Kristi L

2015-03-27

Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

A modified eco-efficiency framework and methodology for advancing the state of practice of sustainability analysis as applied to green infrastructure

EPA Science Inventory

We propose a modified eco-efficiency (EE) framework and novel sustainability analysis methodology for green infrastructure (GI) practices used in water resource management. Green infrastructure practices such as rainwater harvesting (RWH), rain gardens, porous pavements, and gree...

Advancing scoping study methodology: a web-based survey and consultation of perceptions on terminology, definition and methodological steps.

PubMed

O'Brien, Kelly K; Colquhoun, Heather; Levac, Danielle; Baxter, Larry; Tricco, Andrea C; Straus, Sharon; Wickerson, Lisa; Nayar, Ayesha; Moher, David; O'Malley, Lisa

2016-07-26

Scoping studies (or reviews) are a method used to comprehensively map evidence across a range of study designs in an area, with the aim of informing future research practice, programs and policy. However, no universal agreement exists on terminology, definition or methodological steps. Our aim was to understand the experiences of, and considerations for conducting scoping studies from the perspective of academic and community partners. Primary objectives were to 1) describe experiences conducting scoping studies including strengths and challenges; and 2) describe perspectives on terminology, definition, and methodological steps. We conducted a cross-sectional web-based survey with clinicians, educators, researchers, knowledge users, representatives from community-based organizations, graduate students, and policy stakeholders with experience and/or interest in conducting scoping studies to gain an understanding of experiences and perspectives on the conduct and reporting of scoping studies. We administered an electronic self-reported questionnaire comprised of 22 items related to experiences with scoping studies, strengths and challenges, opinions on terminology, and methodological steps. We analyzed questionnaire data using descriptive statistics and content analytical techniques. Survey results were discussed during a multi-stakeholder consultation to identify key considerations in the conduct and reporting of scoping studies. Of the 83 invitations, 54 individuals (65 %) completed the scoping questionnaire, and 48 (58 %) attended the scoping study meeting from Canada, the United Kingdom and United States. Many scoping study strengths were dually identified as challenges including breadth of scope, and iterative process. No consensus on terminology emerged, however key defining features that comprised a working definition of scoping studies included the exploratory mapping of literature in a field; iterative process, inclusion of grey literature; no quality assessment of included studies, and an optional consultation phase. We offer considerations for the conduct and reporting of scoping studies for researchers, clinicians and knowledge users engaging in this methodology. Lack of consensus on scoping terminology, definition and methodological steps persists. Reasons for this may be attributed to diversity of disciplines adopting this methodology for differing purposes. Further work is needed to establish guidelines on the reporting and methodological quality assessment of scoping studies.

Execution of a self-directed risk assessment methodology to address HIPAA data security requirements

NASA Astrophysics Data System (ADS)

Coleman, Johnathan

2003-05-01

This paper analyzes the method and training of a self directed risk assessment methodology entitled OCTAVE (Operationally Critical Threat Asset and Vulnerability Evaluation) at over 170 DOD medical treatment facilities. It focuses specifically on how OCTAVE built interdisciplinary, inter-hierarchical consensus and enhanced local capabilities to perform Health Information Assurance. The Risk Assessment Methodology was developed by the Software Engineering Institute at Carnegie Mellon University as part of the Defense Health Information Assurance Program (DHIAP). The basis for its success is the combination of analysis of organizational practices and technological vulnerabilities. Together, these areas address the core implications behind the HIPAA Security Rule and can be used to develop Organizational Protection Strategies and Technological Mitigation Plans. A key component of OCTAVE is the inter-disciplinary composition of the analysis team (Patient Administration, IT staff and Clinician). It is this unique composition of analysis team members, along with organizational and technical analysis of business practices, assets and threats, which enables facilities to create sound and effective security policies. The Risk Assessment is conducted in-house, and therefore the process, results and knowledge remain within the organization, helping to build consensus in an environment of differing organizational and disciplinary perspectives on Health Information Assurance.

Quantitative application of the primary progressive aphasia consensus criteria

PubMed Central

Wicklund, Meredith R.; Duffy, Joseph R.; Strand, Edythe A.; Machulda, Mary M.; Whitwell, Jennifer L.

2014-01-01

Objective: To determine how well the consensus criteria could classify subjects with primary progressive aphasia (PPA) using a quantitative speech and language battery that matches the test descriptions provided by the consensus criteria. Methods: A total of 105 participants with a neurodegenerative speech and language disorder were prospectively recruited and underwent neurologic, neuropsychological, and speech and language testing and MRI in this case-control study. Twenty-one participants with apraxia of speech without aphasia served as controls. Select tests from the speech and language battery were chosen for application of consensus criteria and cutoffs were employed to determine syndromic classification. Hierarchical cluster analysis was used to examine participants who could not be classified. Results: Of the 84 participants, 58 (69%) could be classified as agrammatic (27%), semantic (7%), or logopenic (35%) variants of PPA. The remaining 31% of participants could not be classified. Of the unclassifiable participants, 2 clusters were identified. The speech and language profile of the first cluster resembled mild logopenic PPA and the second cluster semantic PPA. Gray matter patterns of loss of these 2 clusters of unclassified participants also resembled mild logopenic and semantic variants. Conclusions: Quantitative application of consensus PPA criteria yields the 3 syndromic variants but leaves a large proportion unclassified. Therefore, the current consensus criteria need to be modified in order to improve sensitivity. PMID:24598709

Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia

PubMed Central

Keefe, Richard S. E.; Haig, George M.; Marder, Stephen R.; Harvey, Philip D.; Dunayevich, Eduardo; Medalia, Alice; Davidson, Michael; Lombardo, Ilise; Bowie, Christopher R.; Buchanan, Robert W.; Bugarski-Kirola, Dragana; Carpenter, William T.; Csernansky, John T.; Dago, Pedro L.; Durand, Dante M.; Frese, Frederick J.; Goff, Donald C.; Gold, James M.; Hooker, Christine I.; Kopelowicz, Alex; Loebel, Antony; McGurk, Susan R.; Opler, Lewis A.; Pinkham, Amy E.; Stern, Robert G.

2016-01-01

If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus. PMID:26362273

Borderline intellectual functioning: consensus and good practice guidelines.

PubMed

Salvador-Carulla, Luis; García-Gutiérrez, Juan Carlos; Ruiz Gutiérrez-Colosía, Mencía; Artigas-Pallarès, Josep; García Ibáñez, José; González Pérez, Joan; Nadal Pla, Margarida; Aguilera Inés, Francisco; Isus, Sofia; Cereza, Josep Maria; Poole, Miriam; Portero Lazcano, Guillermo; Monzón, Patricio; Leiva, Marta; Parellada, Mara; García Nonell, Katia; Martínez I Hernández, Andreu; Rigau, Eugenia; Martínez-Leal, Rafael

2013-01-01

The Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits "normal" intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. To elaborate a conceptual framework and to establish consensus guidelines. A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Scientific publications covering BIF are scarce. The term that yields a bigger number of results is "Borderline Intelligence". The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual. Copyright © 2011 SEP y SEPB. Published by Elsevier Espana. All rights reserved.

Evaluating Quality Management in University Departments

ERIC Educational Resources Information Center

Becket, Nina; Brookes, Maureen

2006-01-01

Purpose: Despite the abundance of research on quality management there is no universal consensus on how best to measure quality in higher education. This paper undertakes a critical evaluation of the different methods used to assess the quality of provision in higher education departments in the UK. Design/methodology/approach: Drawing on relevant…

Spirituality and Health: Implications for Policy and Practice

ERIC Educational Resources Information Center

Vazin, Dara

2013-01-01

Purpose. The purpose of this study was to establish among health educators a consensus in the definition of spirituality and health that would ultimately guide effective development of a curriculum or program in spirituality and health for undergraduate programs in college health science departments. Methodology. This mixed-methods research study…

The Delphi Method in Rehabilitation Counseling Research

ERIC Educational Resources Information Center

Vazquez-Ramos, Robinson; Leahy, Michael; Estrada Hernandez, Noel

2007-01-01

Rehabilitation researchers have found in the application of the Delphi method a more sophisticated way of obtaining consensus from experts in the field on certain matters. The application of this research methodology has affected and certainly advanced the body of knowledge of the rehabilitation counseling practice. However, the rehabilitation…

Maternal Depression and Developmental Disability: Research Critique

ERIC Educational Resources Information Center

Bailey, Donald B., Jr.; Golden, Robert N.; Roberts, Jane; Ford, Amy

2007-01-01

Maternal depression in families having a child with a disability has been the subject of considerable research over the past 25 years. This review was designed to describe the literature on maternal depression, critique its research methodology, identify consensus findings across studies, and make recommendations for future research. A particular…

Development of Weighted Distributions of REPs for Dioxin-Like Compounds: Implications for Risk Assessment

EPA Science Inventory

In their recent reevaluation of the TEF methodology, the WHO expert panel indicated that consideration should be given to developing weighted distributions of REP values to establish TEFs for each dioxin-like compound (DLC). As such, we developed a consensus-based weighting frame...

Applying Generalizability Theory for Making Quantitative RTI Progress-Monitoring Decisions

ERIC Educational Resources Information Center

Fan, Chung-Hau; Hansmann, Paul R.

2015-01-01

Language in the Individuals With Disabilities Education Improvement Act (IDEIA) allows the use of response-to-intervention (RTI) methodology in the identification of specific learning disabilities. However, there is no consensus on decision rules using curriculum-based measurement of oral reading fluency (CBM-R) for defining responsiveness. The…

Quality Indicators for Continuous Monitoring to Improve Maternal and Infant Health in Maternity Departments: A Modified Delphi Survey of an International Multidisciplinary Panel

PubMed Central

Boulkedid, Rym; Sibony, Olivier; Goffinet, François; Fauconnier, Arnaud; Branger, Bernard; Alberti, Corinne

2013-01-01

Objective Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals. Methodology and Main Findings An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators. Conclusion A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units. PMID:23577143

Quantized Average Consensus on Gossip Digraphs with Reduced Computation

NASA Astrophysics Data System (ADS)

Cai, Kai; Ishii, Hideaki

The authors have recently proposed a class of randomized gossip algorithms which solve the distributed averaging problem on directed graphs, with the constraint that each node has an integer-valued state. The essence of this algorithm is to maintain local records, called “surplus”, of individual state updates, thereby achieving quantized average consensus even though the state sum of all nodes is not preserved. In this paper we study a modified version of this algorithm, whose feature is primarily in reducing both computation and communication effort. Concretely, each node needs to update fewer local variables, and can transmit surplus by requiring only one bit. Under this modified algorithm we prove that reaching the average is ensured for arbitrary strongly connected graphs. The condition of arbitrary strong connection is less restrictive than those known in the literature for either real-valued or quantized states; in particular, it does not require the special structure on the network called balanced. Finally, we provide numerical examples to illustrate the convergence result, with emphasis on convergence time analysis.

Composition of a Vision Screen for Servicemembers With Traumatic Brain Injury: Consensus Using a Modified Nominal Group Technique

PubMed Central

Finkelstein, Marsha; Llanos, Imelda; Scheiman, Mitchell; Wagener, Sharon Gowdy

2014-01-01

Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far–near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults. PMID:25005505

Evaluating the construct of triage acuity against a set of reference vignettes developed via modified Delphi method.

PubMed

Twomey, Michèle; Wallis, Lee A; Myers, Jonathan E

2014-07-01

To evaluate the construct of triage acuity as measured by the South African Triage Scale (SATS) against a set of reference vignettes. A modified Delphi method was used to develop a set of reference vignettes. Delphi participants completed a 2-round consensus-building process, and independently assigned triage acuity ratings to 100 written vignettes unaware of the ratings given by others. Triage acuity ratings were summarised for all vignettes, and only those that reached 80% consensus during round 2 were included in the reference set. Triage ratings for the reference vignettes given by two independent experts using the SATS were compared with the ratings given by the international Delphi panel. Measures of sensitivity, specificity, associated percentages for over-triage/under-triage were used to evaluate the construct of triage acuity (as measured by the SATS) by examining the association between the ratings by the two experts and the international panel. On completion of the Delphi process, 42 of the 100 vignettes reached 80% consensus on their acuity rating and made up the reference set. On average, over all acuity levels, sensitivity was 74% (CI 64% to 82%), specificity 92% (CI 87% to 94%), under-triage occurred 14% (CI 8% to 23%) and over-triage 12% (CI 8% to 23%) of the time. The results of this study provide an alternative to evaluating triage scales against the construct of acuity as measured with the SATS. This method of using 80% consensus vignettes may, however, systematically bias the validity estimate towards better performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis

PubMed Central

Stockfleth, Eggert; Peris, Ketty; Guillen, Carlos; Cerio, Rino; Basset-Seguin, Nicole; Foley, Peter; Sanches, José; Culshaw, Alex; Erntoft, Sandra; Lebwohl, Mark

2015-01-01

Background Topical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. Objectives To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis. Methods An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Results Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated. Conclusions The recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy. PMID:25865875

Assessment, Selection, Use, and Evaluation of Body-Worn Absorbent Products for Adults With Incontinence: A WOCN Society Consensus Conference.

PubMed

Gray, Mikel; Kent, Dea; Ermer-Seltun, JoAnn; McNichol, Laurie

The Wound, Ostomy and Continence Nurses (WOCN) Society charged a task force with creating recommendations for assessment, selection, use, and evaluation of body-worn absorbent products. The 3-member task force, assisted by a moderator with knowledge of this area of care, completed a scoping literature review to identify recommendations supported by adequate research to qualify as evidence-based, and area of care where evidence needed to guide care was missing. Based on findings of this scoping review, the Society then convened a panel of experts to develop consensus statements guiding assessment, use, and evaluation of the effect of body-worn absorbent products for adults with urinary and/or fecal incontinence. These consensus-based statements underwent a second round of content validation using a modified Delphi technique using a different panel of clinicians with expertise in this area of care. This article reports on the scoping review and subsequent evidence-based statements, along with generation and validation of consensus-based statements that will be used to create an algorithm to aid clinical decision making.

Best Practices for Chiropractic Care of Children: A Consensus Update.

PubMed

Hawk, Cheryl; Schneider, Michael J; Vallone, Sharon; Hewitt, Elise G

2016-01-01

Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States, and it is used frequently by children internationally as well. The purpose of this project was to update the 2009 recommendations on best practices for chiropractic care of children. A formal consensus process was completed based on the existing recommendations and informed by the results of a systematic review of relevant literature from January 2009 through March 2015. The primary search question for the systematic review was, "What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by children (<18 years of age)?" A secondary search question was, "What are the adverse events associated with chiropractic care including spinal manipulation among children (<18 years of age)?" The consensus process was conducted electronically, by e-mail, using a multidisciplinary Delphi panel of 29 experts from 5 countries and using the RAND Corporation/University of California, Los Angeles, consensus methodology. Only 2 statements from the previous set of recommendations did not reach 80% consensus on the first round, and revised versions of both were agreed upon in a second round. All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Consensus on measurement properties and feasibility of performance tests for the exercise and sport sciences: a Delphi study.

PubMed

Robertson, Sam; Kremer, Peter; Aisbett, Brad; Tran, Jacqueline; Cerin, Ester

2017-12-01

Performance tests are used for multiple purposes in exercise and sport science. Ensuring that a test displays an appropriate level of measurement properties for use within a population is important to ensure confidence in test findings. The aim of this study was to obtain subject matter expert consensus on the measurement and feasibility properties that should be considered for performance tests used in the exercise and sport sciences and how these should be defined. This information was used to develop a checklist for broader dissemination. A two-round Delphi study was undertaken including 33 exercise scientists, academics and sport scientists. Participants were asked to rate the importance of a range of measurement properties relevant to performance tests in exercise and sport science. Responses were obtained in binary and Likert-scale formats, with consensus defined as achieving 67% agreement on each question. Consensus was reached on definitions and terminology for all items. Ten level 1 items (those that achieved consensus on all four questions) and nine level 2 items (those achieving consensus on ≥2 questions) were included. Both levels were included in the final checklist. The checklist developed from this study can be used to inform decision-making and test selection for practitioners and researchers in the exercise and sport sciences. This can facilitate knowledge sharing and performance comparisons across sub-disciplines, thereby improving existing field practice and research methodological quality.

An independent jury-based consensus conference model for the development of recommendations in medico-surgical practice.

PubMed

Lesurtel, Mickaël; Perrier, Arnaud; Bossuyt, Patrick M M; Langer, Bernard; Clavien, Pierre-Alain

2014-03-01

There is an increasing demand for standardization in the choice of treatments for specific conditions, so-called personalized medicine. The task is far from trivial, because the perspectives from many stakeholders must be respected, including patients and health care providers, as well as payers or governments to better control costs while optimizing quality of care. One approach to provide widely accepted therapies is the consensus conference. We describe a novel methodology to achieve consensus in controversial areas with the main goal to minimize biases. The principle of this approach relies on a clear distinction between those who provide the evidence (experts) and those who draw the final recommendations (the jury). The jury consists of individuals with sufficient background knowledge to cover the perspectives of all stakeholders' without being involved directly in the topic under evaluation. The organizing committee, the experts, and the jury interact within 3 phases: Preparation, the actual consensus conference, and deliberations. Each question is addressed by a panel of experts, leading to the proposition of recommendations at the conference meeting, which are challenged by the jury and the audience. Based on all available information, the jury finalizes the consensus recommendations, which are eventually published and made available to all. This novel model of consensus conference allows the construction of consensual, evidence-based, explicit recommendations for therapies in a process that may also identify issues for further research, eventually fostering progress in the field. Copyright © 2014 Mosby, Inc. All rights reserved.

Asian Organization for Crohn's and Colitis and Asian Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: Risk assessment.

PubMed

Park, Dong Ii; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asian Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection, and prevention of latent TB infection and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised two parts: (i) risk of TB infection during anti-TNF therapy and (ii) screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: Management.

PubMed

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised three parts: (3) management of latent TB in preparation for anti-TNF therapy, (4) monitoring during anti-TNF therapy, and (5) management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

RPP-PRT-58489, Revision 1, One Systems Consistent Safety Analysis Methodologies Report. 24590-WTP-RPT-MGT-15-014

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gupta, Mukesh; Niemi, Belinda; Paik, Ingle

2015-09-02

In 2012, One System Nuclear Safety performed a comparison of the safety bases for the Tank Farms Operations Contractor (TOC) and Hanford Tank Waste Treatment and Immobilization Plant (WTP) (RPP-RPT-53222 / 24590-WTP-RPT-MGT-12-018, “One System Report of Comparative Evaluation of Safety Bases for Hanford Waste Treatment and Immobilization Plant Project and Tank Operations Contract”), and identified 25 recommendations that required further evaluation for consensus disposition. This report documents ten NSSC approved consistent methodologies and guides and the results of the additional evaluation process using a new set of evaluation criteria developed for the evaluation of the new methodologies.

Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion.

PubMed

Paruthi, Shalini; Brooks, Lee J; D'Ambrosio, Carolyn; Hall, Wendy A; Kotagal, Suresh; Lloyd, Robin M; Malow, Beth A; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F; Rosen, Carol L; Troester, Matthew M; Wise, Merrill S

2016-11-15

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. A commentary on this article apears in this issue on page 1439. © 2016 American Academy of Sleep Medicine

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

PubMed

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Engagement and Education

PubMed Central

Tosh, Pritish K.; Hick, John L.; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M.; Shah, Umair A.; Fagbuyi, Daniel B.; Skippen, Peter; Dichter, Jeffrey R.; Kissoon, Niranjan; Christian, Michael D.; Upperman, Jeffrey S.; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

2014-01-01

BACKGROUND: Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS: The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians. PMID:25144161

The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology.

PubMed

Migliore, Alberto; Scirè, Carlo Alberto; Carmona, Loreto; Herrero-Beaumont, Gabriel; Bizzi, Emanuele; Branco, Jaime; Carrara, Greta; Chevalier, Xavier; Collaku, Ledio; Aslanidis, Spiros; Denisov, Lev; Di Matteo, Luigi; Bianchi, Gerolamo; Diracoglu, Demirhan; Frediani, Bruno; Maheu, Emmanuel; Martusevich, Natalia; Bagnato, Gian Filippo; Scarpellini, Magda; Minisola, Giovanni; Akkoc, Nurullah; Ramonda, Roberta; Barskova, Tatiana; Babic-Naglic, Durda; Muelas, Jose Vicente Moreno; Ionescu, Ruxandra; Rashkov, Rasho; Damjanov, Nemanja; Cerinic, Marco Matucci

2017-08-01

The aim of this study was to establish consensus for potential early symptomatic knee osteoarthritis (ESKOA) clinical definition and referral criteria from primary care to rheumatologists, based on available data from literature and a qualitative approach, in order to perform studies on patients fulfilling such criteria and to validate the obtained ESKOA definition. A complex methodological approach was followed including: (1) three focus groups (FG), including expert clinicians, researchers and patients; (2) a systematic literature review (SLR); (3) two discussion groups followed by a Delphi survey. FG and SLR were performed in parallel to inform discussion groups in order to identify relevant constructs to be included in the modified Delphi survey. ESKOA is defined in the presence of: (a) two mandatory symptoms (knee pain in the absence of any recent trauma or injury and very short joint stiffness, lasting for less than 10 min, when starting movement) even in the absence of risk factors, or (b) knee pain, and 1 or 2 risk factors or (c) three or more risk factors in the presence of at least one mandatory symptom, with symptoms lasting less than 6 months. These criteria are applicable in the absence of active inflammatory arthritis, generalized pain, Kellgren-Lawrence grade >0, any recent knee trauma or injury, and age lower than 40 years. Knee pain in the absence of any recent trauma lasting for less than 6 months was considered as the referral criterion to the rheumatologist for the suspicion of ESKOA. This consensus process has identified provisional clinical definition of ESKOA and defined potential referral criterion to rheumatologist, in order to test ESKOA obtained definition in prospective validation studies.

A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM).

PubMed

González, A; Lluch, A; Aba, E; Albanell, J; Antón, A; Álvarez, I; Ayala, F; Barnadas, A; Calvo, L; Ciruelos, E; Cortés, J; de la Haba, J; López-Vega, J M; Martínez, E; Muñoz, M; Peláez, I; Redondo, A; Rodríguez, Á; Rodríguez, C A; Ruíz, A; Llombart, A

2017-05-01

To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.

ACR Appropriateness Criteria®  Resectable Rectal Cancer

PubMed Central

2012-01-01

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23006527

Developing a Canadian Curriculum for Simulation-Based Education in Obstetrics and Gynaecology: A Delphi Study.

PubMed

Craig, Catherine; Posner, Glenn D

2017-09-01

As obstetrics and gynaecology (Ob/Gyn) residency training programs move towards a competence-based approach to training and assessment, the development of a national standardized simulation curriculum is essential. The primary goal of this study was to define the fundamental content for the Canadian Obstetrics and Gynecology Simulation curriculum. A modified Delphi technique was used to achieve consensus in three rounds by surveying residency program directors or their local simulation educator delegates in 16 accredited Canadian Ob/Gyn residency programs. A consensus rate of 80% was agreed upon. Survey results were collected over 11 months in 2016. Response rates for the Delphi were 50% for the first round, 81% for the second round, and 94% for the third round. The first survey resulted in 84 suggested topics. These were organized into four categories: obstetrics high acuity low frequency events, obstetrics common events, gynaecology high acuity low frequency events, and gynaecology common events. Using the modified Delphi method, consensus was reached on 6 scenarios. This study identified the content for a national simulation-based curriculum for Ob/Gyn residency training programs and is the first step in the development of this curriculum. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique

PubMed Central

Masud, Tahir; Blundell, Adrian; Gordon, Adam Lee; Mulpeter, Ken; Roller, Regina; Singler, Katrin; Goeldlin, Adrian; Stuck, Andreas

2014-01-01

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe. PMID:24603283

Planning the content of a brief educational course in maxillofacial emergencies for staff in accident and emergency departments: a modified Delphi study.

PubMed

Elledge, Ross O C; McAleer, Sean

2015-02-01

It is well known that staff in accident and emergency (A&E) departments lack the knowledge and confidence needed to deal with maxillofacial emergencies, and that it is related to limited education at undergraduate and postgraduate levels. We therefore aimed to design a syllabus for a short course to educate staff about the most common emergencies. To find out which learning outcomes should be included and to reach a consensus, we did a 3-stage modified Delphi study of the opinions of members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Of a possible 890 members, 188 responded (21%) in the second round and 105 in the third (12%). Eighteen (37%) of the 49 proposed learning outcomes were rated very important and all of them were retained in the syllabus after the third round. Thirty (61%) items were retained with a consensus of 51% or above in the final round. The Delphi technique is a useful addition to the armamentarium of those involved in education, and has been used effectively in syllabus design. We achieved good consensus on the items to be included and the syllabus will be piloted locally. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel

PubMed Central

Sudore, Rebecca L.; Lum, Hillary D.; You, John J.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Matlock, Daniel D.; Rietjens, Judith A. C.; Korfage, Ida J.; Ritchie, Christine S.; Kutner, Jean S.; Teno, Joan M.; Thomas, Judy; McMahan, Ryan D.; Heyland, Daren K.

2017-01-01

Background Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. Objective To develop a consensus definition of ACP for adults. Design Delphi Panel Setting/Participants Participants included a multidisciplinary panel of international ACP experts consisting of 52 clinicians, researchers, and policy leaders from 4 countries, and a patient/surrogate advisory committee. Measurements We conducted 10 rounds of a modified Delphi method and qualitatively analyzed panelists’ input. Panelists identified several themes lacking consensus, and iteratively discussed and developed a final consensus definition. Results Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients’ values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: “Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” The panel also described strategies to best support adults in ACP. Conclusions A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. PMID:28062339

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.].

PubMed

Medrano López, C; García-Guereta, L; Fernández Pineda, L; Malo Concepción, P; Maroto Alvaro, E; Santos de Soto, J; Lirio Casero, J; Suárez Cabrera, P; Caballero Martínez, F

2010-06-01

Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review. Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.

PubMed

Sudore, Rebecca L; Lum, Hillary D; You, John J; Hanson, Laura C; Meier, Diane E; Pantilat, Steven Z; Matlock, Daniel D; Rietjens, Judith A C; Korfage, Ida J; Ritchie, Christine S; Kutner, Jean S; Teno, Joan M; Thomas, Judy; McMahan, Ryan D; Heyland, Daren K

2017-05-01

Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. The aim of this study was to develop a consensus definition of ACP for adults. We convened a Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee. We conducted 10 rounds using a modified Delphi method and qualitatively analyzed panelists' input. Panelists identified several themes lacking consensus and iteratively discussed and developed a final consensus definition. Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients' values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: "Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness." The panel also described strategies to best support adults in ACP. A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. Published by Elsevier Inc.

Expert consensus v. evidence-based approaches in the revision of the DSM.

PubMed

Kendler, K S; Solomon, M

2016-08-01

The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions - which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process - should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

N-Glycopeptide Profiling in Arabidopsis Inflorescence

DOE PAGES

Xu, Shou-Ling; Medzihradszky, Katalin F.; Wang, Zhi-Yong; ...

2016-04-11

This study presents the first large scale analysis of plant intact glycopeptides. Using wheat germ agglutinin lectin weak affinity chromatography to enrich modified peptides, followed by ETD fragmentation tandem mass spectrometry, glycan compositions on over 1100 glycopeptides from 270 proteins found in Arabidopsis inflorescence tissue were characterized. While some sites were only detected with a single glycan attached, others displayed up to 16 different glycoforms. Among the identified glycopeptides were four modified in non-consensus glycosylation motifs. Finally, while most of the modified proteins are secreted, membrane, ER or Golgi localized proteins, surprisingly N-linked sugars were detected on a protein predictedmore » to be cytosolic or nuclear.« less

PDSM, a motif for phosphorylation-dependent SUMO modification

PubMed Central

Hietakangas, Ville; Anckar, Julius; Blomster, Henri A.; Fujimoto, Mitsuaki; Palvimo, Jorma J.; Nakai, Akira; Sistonen, Lea

2006-01-01

SUMO (small ubiquitin-like modifier) modification regulates many cellular processes, including transcription. Although sumoylation often occurs on specific lysines within the consensus tetrapeptide ΨKxE, other modifications, such as phosphorylation, may regulate the sumoylation of a substrate. We have discovered PDSM (phosphorylation-dependent sumoylation motif), composed of a SUMO consensus site and an adjacent proline-directed phosphorylation site (ΨKxExxSP). The highly conserved motif regulates phosphorylation-dependent sumoylation of multiple substrates, such as heat-shock factors (HSFs), GATA-1, and myocyte enhancer factor 2. In fact, the majority of the PDSM-containing proteins are transcriptional regulators. Within the HSF family, PDSM is conserved between two functionally distinct members, HSF1 and HSF4b, whose transactivation capacities are repressed through the phosphorylation-dependent sumoylation. As the first recurrent sumoylation determinant beyond the consensus tetrapeptide, the PDSM provides a valuable tool in predicting new SUMO substrates. PMID:16371476

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. SLEEP 2015;38(6):843–844. PMID:26039963

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11(6):591–592. PMID:25979105

Boltzmann-type control of opinion consensus through leaders

PubMed Central

Albi, G.; Pareschi, L.; Zanella, M.

2014-01-01

The study of formations and dynamics of opinions leading to the so-called opinion consensus is one of the most important areas in mathematical modelling of social sciences. Following the Boltzmann-type control approach recently introduced by the first two authors, we consider a group of opinion leaders who modify their strategy accordingly to an objective functional with the aim of achieving opinion consensus. The main feature of the Boltzmann-type control is that, owing to an instantaneous binary control formulation, it permits the minimization of the cost functional to be embedded into the microscopic leaders’ interactions of the corresponding Boltzmann equation. The related Fokker–Planck asymptotic limits are also derived, which allow one to give explicit expressions of stationary solutions. The results demonstrate the validity of the Boltzmann-type control approach and the capability of the leaders’ control to strategically lead the followers’ opinion. PMID:25288820

Distributed attitude synchronization of formation flying via consensus-based virtual structure

NASA Astrophysics Data System (ADS)

Cong, Bing-Long; Liu, Xiang-Dong; Chen, Zhen

2011-06-01

This paper presents a general framework for synchronized multiple spacecraft rotations via consensus-based virtual structure. In this framework, attitude control systems for formation spacecrafts and virtual structure are designed separately. Both parametric uncertainty and external disturbance are taken into account. A time-varying sliding mode control (TVSMC) algorithm is designed to improve the robustness of the actual attitude control system. As for the virtual attitude control system, a behavioral consensus algorithm is presented to accomplish the attitude maneuver of the entire formation and guarantee a consistent attitude among the local virtual structure counterparts during the attitude maneuver. A multiple virtual sub-structures (MVSSs) system is introduced to enhance current virtual structure scheme when large amounts of spacecrafts are involved in the formation. The attitude of spacecraft is represented by modified Rodrigues parameter (MRP) for its non-redundancy. Finally, a numerical simulation with three synchronization situations is employed to illustrate the effectiveness of the proposed strategy.

Management of intrathecal baclofen therapy for severe acquired brain injury: consensus and recommendations for good clinical practice.

PubMed

De Tanti, Antonio; Scarponi, Federico; Bertoni, Michele; Gasperini, Giulio; Lanzillo, Bernardo; Molteni, Franco; Posteraro, Federico; Vitale, Dino Francesco; Zanpolini, Mauro

2017-08-01

Although widespread in the treatment of generalised spasticity due to severe acquired brain injury, clinical use of intrathecal baclofen administered through an implanted catheter is not yet supported by full scientific evidence. The aim of the study is to provide recommendations for good clinical practice regarding intrathecal baclofen therapy. We used a modified RAND Delphi method to develop consensus-based medical guidelines, involving clinicians who use intrathecal baclofen therapy throughout Italy. The clinicians were asked 38 questions grouped in six areas (patient selection, contraindications for implant, tests prior to implant, method of implant and management of therapy, efficacy evaluation and goal setting, and management of complications). To establish consensus, 75% agreement was required in answers to every question. Consensus was reached on the second round of the Delphi process on 27/38 questions (71%), specifically those regarding identification of objectives, efficacy evaluation, and method of implant and management of therapy, whereas management of complications and contraindications for implant remained critical areas. Despite the limits of our method, a set of recommendations was drawn up for clinical practice in this sector. The study also revealed residual critical areas and indicated future lines of research necessary to reach evidence-based consensus.

ACUTE DIALYSIS QUALITY INITIATIVE (ADQI) XIV SEPSIS PHENOTYPES AND TARGETS FOR BLOOD PURIFICATION IN SEPSIS: THE BOGOTÁ CONSENSUS.

PubMed

Kellum, John A; Gómez, Hernando; Gómez, Alonso; Murray, Patrick; Ronco, Claudio

2016-03-01

Despite widespread use, there is currently no consensus on how extracorporeal blood purification therapies should be applied or studied in patients with sepsis. One major obstacle has been the lack of clear descriptions of specific sepsis phenotypes tied to mechanisms that would permit the identification of molecular targets. Current evidence suggests that sepsis-related morbidity and mortality involve widely different clinical phenotypes that variably include mitochondrial dysfunction, abnormalities of vascular biology including endothelial dysfunction and coagulopathy, epithelial dysfunction, and immune suppression and dysregulation. While most cases of sepsis involve some element of all of these pathobiologic processes, the magnitude of each varies greatly from patient to patient in part as a result of the pathogen and in part related to host-specific factors. Thus, the purpose of the fourteenth international consensus conference of acute dialysis quality initiative was to develop consensus for a conceptual model of sepsis-induced organ failure that can be treated by extracorporeal blood purification and possibly also with drugs or other therapies. We assembled a group of experts from around the world and used a modified Delphi method to reach consensus. Specific findings and recommendations for future research are provided in the four accompanying papers.

Anthropology of fire in the Ozark Highland region

Treesearch

David H. Jurney

2012-01-01

Native Americans are often considered to have exploited available natural resources rather than modifying their environments to maximize yields. As simpler societies evolved into more complex ones, there is a consensus that intensification of habitat modifications also increased. However, landscape scale archeological inventories now show relatively intensive...

Treating Illiteracy in the High Desert of California: A Psychological Approach.

ERIC Educational Resources Information Center

Henderson, Joe L.

The United States lacks uniform popular definitions of "literacy," remediations, or consensus for national standards. Factors beyond the control of educational and political structures continually modify and dominate discussions of illiteracy and strategies of remediation. In most advanced cultures, alienation and functional illiteracy…

[Recommendations in neonatal resuscitation].

PubMed

2004-01-01

The recommendations for neonatal resuscitation are not always based on sufficient scientific evidence and thus expert consensus based on current research, knowledge, and experience are useful for formulating practical protocols that are easy to follow. The latest recommendations, in 2000, modified previously published recommendations and are included in the present text.

Identifying Critical Issues and Problems in Technology Education Using a Modified-Delphi Technique.

ERIC Educational Resources Information Center

Wicklein, Robert C.

1993-01-01

Critical issues for technology education (TE) identified by a 25-member Delphi panel were identification of the knowledge base, curriculum development approaches, interdisciplinary approaches, and teacher education reform. Problems identified included inadequate marketing/public relations, teacher shortage, lack of content consensus, and…

[Principles for the evaluation of telemedicine applications: Results of a systematic review and consensus process].

PubMed

Arnold, Katrin; Scheibe, Madlen; Müller, Olaf; Schmitt, Jochen

2016-11-01

The limited number of telemedicine applications being transferred to standard medical care in Germany may to some extent be explained by deficits in the current evaluation practice. Effectiveness and cost effectiveness can only be demonstrated to decision makers and potential users with methodologically sound and fully published evaluations. There is a lack of well-founded and mandatory standards for adequate, comparable evaluations of telemedicine applications. As part of the project CCS Telehealth Eastern Saxony (CCS THOS), a systematic review on evaluation concepts for telemedicine applications (search period until September 2014, databases Medline, Embase, HTA-Database, DARE, NHS EED) as well as an additional selective literature search were conducted. Suggestions for evaluation fundamentals were derived from the results. These suggestions were subjected to a formal consensus process (nominal group process) with relevant stakeholder groups (healthcare payers, healthcare providers, health policy representatives, researchers). 19 papers were included in the systematic review. In accordance with the predefined inclusion criteria, each presented an evaluation concept for telemedicine applications that was based upon a systematic review and/or a consensus process. Via a formal consensus process, the suggestions for evaluation principles derived from the review and the selective literature search (23 papers) resulted in ten agreed evaluation principles. Eight of them were unanimously agreed upon, two were arrived at with one abstention each. The principles enclose criteria for the planning, conduct and reporting of telemedicine evaluations. Adherence to them is obligatory for users of the telemedical infrastructure provided by CCS THOS. Furthermore, right from the beginning the intention was very much for these principles to be seized upon by other projects and initiatives. The agreed evaluation principles for telemedicine applications are the first in Germany to be based both upon evidence and consensus. Due to the methodology of development, they have a strong scientific and health policy legitimation. Therefore, and because of their general applicability, adherence to these principles beyond the context of the telemedicine platform developed within CCS THOS is recommended, namely throughout the German telemedicine scene. Copyright © 2016. Published by Elsevier GmbH.

Moving Forward Through Consensus: A Modified Delphi Approach to Determine the Top Research Priorities in Orthopaedic Oncology.

PubMed

Schneider, Patricia Jacqueline; Evaniew, Nathan; McKay, Paula; Ghert, Michelle

2017-12-01

Several challenges presently impede the conduct of prospective clinical studies in orthopaedic oncology, including limited financial resources to support their associated costs and inadequate patient volume at most single institutions. This study was conducted to prioritize research questions within the field so that the Musculoskeletal Tumor Society (MSTS), and other relevant professional societies, can direct the limited human and fiscal resources available to address the priorities that the stakeholders involved believe will have the most meaningful impact on orthopaedic oncology patient care. The purpose of this study was to use a formal consensus-based approach involving clinician-scientists and other stakeholders to identify the top priority research questions for future international prospective clinical studies in orthopaedic oncology. A three-step modified Delphi process involving multiple stakeholder groups (including orthopaedic oncologists, research personnel, funding agency representation, and patient representation) was conducted. First, we sent an electronic questionnaire to all participants to solicit clinically relevant research questions (61 participants; 54% of the original 114 individuals invited to participate returned the questionnaires). Then, participants rated the candidate research questions using a 5-point Likert scale for five criteria (60 participants; 53% of the original group participated in this portion of the process). Research questions that met a priori consensus thresholds progressed for consideration to an in-person consensus meeting, which was attended by 44 participants (39% of the original group; 12 countries were represented at this meeting). After the consensus panel's discussion, members individually assigned scores to each question using a 9-point Likert scale. Research questions that met preset criteria advanced to final ranking, and panel members individually ranked their top three priority research questions, resulting in a final overall ranking of research priorities. A total of 73 candidate research questions advanced to the consensus meeting. In the end, the consensus panel identified four research priorities: (1) Does less intensive surveillance of patients with sarcoma affect survival? (2) What are the survival outcomes over time for orthopaedic oncology implants? (3) Does resection versus stabilization improve oncologic and functional outcomes in oligometastatic bone disease? (4) What is the natural history of untreated fibromatosis? The results of this study will assist in developing a long-term research strategy for the MSTS and, possibly, the orthopaedic oncology field as a whole. Furthermore, the results of this study can assist researchers in guiding their research efforts and in providing a justified rationale to funding agencies when requesting the resources necessary to support future collaborative research studies that address the identified orthopaedic oncology priorities.

Core outcome measurement instruments for clinical trials in nonspecific low back pain

PubMed Central

Chiarotto, Alessandro; Boers, Maarten; Deyo, Richard A.; Buchbinder, Rachelle; Corbin, Terry P.; Costa, Leonardo O.P.; Foster, Nadine E.; Grotle, Margreth; Koes, Bart W.; Kovacs, Francisco M.; Lin, C.-W. Christine; Maher, Chris G.; Pearson, Adam M.; Peul, Wilco C.; Schoene, Mark L.; Turk, Dennis C.; van Tulder, Maurits W.; Terwee, Caroline B.; Ostelo, Raymond W.

2018-01-01

Abstract To standardize outcome reporting in clinical trials of patients with nonspecific low back pain, an international multidisciplinary panel recommended physical functioning, pain intensity, and health-related quality of life (HRQoL) as core outcome domains. Given the lack of a consensus on measurement instruments for these 3 domains in patients with low back pain, this study aimed to generate such consensus. The measurement properties of 17 patient-reported outcome measures for physical functioning, 3 for pain intensity, and 5 for HRQoL were appraised in 3 systematic reviews following the COSMIN methodology. Researchers, clinicians, and patients (n = 207) were invited in a 2-round Delphi survey to generate consensus (≥67% agreement among participants) on which instruments to endorse. Response rates were 44% and 41%, respectively. In round 1, consensus was achieved on the Oswestry Disability Index version 2.1a for physical functioning (78% agreement) and the Numeric Rating Scale (NRS) for pain intensity (75% agreement). No consensus was achieved on any HRQoL instrument, although the Short Form 12 (SF12) approached the consensus threshold (64% agreement). In round 2, a consensus was reached on an NRS version with a 1-week recall period (96% agreement). Various participants requested 1 free-to-use instrument per domain. Considering all issues together, recommendations on core instruments were formulated: Oswestry Disability Index version 2.1a or 24-item Roland-Morris Disability Questionnaire for physical functioning, NRS for pain intensity, and SF12 or 10-item PROMIS Global Health form for HRQoL. Further studies need to fill the evidence gaps on the measurement properties of these and other instruments. PMID:29194127

Developing guidelines for return to play: consensus and evidence-based approaches.

PubMed

Echemendia, Ruben J; Giza, Christopher C; Kutcher, Jeffrey S

2015-01-01

Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process. The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers' Association, and the 2013 Team Physician Consensus Statement Update. An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research. The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements.

Utilization and Harmonization of Adult Accelerometry Data: Review and Expert Consensus.

PubMed

Wijndaele, Katrien; Westgate, Kate; Stephens, Samantha K; Blair, Steven N; Bull, Fiona C; Chastin, Sebastien F M; Dunstan, David W; Ekelund, Ulf; Esliger, Dale W; Freedson, Patty S; Granat, Malcolm H; Matthews, Charles E; Owen, Neville; Rowlands, Alex V; Sherar, Lauren B; Tremblay, Mark S; Troiano, Richard P; Brage, Søren; Healy, Genevieve N

2015-10-01

This study aimed to describe the scope of accelerometry data collected internationally in adults and to obtain a consensus from measurement experts regarding the optimal strategies to harmonize international accelerometry data. In March 2014, a comprehensive review was undertaken to identify studies that collected accelerometry data in adults (sample size, n ≥ 400). In addition, 20 physical activity experts were invited to participate in a two-phase Delphi process to obtain consensus on the following: unique research opportunities available with such data, additional data required to address these opportunities, strategies for enabling comparisons between studies/countries, requirements for implementing/progressing such strategies, and value of a global repository of accelerometry data. The review identified accelerometry data from more than 275,000 adults from 76 studies across 36 countries. Consensus was achieved after two rounds of the Delphi process; 18 experts participated in one or both rounds. The key opportunities highlighted were the ability for cross-country/cross-population comparisons and the analytic options available with the larger heterogeneity and greater statistical power. Basic sociodemographic and anthropometric data were considered a prerequisite for this. Disclosure of monitor specifications and protocols for data collection and processing were deemed essential to enable comparison and data harmonization. There was strong consensus that standardization of data collection, processing, and analytical procedures was needed. To implement these strategies, communication and consensus among researchers, development of an online infrastructure, and methodological comparison work were required. There was consensus that a global accelerometry data repository would be beneficial and worthwhile. This foundational resource can lead to implementation of key priority areas and identification of future directions in physical activity epidemiology, population monitoring, and burden of disease estimates.

Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia.

PubMed

Keefe, Richard S E; Haig, George M; Marder, Stephen R; Harvey, Philip D; Dunayevich, Eduardo; Medalia, Alice; Davidson, Michael; Lombardo, Ilise; Bowie, Christopher R; Buchanan, Robert W; Bugarski-Kirola, Dragana; Carpenter, William T; Csernansky, John T; Dago, Pedro L; Durand, Dante M; Frese, Frederick J; Goff, Donald C; Gold, James M; Hooker, Christine I; Kopelowicz, Alex; Loebel, Antony; McGurk, Susan R; Opler, Lewis A; Pinkham, Amy E; Stern, Robert G

2016-01-01

If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process.

PubMed

Marino, Luise V; Johnson, Mark J; Hall, Nigel J; Davies, Natalie J; Kidd, Catherine S; Daniels, M Lowri; Robinson, Julia E; Richens, Trevor; Bharucha, Tara; Darlington, Anne-Sophie E

2018-04-29

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Bibliometric Evidence for a Hierarchy of the Sciences.

PubMed

Fanelli, Daniele; Glänzel, Wolfgang

2013-01-01

The hypothesis of a Hierarchy of the Sciences, first formulated in the 19(th) century, predicts that, moving from simple and general phenomena (e.g. particle dynamics) to complex and particular (e.g. human behaviour), researchers lose ability to reach theoretical and methodological consensus. This hypothesis places each field of research along a continuum of complexity and "softness", with profound implications for our understanding of scientific knowledge. Today, however, the idea is still unproven and philosophically overlooked, too often confused with simplistic dichotomies that contrast natural and social sciences, or science and the humanities. Empirical tests of the hypothesis have usually compared few fields and this, combined with other limitations, makes their results contradictory and inconclusive. We verified whether discipline characteristics reflect a hierarchy, a dichotomy or neither, by sampling nearly 29,000 papers published contemporaneously in 12 disciplines and measuring a set of parameters hypothesised to reflect theoretical and methodological consensus. The biological sciences had in most cases intermediate values between the physical and the social, with bio-molecular disciplines appearing harder than zoology, botany or ecology. In multivariable analyses, most of these parameters were independent predictors of the hierarchy, even when mathematics and the humanities were included. These results support a "gradualist" view of scientific knowledge, suggesting that the Hierarchy of the Sciences provides the best rational framework to understand disciplines' diversity. A deeper grasp of the relationship between subject matter's complexity and consensus could have profound implications for how we interpret, publish, popularize and administer scientific research.

Tooth wear and erosion: methodological issues in epidemiological and public health research and the future research agenda.

PubMed

Ganss, C; Young, A; Lussi, A

2011-09-01

This paper addresses methodological issues in the field of tooth wear and erosion research including the epidemiological indices, and identifies future work that is needed to improve knowledge about tooth wear and erosion. The paper is result of the work done at the meetings of the Special Interest Group "Tooth Surface Loss and Erosion" at the 2008, 2009 and 2010 conferences of the European Association for Dental Public Health, and the Workshop "Current Erosion indices- flawed or valid" which took place in Basel in 2007. Although there is consensus about the definition and the diagnostic criteria of various forms of tooth wear, gaps in research strategies have been identified. A basic problem is that fundamental concepts of wear and erosion as an oral health problem, have not yet been sufficiently defined. To a certain extent, tooth wear is a physiological condition, and there is no consensus as to whether it can be regarded as a disease. Furthermore, the multitude of indices and flaws in existing indices, make published data difficult to interpret. Topics for the research agenda are: the initiation of a consensus process towards an internationally accepted index, and the initiation of data collection on the prevalence of various forms of wear on a population-based level. There should be an emphasis on promoting communication between basic and clinical sciences, and the area of Public Health Dentistry. Furthermore, the question of whether tooth wear is a public health problem remains open for debate.

Methodological Controversies in the Treatment of Panic Disorder.

ERIC Educational Resources Information Center

McNally, Richard J.

1996-01-01

Although the National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder endorsed the effectiveness of cognitive-behavior therapy (CBT), D. F. Klein argues that fatal flaws in all but one CBT study undermine claims about the effectiveness of CBT for panic disorder. This article critiques Klein's arguments and…

Challenges in Higher Education Research: The Use of Quantitative Tools in Comparative Analyses

ERIC Educational Resources Information Center

Reale, Emanuela

2014-01-01

Despite the value of the comparative perspective for the study of higher education is widely recognised, there is little consensus about the specific methodological approaches. Quantitative tools outlined their relevance for addressing comparative analyses since they are supposed to reducing the complexity, finding out and graduating similarities…

Using the Delphi Technique to Support Curriculum Development

ERIC Educational Resources Information Center

Sitlington, Helen Barbara; Coetzer, Alan John

2015-01-01

Purpose: The purpose of this paper is to present an analysis of the use of the Delphi technique to support curriculum development with a view to enhancing existing literature on use of the technique for renewal of business course curricula. Design/methodology/approach: The authors outline the Delphi process for obtaining consensus amongst a…

Surface Electromyography for Speech and Swallowing Systems: Measurement, Analysis, and Interpretation

ERIC Educational Resources Information Center

Stepp, Cara E.

2012-01-01

Purpose: Applying surface electromyography (sEMG) to the study of voice, speech, and swallowing is becoming increasingly popular. An improved understanding of sEMG and building a consensus as to appropriate methodology will improve future research and clinical applications. Method: An updated review of the theory behind recording sEMG for the…

A Critical Look at Methodologies Used to Evaluate Charter School Effectiveness

ERIC Educational Resources Information Center

Ackerman, Matthew; Egalite, Anna J.

2017-01-01

There is no consensus among researchers on charter school effectiveness in the USA, in part because of discrepancies in the research methods employed across various studies. Causal impact estimates from experimental studies demonstrate large positive impacts, but concerns about the generalizability of these results have prompted the development of…

Profiling Students for Remediation Using Latent Class Analysis

ERIC Educational Resources Information Center

Boscardin, Christy K.

2012-01-01

While clinical exams using SPs are used extensively across the medical schools for summative purposes and high-stakes decisions, the method of identifying students for remediation varies widely and there is a lack of consensus on the best methodological approach. The purpose of this study is to provide an alternative approach to identification of…

Combining analytical hierarchy process and agglomerative hierarchical clustering in search of expert consensus in green corridors development management.

PubMed

Shapira, Aviad; Shoshany, Maxim; Nir-Goldenberg, Sigal

2013-07-01

Environmental management and planning are instrumental in resolving conflicts arising between societal needs for economic development on the one hand and for open green landscapes on the other hand. Allocating green corridors between fragmented core green areas may provide a partial solution to these conflicts. Decisions regarding green corridor development require the assessment of alternative allocations based on multiple criteria evaluations. Analytical Hierarchy Process provides a methodology for both a structured and consistent extraction of such evaluations and for the search for consensus among experts regarding weights assigned to the different criteria. Implementing this methodology using 15 Israeli experts-landscape architects, regional planners, and geographers-revealed inherent differences in expert opinions in this field beyond professional divisions. The use of Agglomerative Hierarchical Clustering allowed to identify clusters representing common decisions regarding criterion weights. Aggregating the evaluations of these clusters revealed an important dichotomy between a pragmatist approach that emphasizes the weight of statutory criteria and an ecological approach that emphasizes the role of the natural conditions in allocating green landscape corridors.

Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1).

PubMed

Mañós, M; Giralt, J; Rueda, A; Cabrera, J; Martinez-Trufero, J; Marruecos, J; Lopez-Pousa, A; Rodrigo, J P; Castelo, B; Martínez-Galán, J; Arias, F; Chaves, M; Herranz, J J; Arrazubi, V; Baste, N; Castro, A; Mesía, R

2017-07-01

Head and neck cancer is one of the most frequent malignances worldwide. Despite the site-specific multimodality therapy, up to half of the patients will develop recurrence. Treatment selection based on a multidisciplinary tumor board represents the cornerstone of head and neck cancer, as it is essential for achieving the best results, not only in terms of outcome, but also in terms of organ-function preservation and quality of life. Evidence-based international and national clinical practice guidelines for head and neck cancer not always provide answers in terms of decision-making that specialists must deal with in their daily practice. This is the first Expert Consensus on the Multidisciplinary Approach for Head and Neck Squamous Cell Carcinoma (HNSCC) elaborated by the Spanish Society for Head and Neck Cancer and based on a Delphi methodology. It offers several specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved. Copyright © 2017. Published by Elsevier Ltd.

Combining Analytical Hierarchy Process and Agglomerative Hierarchical Clustering in Search of Expert Consensus in Green Corridors Development Management

NASA Astrophysics Data System (ADS)

Shapira, Aviad; Shoshany, Maxim; Nir-Goldenberg, Sigal

2013-07-01

Environmental management and planning are instrumental in resolving conflicts arising between societal needs for economic development on the one hand and for open green landscapes on the other hand. Allocating green corridors between fragmented core green areas may provide a partial solution to these conflicts. Decisions regarding green corridor development require the assessment of alternative allocations based on multiple criteria evaluations. Analytical Hierarchy Process provides a methodology for both a structured and consistent extraction of such evaluations and for the search for consensus among experts regarding weights assigned to the different criteria. Implementing this methodology using 15 Israeli experts—landscape architects, regional planners, and geographers—revealed inherent differences in expert opinions in this field beyond professional divisions. The use of Agglomerative Hierarchical Clustering allowed to identify clusters representing common decisions regarding criterion weights. Aggregating the evaluations of these clusters revealed an important dichotomy between a pragmatist approach that emphasizes the weight of statutory criteria and an ecological approach that emphasizes the role of the natural conditions in allocating green landscape corridors.

Priority target conditions for algorithms for monitoring children's growth: Interdisciplinary consensus.

PubMed

Scherdel, Pauline; Reynaud, Rachel; Pietrement, Christine; Salaün, Jean-François; Bellaïche, Marc; Arnould, Michel; Chevallier, Bertrand; Piloquet, Hugues; Jobez, Emmanuel; Cheymol, Jacques; Bichara, Emmanuelle; Heude, Barbara; Chalumeau, Martin

2017-01-01

Growth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization. To obtain a consensus about the priority target conditions for algorithms monitoring children's growth. We applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating), with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists) as well as parent associations. We asked experts in the pilot (n = 11), reading (n = 8) and rating (n = 60) groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition. Strong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement). This national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.

Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program.

PubMed

Riddell, Michaela A; Edwards, Nancy; Thompson, Simon R; Bernabe-Ortiz, Antonio; Praveen, Devarsetty; Johnson, Claire; Kengne, Andre P; Liu, Peter; McCready, Tara; Ng, Eleanor; Nieuwlaat, Robby; Ovbiagele, Bruce; Owolabi, Mayowa; Peiris, David; Thrift, Amanda G; Tobe, Sheldon; Yusoff, Khalid

2017-03-15

The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams' data collection plans. One year later all teams were asked which consensus measures had been implemented. Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.

A modified reverse one-hybrid screen identifies transcriptional activation in Phyochrome-Interacting Factor 3

USDA-ARS?s Scientific Manuscript database

Transcriptional activation domains (TAD) are difficult to predict and identify, since they are not conserved and have little consensus. Here, we describe a yeast-based screening method that is able to identify individual amino acid residues involved in transcriptional activation in a high throughput...

Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness.

PubMed

Hawk, Cheryl; Schneider, Michael; Evans, Marion Willard; Redwood, Daniel

2012-09-01

The purposes of this project were to develop consensus definitions for a set of best practices that doctors of chiropractic may use for promoting health and wellness and preventing disease and to describe the appropriate components and procedures for these practices. A multidisciplinary steering committee of 10 health care professionals developed seed statements based on their clinical experience and relevant literature. A Delphi consensus process was conducted from January to July 2011, following the RAND methodology. Consensus was reached when at least 80% of the panelists were in agreement. There were 44 Delphi panelists (36 doctors of chiropractic, 6 doctors of philosophy, 1 doctor of naturopathy, 1 registered nurse). The statements developed defined the terms and practices for chiropractic care to promote health and wellness and prevent disease. This document describes the procedures and features of wellness care that represent a reasonable approach to wellness care and disease prevention in chiropractic clinical practice. This living document provides a general framework for an evidence-based approach to chiropractic wellness care. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

S3 Guideline for the treatment of psoriasis vulgaris, update - Short version part 1 - Systemic treatment.

PubMed

Nast, Alexander; Amelunxen, Lasse; Augustin, Matthias; Boehncke, Wolf-Henning; Dressler, Corinna; Gaskins, Matthew; Härle, Peter; Hoffstadt, Bernd; Klaus, Joachim; Koza, Joachim; Mrowietz, Ulrich; Ockenfels, Hans-Michael; Philipp, Sandra; Reich, Kristian; Rosenbach, Thomas; Rzany, Berthold; Schlaeger, Martin; Schmid-Ott, Gerhard; Sebastian, Michael; von Kiedrowski, Ralph; Weberschock, Tobias

2018-05-01

The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The first section of this short version of the guideline covers systemic treatment options considered relevant by the expert panel and approved in Germany at the time of the consensus conference (acitretin, adalimumab, apremilast, cyclosporine, etanercept, fumaric acid esters, infliximab, methotrexate, secukinumab and ustekinumab). Detailed information is provided on the management and monitoring of the included treatment options. © 2018 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

PubMed

Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

2016-01-01

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Methodology and reporting quality of reporting guidelines: systematic review.

PubMed

Wang, Xiaoqin; Chen, Yaolong; Yang, Nan; Deng, Wei; Wang, Qi; Li, Nan; Yao, Liang; Wei, Dang; Chen, Gen; Yang, Kehu

2015-09-22

With increasing attention put on the methodology of reporting guidelines, Moher et al. conducted a review of reporting guidelines up to December 2009. Information gaps appeared on many aspects. Therefore, in 2010, the Guidance for Developers of Health Research Reporting Guidelines was developed. With more than four years passed and a considerable investment was put into reporting guideline development, a large number of new, updated, and expanded reporting guidelines have become available since January 2010. We aimed to systematically review the reporting guidelines published since January 2010, and investigate the application of the Guidance. We systematically searched databases including the Cochrane Methodology Register, MEDLINE, and EMBASE, and retrieved EQUATOR and the website (if available) to find reporting guidelines as well as their accompanying documents. We screened the titles and abstracts resulting from searches and extracted data. We focused on the methodology and reporting of the included guidelines, and described information with a series of tables and narrative summaries. Data were summarized descriptively using frequencies, proportions, and medians as appropriate. Twenty-eight and 32 reporting guidelines were retrieved from databases and EQUATOR network, respectively. Reporting guidelines were designed for a broad spectrum of types of research. A considerable number of reporting guidelines were published and updated in recent years. Methods of initial items were given in 45 (75%) guidelines. Thirty-eight (63%) guidelines reported they have reached consensus, and 35 (58%) described their consensus methods. Only 9 (15%) guidelines followed the Guidance. Only few guidelines were developed complying with the Guidance. More attention should be paid to the quality of reporting guidelines.

A systematic review of mosquito coils and passive emanators: defining recommendations for spatial repellency testing methodologies.

PubMed

Ogoma, Sheila B; Moore, Sarah J; Maia, Marta F

2012-12-07

Mosquito coils, vaporizer mats and emanators confer protection against mosquito bites through the spatial action of emanated vapor or airborne pyrethroid particles. These products dominate the pest control market; therefore, it is vital to characterize mosquito responses elicited by the chemical actives and their potential for disease prevention. The aim of this review was to determine effects of mosquito coils and emanators on mosquito responses that reduce human-vector contact and to propose scientific consensus on terminologies and methodologies used for evaluation of product formats that could contain spatial chemical actives, including indoor residual spraying (IRS), long lasting insecticide treated nets (LLINs) and insecticide treated materials (ITMs). PubMed, (National Centre for Biotechnology Information (NCBI), U.S. National Library of Medicine, NIH), MEDLINE, LILAC, Cochrane library, IBECS and Armed Forces Pest Management Board Literature Retrieval System search engines were used to identify studies of pyrethroid based coils and emanators with key-words "Mosquito coils" "Mosquito emanators" and "Spatial repellents". It was concluded that there is need to improve statistical reporting of studies, and reach consensus in the methodologies and terminologies used through standardized testing guidelines. Despite differing evaluation methodologies, data showed that coils and emanators induce mortality, deterrence, repellency as well as reduce the ability of mosquitoes to feed on humans. Available data on efficacy outdoors, dose-response relationships and effective distance of coils and emanators is inadequate for developing a target product profile (TPP), which will be required for such chemicals before optimized implementation can occur for maximum benefits in disease control.

Clinical practice guidelines in breast cancer

PubMed Central

Tyagi, N. Kumar; Dhesy-Thind, S.

2018-01-01

Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability. Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor–positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario’s Program in Evidence Based Care (cco’s pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool. Results The quality of the cpgs was greatest for the guidelines developed by asco and cco’s pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory. Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations—such as intrinsic guideline characteristics and the needs of end users—is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.

Framework and components for effective discharge planning system: a delphi methodology

PubMed Central

2012-01-01

Background To reduce avoidable hospital readmissions, effective discharge planning and appropriate post discharge support care are key requirements. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. This paper reports on the methodology of Delphi approach and findings of the second stage on pre-testing the framework developed so as to validate and attest to its applicability and practicability in which consensus was sought on the key components of discharge planning. Methods Delphi methodology was adopted to engage a group of experienced healthcare professionals to rate and discuss the framework and components of an effective discharge planning. The framework was consisted 36 statements under 5 major themes: initial screening, discharge planning process, coordination of discharge, implementation of discharge, and post discharge follow-up. Each statement was rated independently based on 3 aspects including clarity, validity and applicability on a 5-point Likert-scale. Statement with 75% or above of participants scoring 4–5 on all 3 aspects would be included in the discharge planning framework. For those statements not reaching 75% of consensus in any one of the aspect, it would be revised or discarded following the group discussion, and be re-rated in another round. Results A total of 24 participants participated in the consensus-building process. In round one rating, consensus was achieved in 25 out of 36 statements. Among those 11 statements not reaching consensus, the major concern was related to the “applicability” of the statements. The participants expressed a lack of manpower, skills and time in particular during weekends and long holidays in carrying out assessment and care plans within 24 h after admission. There were also timeliness and availability issue in providing transportation and necessary equipment to the patients. To make the statements more applicable, the wordings of some of the statements were revised to provide greater flexibility. Due to the lack of a statement in clarifying the role of the members of the healthcare professional team, one additional statement on the role and responsibility of the multidisciplinary team members was added. The first theme on “initial screening” was further revised to “initial screening and assessment” to better reflect the first stage of discharge planning process. After two rounds of rating process, all the 36 statements and the newly added statement reached consensus Conclusions A structured, systematic and coordinated system of hospital discharge system is required to facilitate the discharge process to ensure a smooth patient transition from the hospital to the community and improve patient health outcome in both clinical and social aspect. The findings of this paper provide a reference framework helping policymakers and hospital managers to facilitate the development of a coherent and systematized discharge planning process. Adopting a Delphi approach also demonstrates the values of the method as a pre-test (before the clinical run) of the components and requirements of a discharge planning system taking into account of the local context and system constraints, which would lead to improvements to its applicability and practicability. To confirm the applicability and practicability of this consensus framework for discharge planning system, the third stage of process of development of the discharge planning framework is to apply and pilot the framework in a hospital setting to evaluate its feasibility, applicability and impact in hospital including satisfaction from both the perspectives of staff and patients. PMID:23151173

The applicability of real-time PCR in the diagnostic of cutaneous leishmaniasis and parasite quantification for clinical management: Current status and perspectives.

PubMed

Moreira, Otacilio C; Yadon, Zaida E; Cupolillo, Elisa

2017-09-29

Cutaneous leishmaniasis (CL) is spread worldwide and is the most common manifestation of leishmaniasis. Diagnosis is performed by combining clinical and epidemiological features, and through the detection of Leishmania parasites (or DNA) in tissue specimens or trough parasite isolation in culture medium. Diagnosis of CL is challenging, reflecting the pleomorphic clinical manifestations of this disease. Skin lesions vary in severity, clinical appearance, and duration, and in some cases, they can be indistinguishable from lesions related to other diseases. Over the past few decades, PCR-based methods, including real-time PCR assays, have been developed for Leishmania detection, quantification and species identification, improving the molecular diagnosis of CL. This review provides an overview of many real-time PCR methods reported for the diagnostic evaluation of CL and some recommendations for the application of these methods for quantification purposes for clinical management and epidemiological studies. Furthermore, the use of real-time PCR for Leishmania species identification is also presented. The advantages of real-time PCR protocols are numerous, including increased sensitivity and specificity and simpler standardization of diagnostic procedures. However, despite the numerous assays described, there is still no consensus regarding the methods employed. Furthermore, the analytical and clinical validation of CL molecular diagnosis has not followed international guidelines so far. A consensus methodology comprising a DNA extraction protocol with an exogenous quality control and an internal reference to normalize parasite load is still needed. In addition, the analytical and clinical performance of any consensus methodology must be accurately assessed. This review shows that a standardization initiative is essential to guide researchers and clinical laboratories towards the achievement of a robust and reproducible methodology, which will permit further evaluation of parasite load as a surrogate marker of prognosis and monitoring of aetiological treatment, particularly in multi-centric observational studies and clinical trials. Copyright © 2017 Elsevier B.V. All rights reserved.

Integration of heterogeneous molecular networks to unravel gene-regulation in Mycobacterium tuberculosis.

PubMed

van Dam, Jesse C J; Schaap, Peter J; Martins dos Santos, Vitor A P; Suárez-Diez, María

2014-09-26

Different methods have been developed to infer regulatory networks from heterogeneous omics datasets and to construct co-expression networks. Each algorithm produces different networks and efforts have been devoted to automatically integrate them into consensus sets. However each separate set has an intrinsic value that is diluted and partly lost when building a consensus network. Here we present a methodology to generate co-expression networks and, instead of a consensus network, we propose an integration framework where the different networks are kept and analysed with additional tools to efficiently combine the information extracted from each network. We developed a workflow to efficiently analyse information generated by different inference and prediction methods. Our methodology relies on providing the user the means to simultaneously visualise and analyse the coexisting networks generated by different algorithms, heterogeneous datasets, and a suite of analysis tools. As a show case, we have analysed the gene co-expression networks of Mycobacterium tuberculosis generated using over 600 expression experiments. Regarding DNA damage repair, we identified SigC as a key control element, 12 new targets for LexA, an updated LexA binding motif, and a potential mismatch repair system. We expanded the DevR regulon with 27 genes while identifying 9 targets wrongly assigned to this regulon. We discovered 10 new genes linked to zinc uptake and a new regulatory mechanism for ZuR. The use of co-expression networks to perform system level analysis allows the development of custom made methodologies. As show cases we implemented a pipeline to integrate ChIP-seq data and another method to uncover multiple regulatory layers. Our workflow is based on representing the multiple types of information as network representations and presenting these networks in a synchronous framework that allows their simultaneous visualization while keeping specific associations from the different networks. By simultaneously exploring these networks and metadata, we gained insights into regulatory mechanisms in M. tuberculosis that could not be obtained through the separate analysis of each data type.

Medication dispensing errors in Palestinian community pharmacy practice: a formal consensus using the Delphi technique.

PubMed

Shawahna, Ramzi; Haddad, Aseel; Khawaja, Baraa; Raie, Rand; Zaneen, Sireen; Edais, Tasneem

2016-10-01

Background Medication dispensing errors (MDEs) are frequent in community pharmacy practice. A definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice were not previously approached using formal consensus techniques. Objective This study was conducted to achieve consensus on a definition of MDEs and a wide range of scenarios that should or should not be considered as MDEs in Palestinian community pharmacy practice by a panel of community pharmacists. Setting Community pharmacy practice in Palestine. Method This was a descriptive study using the Delphi technique. A panel of fifty community pharmacists was recruited from different geographical locations of the West Bank of Palestine. A three round Delphi technique was followed to achieve consensus on a proposed definition of MDEs and 83 different scenarios representing potential MDEs using a nine-point scale. Main outcome measure Agreement or disagreement of a panel of community pharmacists on a proposed definition of MDEs and a series of scenarios representing potential MDEs. Results In the first Delphi round, views of key contact community pharmacists on MDEs were explored and situations representing potential MDEs were collected. In the second Delphi round, consensus was achieved to accept the proposed definition and to include 49 (59 %) of the 83 proposed scenarios as MDEs. In the third Delphi round, consensus was achieved to include further 13 (15.7 %) scenarios as MDEs, exclude 9 (10.8 %) scenarios and the rest of 12 (14.5 %) scenarios were considered equivocal based on the opinions of the panelists. Conclusion Consensus on a definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice was achieved using a formal consensus technique. The use of consensual definitions and scenarios representing MDE situations in community pharmacy practice might minimize methodological variations and their significant effects on the number and rate of MDEs reported in different studies.

Democracy-based consensus in medicine.

PubMed

Greco, Massimiliano; Zangrillo, Alberto; Mucchetti, Marta; Nobile, Leda; Landoni, Paolo; Bellomo, Rinaldo; Landoni, Giovanni

2015-04-01

High-quality evidence and derived guidelines, as typically published in major academic journals, are a major process that shapes physician decision-making worldwide. However, for many aspects of medical practice, there is a lack of High-quality evidence or an overload of somewhat contradictory low-quality information, which makes decision-making a difficult, uncertain, and unpredictable process. When the issues in question are important and evidence limited or controversial, the medical community seeks to establish common ground for "best practice" through consensus conferences and consensus statements or guidelines. Such consensus statements are seen as a useful tool to establish expert agreement, define the boundaries of acceptable practice, provide priorities for the research agenda, and obtain opinions from different countries and healthcare systems. This standard approach, however, can be criticized for being elitist, noninclusive, and poorly representative of the community of clinicians who will have to make decisions about the implementation of such recommendations. Accordingly, the authors propose a new model based on a combination of a local core meeting (detailed review and expert input) followed by a worldwide web-based network assessment (democracy-based consensus). The authors already have applied this approach to develop consensus on all nonsurgical interventions that increase or reduce perioperative mortality in critically ill patients and in those with acute kidney injury. The methodology was based on 5 sequential local and web-based steps. Both a panel of experts and a large number of professionals from all over the world were involved, giving birth to a new type of "democracy-based consensus." This new type of "democracy-based consensus" has the potential to increase grass-root clinician involvement, expand the reach to less-developed countries, provide a more global perspective on proposed interventions, and perhaps more importantly, increase awareness, ownership, and the statistical likelihood of subsequent implementation. Copyright © 2015 Elsevier Inc. All rights reserved.

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

PubMed Central

Allahabadi, Sachin; Haroun, Kareem B.; Musher, Daniel M.; Lipsky, Benjamin A.; Barshes, Neal R.

2016-01-01

Background The aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data. Methods We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0. Results The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO. Conclusions Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO. PMID:27414481

Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project.

PubMed

Schwartz, Hamilton P; Bigham, Michael T; Schoettker, Pamela J; Meyer, Keith; Trautman, Michael S; Insoft, Robert M

2015-10-01

The transport of neonatal and pediatric patients to tertiary care facilities for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. In 2011, pediatric transport teams in Ohio met to identify quality indicators permitting comparisons among programs. However, no set of national consensus quality metrics exists for benchmarking transport teams. The aim of this project was to achieve national consensus on appropriate neonatal and pediatric transport quality metrics. Modified Delphi technique. The first round of consensus determination was via electronic mail survey, followed by rounds of consensus determination in-person at the American Academy of Pediatrics Section on Transport Medicine's 2012 Quality Metrics Summit. All attendees of the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit, conducted on October 21-23, 2012, in New Orleans, LA, were eligible to participate. Candidate quality metrics were identified through literature review and those metrics currently tracked by participating programs. Participants were asked in a series of rounds to identify "very important" quality metrics for transport. It was determined a priori that consensus on a metric's importance was achieved when at least 70% of respondents were in agreement. This is consistent with other Delphi studies. Eighty-two candidate metrics were considered initially. Ultimately, 12 metrics achieved consensus as "very important" to transport. These include metrics related to airway management, team mobilization time, patient and crew injuries, and adverse patient care events. Definitions were assigned to the 12 metrics to facilitate uniform data tracking among programs. The authors succeeded in achieving consensus among a diverse group of national transport experts on 12 core neonatal and pediatric transport quality metrics. We propose that transport teams across the country use these metrics to benchmark and guide their quality improvement activities.

ACR appropriateness criteria jaundice.

PubMed

Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

2013-06-01

A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Framework of behavioral indicators evaluating TB health promotion outcomes: a modified Delphi study of TB policymakers and health workers.

PubMed

Li, Ying; Ehiri, John; Hu, Daiyu; Oren, Eyal; Cao, Jia

2015-12-15

Although TB health promotion directed at policy makers and healthcare workers (HCWs) is considered important to tuberculosis (TB) control, no indicators currently assess the impact of such promotional activities. This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion, using the Delphi method. In the first article, we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients. The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs. A two-round, modified Delphi method was used to establish the indicators. Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys. A questionnaire was developed following 4 steps, and involved ranking indicators on a five-point Likert scale. The consensus level was 70 %. Median, mode, and Coefficient of variation (CV) were used to describe expert responses. An authority coefficient (Cr) was used to assess the degree of each expert's authority. Consensus was achieved following the two survey rounds and several iterations among the experts. For TB health-promotion activities directed at policymakers, the experts reached consensus on 2 domains ("Resource inputs" and "Policymaking and monitoring behaviors"), 4 subdomains ("Human resources" among others), and 13 indicators ("Human resources per 100,000 person" among others). For TB health-promotion activities directed at HCWs, the experts reached consensus on 5 domains ("Self-protective behaviors" among others), 6 sub-domains ("Preventing infection" among others), and 15 indicators ("Average hours of daily workplace disinfection by ultraviolet radiation" among others). This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control. Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.

[Cross-cultural adaptation to the European Portuguese of the questionnaire "Patient Knowledge about their Medications" (CPM-ES-ES)].

PubMed

Salmerón Rubio, Joaquín; Iglésias-Ferreira, Paula; García Delgado, Pilar; Mateus-Santos, Henrique; Martínez-Martínez, Fernando

2013-12-01

The scope of this work is to conduct the cross-cultural adaptation from Spanish to European Portuguese of a questionnaire to measure the degree of "Patient Knowledge about their Medications" (CPM-ES-ES). A method based on six steps was applied: 1. Translation into Portuguese, 2. Elaboration of the first consensus version in Portuguese; 3.Back-translation into Spanish; 4. Elaboration of the second consensus version (cultural equivalency); 5. Conducting the pre-test; 6. Evaluation of the overall results. A cross-culturally adapted questionnaire in European Portuguese that measures the degree of "Patient Knowledge about their Medications" is proposed. The pre-test confirmation obtained 100% agreement with the corrected version of the second consensus version after pre-testing. The methodology selected made it possible to cross-culturally adapt the Spanish version of the CPM-ES-ES questionnaire to the Portuguese version. Further studies should demonstrate the equivalence of the psychometric properties of the cross-cultural translation into Portuguese with the original version.

Working towards an international consensus on criteria for assessing internet gaming disorder: a critical commentary on Petry et al. (2014)

PubMed Central

GRIFFITHS, MARK D.; VAN ROOIJ, ANTONIUS J.; KARDEFELT-WINTHER, DANIEL; STARCEVIC, VLADAN; KIRÁLY, ORSOLYA; PALLESEN, STÅLE; MÜLLER, KAI; DREIER, MICHAEL; CARRAS, MICHELLE; PRAUSE, NICOLE; KING, DANIEL L.; ABOUJAOUDE, ELLIAS; KUSS, DARIA J.; PONTES, HALLEY M.; FERNANDEZ, OLATZ LOPEZ; NAGYGYORGY, KATALIN; ACHAB, SOPHIA; BILLIEUX, JOËL; QUANDT, THORSTEN; CARBONELL, XAVIER; FERGUSON, CHRISTOPHER J.; HOFF, RANI A.; DEREVENSKY, JEFFREY; HAAGSMA, MARIA C.; DELFABBRO, PAUL; COULSON, MARK; HUSSAIN, ZAHEER; DEMETROVICS, ZSOLT

2017-01-01

This commentary paper critically discusses the recent debate paper by Petry et al. (2014) that argued there was now an international consensus for assessing Internet Gaming Disorder (IGD). Our collective opinions vary considerably regarding many different aspects of online gaming. However, we contend that the paper by Petry and colleagues does not provide a true and representative international community of researchers in this area. This paper critically discusses and provides commentary on (i) the representativeness of the international group that wrote the ‘consensus’ paper, and (ii) each of the IGD criteria. The paper also includes a brief discussion on initiatives that could be taken to move the field towards consensus. It is hoped that this paper will foster debate in the IGD field and lead to improved theory, better methodologically designed studies, and more robust empirical evidence as regards problematic gaming and its psychosocial consequences and impact. PMID:26669530

[Consensus on Systemic Arterial Hypertension In México].

PubMed

Rosas-Peralta, Martín; Palomo-Piñón, Silvia; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Almeida-Gutiérrez, Eduardo; Galván-Oseguera, Héctor; Magaña-Serrano, José Antonio; Saturno-Chiu, Guillermo; Ramírez-Arias, Erick; Santos-Martínez, Efrén; Díaz-Díaz, Enrique; Salgado-Pastor, Selene Janette; Morales-Mora, Gerardo; Medina-Concebida, Luz Elena; Mejía-Rodríguez, Oliva; Pérez-Ruiz, Claudia Elsa; Chapa-Mejía, Luis Raúl; Álvarez-Aguilar, Cleto; Pérez-Rodríguez, Gilberto; Castro-Martínez, María Guadalupe; López-Bárcena, Joaquín; Paniagua-Sierra, José Ramón

2016-01-01

This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country.

[The German Disease Management Guideline Asthma: methods and development process].

PubMed

Kopp, Ina; Lelgemann, Monika; Ollenschläger, Günter

2006-01-01

The German National Program for Disease Management Guidelines, which is being operated under the auspices of the German Medical Association (GMA), the Association of the Scientific Medical Societies (AWMF) and the National Association of Statutory Health Insurance Physicians (NASHIP), provides a conceptual basis for the disease management of prioritized healthcare aspects. The main objective of the program is to establish consensus of the medical professions on key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the scope of this program, the Scientific Medical Societies concerned with the prevention, diagnosis, treatment and rehabilitation of asthma in children, adolescents and adults have reached consensus on the core contents for a National Disease Management Guideline for Asthma. This consensus was reached by applying formal techniques and on the basis of the adaptation of recommendations from existing guidelines with high quality standards in methodology and reporting, and information from evidence reports.

Design of feedback control systems for stable plants with saturating actuators

NASA Technical Reports Server (NTRS)

Kapasouris, Petros; Athans, Michael; Stein, Gunter

1988-01-01

A systematic control design methodology is introduced for multi-input/multi-output stable open loop plants with multiple saturations. This new methodology is a substantial improvement over previous heuristic single-input/single-output approaches. The idea is to introduce a supervisor loop so that when the references and/or disturbances are sufficiently small, the control system operates linearly as designed. For signals large enough to cause saturations, the control law is modified in such a way as to ensure stability and to preserve, to the extent possible, the behavior of the linear control design. Key benefits of the methodology are: the modified compensator never produces saturating control signals, integrators and/or slow dynamics in the compensator never windup, the directional properties of the controls are maintained, and the closed loop system has certain guaranteed stability properties. The advantages of the new design methodology are illustrated in the simulation of an academic example and the simulation of the multivariable longitudinal control of a modified model of the F-8 aircraft.

Exercise and osteoporosis: Methodological and practical considerations

NASA Technical Reports Server (NTRS)

Block, Jon E.; Friedlander, Anne L.; Steiger, Peter; Genant, Harry K.

1994-01-01

Physical activity may have important implications for enhancing bone density prior to the initiation of space flight, for preserving bone density during zero gravity, and for rehabilitating the skeleton upon return to Earth. Nevertheless, the beneficial effects of exercise upon the skeleton have not been proven by controlled trials and no consensus exists regarding the type, duration, and intensity of exercise necessary to make significant alterations to the skeleton. The following sections review our current understanding of exercise and osteoporosis, examine some of the methodological shortcomings of these investigations, and make research recommendations for future clinical trials.

Towards standardized testing methodologies for optical properties of components in concentrating solar thermal power plants

NASA Astrophysics Data System (ADS)

Sallaberry, Fabienne; Fernández-García, Aránzazu; Lüpfert, Eckhard; Morales, Angel; Vicente, Gema San; Sutter, Florian

2017-06-01

Precise knowledge of the optical properties of the components used in the solar field of concentrating solar thermal power plants is primordial to ensure their optimum power production. Those properties are measured and evaluated by different techniques and equipment, in laboratory conditions and/or in the field. Standards for such measurements and international consensus for the appropriate techniques are in preparation. The reference materials used as a standard for the calibration of the equipment are under discussion. This paper summarizes current testing methodologies and guidelines for the characterization of optical properties of solar mirrors and absorbers.

A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis.

PubMed

Stockfleth, Eggert; Peris, Ketty; Guillen, Carlos; Cerio, Rino; Basset-Seguin, Nicole; Foley, Peter; Sanches, José; Culshaw, Alex; Erntoft, Sandra; Lebwohl, Mark

2015-01-01

Topical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis. An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated. The recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy. © 2015 The Authors. International Journal of Dermatology published by John Wiley & Sons Ltd on behalf of International Society of Dermatology.

What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation.

PubMed

Gobat, Nina; Kinnersley, Paul; Gregory, John W; Robling, Michael

2015-07-01

To establish consensus on the core domains of agenda setting in consultations. We reviewed the healthcare literature and, using a modified Delphi technique to embrace both patient and clinician perspectives, conducted an iterative online survey, with 30 experts in health communication. Participants described agenda setting and rated the importance of proposed domains. Consensus was determined where the group median was ≥5 on a 7-point Likert-like response scale, and the interquartile range fell to within one point on this scale. Relevant publications were identified in three overlapping bodies of healthcare literature. Survey respondents considered that agenda setting involved a process whereby patients and clinicians establish a joint focus for both their conversation and their working relationship. Consensus was obtained on six core domains: identifying patient talk topics, identifying clinician talk topics, agreement of shared priorities, establishing conversational focus, collaboration and engagement. New terminology--agenda mapping and agenda navigation--is proposed. We identified core agenda setting domains that embraced patient and clinician perspectives. An integrated conceptualization of agenda setting may now be used by researchers and educators in both clinician and patient focused interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Reel History: U.S. History, 1932-1972, as Viewed through the Lens of Hollywood.

ERIC Educational Resources Information Center

Briley, Ron

1990-01-01

Describes a year-long elective film course in modern U.S. history for twelfth grade students. Explains course methodology and objectives. Analyzes selected films to illustrate how the course elucidates the consensus-conflict theme in U.S. history since the 1930s and enhances student understanding of Hollywood's perspective on gender, race, and…

Contradictions and Consensus--Clusters of Opinions on E-Books

ERIC Educational Resources Information Center

Shrimplin, Aaron K.; Revelle, Andy; Hurst, Susan; Messner, Kevin

2011-01-01

Q methodology was used to determine attitudes and opinions about e-books among a group of faculty, graduate students, and undergraduates at Miami University of Ohio. Oral interviews formed the basis for a collection of opinion statements concerning e-books versus print. These statements were then ranked by a second group of research participants.…

The Underutilization of Information and Communication Technology-Assisted Collaborative Project-Based Learning among International Educators: A Delphi Study

ERIC Educational Resources Information Center

Kramer, Barry S.; Walker, Andrew E.; Brill, Jennifer M.

2007-01-01

This study explores the barriers associated with teachers implementing information and communication technology-assisted collaborative project-based learning (ICTCPrjBL) as a classroom teaching methodology with students. We used a Web-based Delphi method to engage experienced educators in anonymous consensus building consisting of three rounds of…

Comparing the Methodologies in ASTM G198: Is There an Easy Way Out?

Treesearch

Samuel L. Zelinka

2013-01-01

ASTM(1) G198, Standard test method for determining the relative corrosion performance of driven fasteners in contact with treated wood, was accepted by consensus and published in 2011. The method has two different exposure conditions for determining fastener corrosion performance in treated wood. The first method places the wood and embedded...

Maximum Likelihood Item Easiness Models for Test Theory without an Answer Key

ERIC Educational Resources Information Center

France, Stephen L.; Batchelder, William H.

2015-01-01

Cultural consensus theory (CCT) is a data aggregation technique with many applications in the social and behavioral sciences. We describe the intuition and theory behind a set of CCT models for continuous type data using maximum likelihood inference methodology. We describe how bias parameters can be incorporated into these models. We introduce…

Marking Time: Some Methodological and Historical Perspectives on the "Crisis of Childhood"

ERIC Educational Resources Information Center

Myers, Kevin

2012-01-01

Historical amnesia besets the consensus that Britain faces an unprecedented "crisis of childhood", and of child well-being. Drawing on evidence about changing uses of instruments and measures of well-being over time, this article explores and critiques claims about historical change and trends over time that are central to the imagined…

The Definition, Assessment, and Mitigation of State Boredom within Educational Settings: A Comprehensive Review

ERIC Educational Resources Information Center

Vogel-Walcutt, Jennifer J.; Fiorella, Logan; Carper, Teresa; Schatz, Sae

2012-01-01

Mitigating the situational factors that give rise to state boredom is a consistent challenge facing educators. Despite the growing amount of literature devoted to the construct, the field has yet to arrive at a consensus regarding a clear theoretical or operational definition. Subsequently, inconsistencies exist in the assessment methodologies,…

Critical Guidelines for U.S.-Based Counselor Educators When Working Transnationally: A Delphi Study

ERIC Educational Resources Information Center

Smith, Paul H.; Benshoff, James M.; Gonzalez, Laura M.

2018-01-01

U.S.-based counselor education faculty increasingly are participating in transnational experiences, such as global research and study abroad. The purpose of this study was to develop guidelines for U.S.-based counselor educators when working transnationally. Using Delphi methodology, 69 consensus guidelines were developed from an expert panel.…

The Impact of Collaborative Scaffolding in Educational Video Games on the Collaborative Support Skills of Middle School Students

ERIC Educational Resources Information Center

Loparev, Anna

2016-01-01

Collaboration is crucial to everything from product development in the workplace to research design in academia, yet there is no consensus on best practice when it comes to teaching collaborative skills. We explore one promising option: collaborative scaffolding in educational video games. Through this methodology, we can impart collaborative…

Sex Differences in Landing Biomechanics and Postural Stability During Adolescence: A Systematic Review with Meta-Analyses.

PubMed

Holden, Sinéad; Boreham, Colin; Delahunt, Eamonn

2016-02-01

The adolescent 'growth spurt' results in rapid growth of the skeletal system. It has been theorised that absence of a concomitant increase in muscular adaptations in female athletes may predispose them to an increased risk of anterior cruciate ligament injuries. To determine if sex differences exist in landing biomechanics and postural stability of adolescent athletes; with a further objective of determining if such differences are propagated during adolescence. The following databases were searched: MEDLINE, EMBASE, CINAHL, PEDro, PubMed, SPORTDiscus and Web of Science. Research papers were identified by including search terms for neuromuscular control, lower limb and pubertal development. Studies were required to be written in English; report on biomechanical analyses; include landing or postural control tasks; be cross-sectional or longitudinal; and include healthy adolescent/pubertal subjects. A modified version of the Strengthening the Reporting of Observational studies in Epidemiology checklist was used to rate methodological quality. Meta-analyses were performed when more than one study reported on an outcome measure. Sixteen articles were included. The overall methodological quality of evaluated studies was low (mean score = 5.75/10 points). Adolescent females exhibited increased knee valgus with increasing maturity. There was no consensus on sex differences in postural stability. With increasing maturation, females are characterized by increased knee valgus during landing tasks. To date, no research has longitudinally investigated postural stability development during adolescence in females, despite the importance of postural control training in injury prevention programmes. Therefore, further research on this topic is warranted.

Defining Malaysian Knowledge Society: Results from the Delphi Technique

NASA Astrophysics Data System (ADS)

Hamid, Norsiah Abdul; Zaman, Halimah Badioze

This paper outlines the findings of research where the central idea is to define the term Knowledge Society (KS) in Malaysian context. The research focuses on three important dimensions, namely knowledge, ICT and human capital. This study adopts a modified Delphi technique to seek the important dimensions that can contribute to the development of Malaysian's KS. The Delphi technique involved ten experts in a five-round iterative and controlled feedback procedure to obtain consensus on the important dimensions and to verify the proposed definition of KS. The finding shows that all three dimensions proposed initially scored high and moderate consensus. Round One (R1) proposed an initial definition of KS and required comments and inputs from the panel. These inputs were then used to develop items for a R2 questionnaire. In R2, 56 out of 73 items scored high consensus and in R3, 63 out of 90 items scored high. R4 was conducted to re-rate the new items, in which 8 out of 17 items scored high. Other items scored moderate consensus and no item scored low or no consensus in all rounds. The final round (R5) was employed to verify the final definition of KS. Findings and discovery of this study are significant to the definition of KS and the development of a framework in the Malaysian context.

Argumentation Based Bioethics Education: Sample Implementation on Genetically Modified Organisms (GMOs) and Genetic Screening Tests

ERIC Educational Resources Information Center

Ozer Keskin, Melike; Keskin Samanci, Nilay; Yaman, Hale

2013-01-01

Nowadays, there is a need in science education to consider scientific research and its applications alongside ethical consensus. Even though classroom debates of value issues have been demonstrated to significantly contribute to the raising of social consciousness and awareness, research shows that neither academics in higher education nor…

Exploring health literacy competencies towards patient education programme for Chinese-speaking healthcare professionals: a Delphi study

PubMed Central

Chang, Li-Chun; Chen, Yu-Chi; Wu, Fei Ling; Liao, Li-Ling

2017-01-01

Objectives To achieve consensus on a set of competencies in health literacy practice based on a literature review and expert consultation. Setting Hospitals and community health centres in Taiwan. Method A 2-stage modified Delphi study involving a literature review was conducted, followed by qualitative interviews and 3 rounds of email-based data collection over a 3-month period in 2011. Participants 15 Chinese healthcare practitioners with more than 6 months’ experience in patient education were interviewed to collect data on health literacy practice. 24 experts (12 academic scholars in health literacy and 12 professionals with training related to health literacy practice) were invited to participate in the Delphi process. Results Qualitative data from the interviews were analysed and summarised to form 99 competency items for health literacy practice, which were categorised into 5 domains of health literacy practice including those pertaining to knowledge and skills. Consensus was reached on 92 of 99 competencies, using a modified Delphi technique. Conclusions The 92 competencies in health literacy practice embraced core components of patient education in the Chinese healthcare profession. PMID:28093428

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

PubMed Central

Barber, Claire E. H.; Marshall, Deborah A; Alvarez, Nanette; John Mancini, G. B.; Lacaille, Diane; Keeling, Stephanie; Aviña-Zubieta, J. Antonio; Khodyakov, Dmitry; Barnabe, Cheryl; Faris, Peter; Smith, Alexa; Noormohamed, Raheem; Hazlewood, Glen; Martin, Liam O.; Esdaile, John M.

2016-01-01

Objective Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QIs) for screening and use in Rheumatology clinics. Methods A systematic review of the literature on CVD risk reduction in RA and the general population was conducted. Based on the best practices identified from this review, a draft set of 12 candidate QIs were presented to a Canadian panel of rheumatologists and cardiologists (n=6) from three academic centers to achieve consensus on the QI specifications. The resulting 11 QIs were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity and feasibility in three rounds of online voting and threaded discussion using a modified RAND/UCLA Appropriateness Methodology. Results Response rates for the online panel were 86%. All 11 QIs were rated as highly relevant, valid and feasible (median rating ≥7 on a 1–9 scale) with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA, CV risk assessment, defining smoking status and providing cessation counseling, screening and addressing hypertension, dyslipidemia and diabetes, exercise recommendations, body mass index screening and lifestyle counseling, minimizing corticosteroid use and communicating to patients at high risk of CVD about the risks/benefits of non-steroidal anti-inflammatory drugs. Conclusion Eleven QIs for CVD care in RA patients have been developed and are rated as highly relevant, valid and feasible by an international multidisciplinary panel. PMID:26178275

Development of quality metrics for ambulatory care in pediatric patients with tetralogy of Fallot.

PubMed

Villafane, Juan; Edwards, Thomas C; Diab, Karim A; Satou, Gary M; Saarel, Elizabeth; Lai, Wyman W; Serwer, Gerald A; Karpawich, Peter P; Cross, Russell; Schiff, Russell; Chowdhury, Devyani; Hougen, Thomas J

2017-12-01

The objective of this study was to develop quality metrics (QMs) relating to the ambulatory care of children after complete repair of tetralogy of Fallot (TOF). A workgroup team (WT) of pediatric cardiologists with expertise in all aspects of ambulatory cardiac management was formed at the request of the American College of Cardiology (ACC) and the Adult Congenital and Pediatric Cardiology Council (ACPC), to review published guidelines and consensus data relating to the ambulatory care of repaired TOF patients under the age of 18 years. A set of quality metrics (QMs) was proposed by the WT. The metrics went through a two-step evaluation process. In the first step, the RAND-UCLA modified Delphi methodology was employed and the metrics were voted on feasibility and validity by an expert panel. In the second step, QMs were put through an "open comments" process where feedback was provided by the ACPC members. The final QMs were approved by the ACPC council. The TOF WT formulated 9 QMs of which only 6 were submitted to the expert panel; 3 QMs passed the modified RAND-UCLA and went through the "open comments" process. Based on the feedback through the open comment process, only 1 metric was finally approved by the ACPC council. The ACPC Council was able to develop QM for ambulatory care of children with repaired TOF. These patients should have documented genetic testing for 22q11.2 deletion. However, lack of evidence in the literature made it a challenge to formulate other evidence-based QMs. © 2017 Wiley Periodicals, Inc.

Maastricht Delphi Consensus on Event Definitions for Classification of Recurrence in Breast Cancer Research

PubMed Central

van Roozendaal, Lori M.; Strobbe, Luc J. A.; Aebi, Stefan; Cameron, David A.; Dixon, J. Michael; Giuliano, Armando E.; Haffty, Bruce G.; Hickey, Brigid E.; Hudis, Clifford A.; Klimberg, V. Suzanne; Koczwara, Bogda; Kühn, Thorsten; Lippman, Marc E.; Lucci, Anthony; Piccart, Martine; Smith, Benjamin D.; Tjan-Heijnen, Vivianne C. G.; van de Velde, Cornelis J. H.; Van Zee, Kimberly J.; Vermorken, Jan B.; Viale, Giuseppe; Voogd, Adri C.; Wapnir, Irene L.; White, Julia R.; Smidt, Marjolein L.

2014-01-01

Background In breast cancer studies, many different endpoints are used. Definitions are often not provided or vary between studies. For instance, “local recurrence” may include different components in similar studies. This limits transparency and comparability of results. This project aimed to reach consensus on the definitions of local event, second primary breast cancer, regional and distant event for breast cancer studies. Methods The RAND-UCLA Appropriateness method (modified Delphi method) was used. A Consensus Group of international breast cancer experts was formed, including representatives of all involved clinical disciplines. Consensus was reached in two rounds of online questionnaires and one meeting. Results Twenty-four international breast cancer experts participated. Consensus was reached on 134 items in four categories. Local event is defined as any epithelial breast cancer or ductal carcinoma in situ (DCIS) in the ipsilateral breast, or skin and subcutaneous tissue on the ipsilateral thoracic wall. Second primary breast cancer is defined as epithelial breast cancer in the contralateral breast. Regional events are breast cancer in ipsilateral lymph nodes. A distant event is breast cancer in any other location. Therefore, this includes metastasis in contralateral lymph nodes and breast cancer involving the sternal bone. If feasible, tissue sampling of a first, solitary, lesion suspected for metastasis is highly recommended. Conclusion This project resulted in consensus-based event definitions for classification of recurrence in breast cancer research. Future breast cancer research projects should adopt these definitions to increase transparency. This should facilitate comparison of results and conducting reviews as well as meta-analysis. PMID:25381395

Assessing Consensus Between UK Renal Clinicians on Listing for Kidney Transplantation: A Modified Delphi Study.

PubMed

Tonkin-Crine, Sarah; Pruthi, Rishi; Taylor, Dominic M; Leydon, Geraldine M; Calestani, Melania; Oniscu, Gabriel C; Bradley, J Andrew; Tomson, Charles R; Bradley, Clare; Dudley, Christopher; Watson, Christopher J E; Draper, Heather; Johnson, Rachel J; Metcalfe, Wendy; Fogarty, Damian G; Ravanan, Rommel; Roderick, Paul

2018-05-01

It is well recognized that there is significant variation between centers in access to kidney transplantation. In the absence of high-grade evidence, it is unclear whether variation is due to patient case mix, other center factors, or individual clinician decisions. This study sought consensus between UK clinicians on factors that should influence access to kidney transplantation. As part of the Access to Transplantation and Transplant Outcome Measures project, consultant nephrologists and transplant surgeons in 71 centers were invited to participate in a Delphi study involving 2 rounds. During rounds 1 and 2, participants rated their agreement to 29 statements covering 8 topics regarding kidney transplantation. A stakeholder meeting was used to discuss statements of interest after the 2 rounds. In total, 122 nephrologists and 16 transplant surgeons from 45 units participated in rounds 1 and 2. After 2 rounds, 12 of 29 statements reached consensus. Fifty people participated in the stakeholder meeting. After the stakeholder meeting, a further 4 statements reached agreement. Of the 8 topics covered, consensus was reached in 6: use of a transplant protocol, patient age, body mass index, patient compliance with treatment, cardiac workup, and use of multidisciplinary meetings. Consensus was not reached on screening for malignancy and use of peripheral Doppler studies. The Delphi process identified factors upon which clinicians agreed and areas where consensus could not be achieved. The findings should inform national guidelines to support decision making in the absence of high quality evidence and to guide areas that warrant future research.

Criteria for social media-based scholarship in health professions education.

PubMed

Sherbino, Jonathan; Arora, Vineet M; Van Melle, Elaine; Rogers, Robert; Frank, Jason R; Holmboe, Eric S

2015-10-01

Social media are increasingly used in health professions education. How can innovations and research that incorporate social media applications be adjudicated as scholarship? To define the criteria for social media-based scholarship in health professions education. In 2014 the International Conference on Residency Education hosted a consensus conference of health professions educators with expertise in social media. An expert working group drafted consensus statements based on a literature review. Draft consensus statements were posted on an open interactive online platform 2 weeks prior to the conference. In-person and virtual (via Twitter) participants modified, added or deleted draft consensus statements in an iterative fashion during a facilitated 2 h session. Final consensus statements were unanimously endorsed. A review of the literature demonstrated no existing criteria for social media-based scholarship. The consensus of 52 health professions educators from 20 organisations in four countries defined four key features of social media-based scholarship. It must (1) be original; (2) advance the field of health professions education by building on theory, research or best practice; (3) be archived and disseminated; and (4) provide the health professions education community with the ability to comment on and provide feedback in a transparent fashion that informs wider discussion. Not all social media activities meet the standard of education scholarship. This paper clarifies the criteria, championing social media-based scholarship as a legitimate academic activity in health professions education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Assessing Consensus Between UK Renal Clinicians on Listing for Kidney Transplantation: A Modified Delphi Study

PubMed Central

Tonkin-Crine, Sarah; Pruthi, Rishi; Taylor, Dominic M.; Leydon, Geraldine M.; Calestani, Melania; Oniscu, Gabriel C.; Bradley, J. Andrew; Tomson, Charles R.; Bradley, Clare; Dudley, Christopher; Watson, Christopher J.E.; Draper, Heather; Johnson, Rachel J.; Metcalfe, Wendy; Fogarty, Damian G.; Ravanan, Rommel; Roderick, Paul

2018-01-01

Background It is well recognized that there is significant variation between centers in access to kidney transplantation. In the absence of high-grade evidence, it is unclear whether variation is due to patient case mix, other center factors, or individual clinician decisions. This study sought consensus between UK clinicians on factors that should influence access to kidney transplantation. Methods As part of the Access to Transplantation and Transplant Outcome Measures project, consultant nephrologists and transplant surgeons in 71 centers were invited to participate in a Delphi study involving 2 rounds. During rounds 1 and 2, participants rated their agreement to 29 statements covering 8 topics regarding kidney transplantation. A stakeholder meeting was used to discuss statements of interest after the 2 rounds. Results In total, 122 nephrologists and 16 transplant surgeons from 45 units participated in rounds 1 and 2. After 2 rounds, 12 of 29 statements reached consensus. Fifty people participated in the stakeholder meeting. After the stakeholder meeting, a further 4 statements reached agreement. Of the 8 topics covered, consensus was reached in 6: use of a transplant protocol, patient age, body mass index, patient compliance with treatment, cardiac workup, and use of multidisciplinary meetings. Consensus was not reached on screening for malignancy and use of peripheral Doppler studies. Conclusions The Delphi process identified factors upon which clinicians agreed and areas where consensus could not be achieved. The findings should inform national guidelines to support decision making in the absence of high quality evidence and to guide areas that warrant future research. PMID:29796414

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.

PubMed

Chastin, Sebastien F M; De Craemer, Marieke; Lien, Nanna; Bernaards, Claire; Buck, Christoph; Oppert, Jean-Michel; Nazare, Julie-Anne; Lakerveld, Jeroen; O'Donoghue, Grainne; Holdsworth, Michelle; Owen, Neville; Brug, Johannes; Cardon, Greet

2016-07-15

Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71% consensus), Social and Cultural Context (59% consensus), Built and Natural Environment (65% consensus), Psychology and Behaviour (80% consensus), Politics and Economics (78% consensus), and Institutional and Home Settings (78% consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89% of the participants. Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time.

Design for performance enhancement in feedback control systems with multiple saturating nonlinearities. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Kapasouris, Petros

1988-01-01

A systematic control design methodology is introduced for multi-input/multi-output systems with multiple saturations. The methodology can be applied to stable and unstable open loop plants with magnitude and/or rate control saturations and to systems in which state limitations are desired. This new methodology is a substantial improvement over previous heuristic single-input/single-output approaches. The idea is to introduce a supervisor loop so that when the references and/or disturbances are sufficiently small, the control system operates linearly as designed. For signals large enough to cause saturations, the control law is modified in such a way to ensure stability and to preserve, to the extent possible, the behavior of the linear control design. Key benefits of this methodology are: the modified compensator never produces saturating control signals, integrators and/or slow dynamics in the compensator never windup, the directional properties of the controls are maintained, and the closed loop system has certain guaranteed stability properties. The advantages of the new design methodology are illustrated by numerous simulations, including the multivariable longitudinal control of modified models of the F-8 (stable) and F-16 (unstable) aircraft.

Do systematic reviews on pediatric topics need special methodological considerations?

PubMed

Farid-Kapadia, Mufiza; Askie, Lisa; Hartling, Lisa; Contopoulos-Ioannidis, Despina; Bhutta, Zulfiqar A; Soll, Roger; Moher, David; Offringa, Martin

2017-03-06

Systematic reviews are key tools to enable decision making by healthcare providers and policymakers. Despite the availability of the evidence based Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA-2009 and PRISMA-P 2015) statements that were developed to improve the transparency and quality of reporting of systematic reviews, uncertainty on how to deal with pediatric-specific methodological challenges of systematic reviews impairs decision-making in child health. In this paper, we identify methodological challenges specific to the design, conduct and reporting of pediatric systematic reviews, and propose a process to address these challenges. One fundamental decision at the outset of a systematic review is whether to focus on a pediatric population only, or to include both adult and pediatric populations. Both from the policy and patient care point of view, the appropriateness of interventions and comparators administered to pre-defined pediatric age subgroup is critical. Decisions need to be based on the biological plausibility of differences in treatment effects across the developmental trajectory in children. Synthesis of evidence from different trials is often impaired by the use of outcomes and measurement instruments that differ between trials and are neither relevant nor validated in the pediatric population. Other issues specific to pediatric systematic reviews include lack of pediatric-sensitive search strategies and inconsistent choices of pediatric age subgroups in meta-analyses. In addition to these methodological issues generic to all pediatric systematic reviews, special considerations are required for reviews of health care interventions' safety and efficacy in neonatology, global health, comparative effectiveness interventions and individual participant data meta-analyses. To date, there is no standard approach available to overcome this problem. We propose to develop a consensus-based checklist of essential items which researchers should consider when they are planning (PRISMA-PC-Protocol for Children) or reporting (PRISMA-C-reporting for Children) a pediatric systematic review. Available guidelines including PRISMA do not cover the complexity associated with the conduct and reporting of systematic reviews in the pediatric population; they require additional and modified standards for reporting items. Such guidance will facilitate the translation of knowledge from the literature to bedside care and policy, thereby enhancing delivery of care and improving child health outcomes.

Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test.

PubMed

Ohtera, Shosuke; Kanazawa, Natsuko; Ozasa, Neiko; Ueshima, Kenji; Nakayama, Takeo

2017-01-27

Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice. This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan. 10 professionals in cardiac rehabilitation for the consensus panel. In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively). A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A DELPHI STUDY OF RISK FACTORS FOR ACHILLES TENDINOPATHY- OPINIONS OF WORLD TENDON EXPERTS

PubMed Central

Watson, Paul J.; Barry, Simon

2016-01-01

Background and Purpose Achilles tendinopathy can be a debilitating chronic condition for both active and inactive individuals. The identification of risk facors is important both in preventing but also treating tendinopathy, many factors have been proposed but there is a lack of primary epidemiological data. The purpose of this study was to develop a statement of expert consensus on risk factors for Achilles tendinopathy in active and sedentary patient populations to inform a primary epidemiological study. Study design Delphi study Methods and Measures An online Delphi study was completed inviting participation from world tendon experts. The consensus was developed using three rounds of the Delphi technique. The first round developed a complete list of potential risk factors, the second round refined this list but also separated the factors into two population groups – active/athletic and inactive/sedentary. The third round ranked this list in order of perceived importance. Results Forty-four experts were invited to participate, 16 participated in the first round (response rate 40%) and two dropped out in the second round (resulting in a response rate of 35%). A total of 27 intrinsic and eight extrinsic risk factors were identified during round one. During round two only 12 intrinsic and five extrinsic risk factors were identified as important in active/athletic tendinopathy while 14 intrinsic and three extrinsic factors were identified as important for inactive/sedentary tendinopathy. Conclusions Risk factors for Achilles tendinopathy were identified based on expert consensus, and these factors provide a basis for primary epidemiological studies. Plantarflexor strength was identified as the primary modifiable factor in the active/athletic group while systemic factors were identified as important in the inactive/sedentary group, many of the potential factors suggested for either group were non-modifiable. Non-modifiable factors include: previous tendinopathy, previous injury, advancing age, sex, steroid exposure, and antibiotic treatment. Level of evidence Level V PMID:27757281

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety by modifying the CONSORT statement.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-03-01

The conduct of randomized controlled trials in livestock with production, health and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on 18-19 November 2008 in Chicago, IL, USA, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health and food-safety outcomes.

Core neurological examination items for neurology clerks: A modified Delphi study with a grass-roots approach

PubMed Central

Liu, Chi-Hung; Hsu, Li-Ling; Hsiao, Cheng-Ting; Hsieh, Suh-Ing; Chang, Chun-Wei; Huang, Elaine Shinwei; Chang, Yeu-Jhy

2018-01-01

Background With the evolution of treatments for neurological diseases, the contents of core neurological examinations (NEs) for medical students may need to be modified. We aimed to establish a consensus on the core NE items for neurology clerks and compare viewpoints between different groups of panelists. Methods First, a pilot group proposed the core contents of NEs for neurology clerks. The proposed core NE items were then subject to a modified web-based Delphi process using the online software “SurveyMonkey”. A total of 30 panelists from different backgrounds (tutors or learners, neurologists or non-neurologists, community hospitals or medical centers, and different academic positions) participated in the modified Delphi process. Each panelist was asked to agree or disagree on the inclusion of each item using a 9-point Likert scale and was encouraged to provide feedback. We also compared viewpoints between different groups of panelists using the Mann-Whitney U test. Results Eighty-three items were used for the first round of the Delphi process. Of them, 18 without consensus of being a core NE item for the neurology clerks in the first round and another 14 items suggested by the panelists were further discussed in the second round. Finally, 75 items with different grades were included in the recommended NE items for neurology clerks. Conclusions Our findings provide a reference regarding the core NE items for milestone development for neurology clerkships. We hope that prioritizing the NE items in this order can help medical students to learn NE more efficiently. PMID:29771997

The Mexican consensus on the treatment of hepatitis C.

PubMed

Aiza-Haddad, I; Ballesteros-Amozurrutia, A; Borjas-Almaguer, O D; Castillo-Barradas, M; Castro-Narro, G; Chávez-Tapia, N; Chirino-Sprung, R A; Cisneros-Garza, L; Dehesa-Violante, M; Flores-Calderón, J; Flores-Gaxiola, A; García-Juárez, I; González-Huezo, M S; González-Moreno, E I; Higuera-de la Tijera, F; Kershenobich-Stalnikowitz, D; López-Méndez, E; Malé-Velázquez, R; Marín-López, E; Mata-Marín, J A; Méndez-Sánchez, N; Monreal-Robles, R; Moreno-Alcántar, R; Muñoz-Espinosa, L; Navarro-Alvarez, S; Pavia-Ruz, N; Pérez-Ríos, A M; Poo-Ramírez, J L; Rizo-Robles, M T; Sánchez-Ávila, J F; Sandoval-Salas, R; Torre, A; Torres-Ibarra, R; Trejo-Estrada, R; Velarde-Ruiz Velasco, J A; Wolpert-Barraza, E; Bosques-Padilla, F

2018-05-23

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Chronic Q Fever Diagnosis—Consensus Guideline versus Expert Opinion

PubMed Central

Wegdam-Blans, Marjolijn C.A.; Wever, Peter C.; Renders, Nicole H.M.; Delsing, Corine E.; Sprong, Tom; van Kasteren, Marjo E.E.; Bijlmer, Henk; Notermans, Daan; Oosterheert, Jan Jelrik; Stals, Frans S.; Nabuurs-Franssen, Marrigje H.; Bleeker-Rovers, Chantal P.

2015-01-01

Chronic Q fever, caused by Coxiella burnetii, has high mortality and morbidity rates if left untreated. Controversy about the diagnosis of this complex disease has emerged recently. We applied the guideline from the Dutch Q Fever Consensus Group and a set of diagnostic criteria proposed by Didier Raoult to all 284 chronic Q fever patients included in the Dutch National Chronic Q Fever Database during 2006–2012. Of the patients who had proven cases of chronic Q fever by the Dutch guideline, 46 (30.5%) would not have received a diagnosis by the alternative criteria designed by Raoult, and 14 (4.9%) would have been considered to have possible chronic Q fever. Six patients with proven chronic Q fever died of related causes. Until results from future studies are available, by which current guidelines can be modified, we believe that the Dutch literature-based consensus guideline is more sensitive and easier to use in clinical practice. PMID:26277798

Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review

PubMed Central

Boulkedid, Rym; Abdoul, Hendy; Loustau, Marine; Sibony, Olivier; Alberti, Corinne

2011-01-01

Objective Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. Methodology and Main Finding Three electronic data bases were searched over a 30 years period (1978–2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. Conclusion The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys. PMID:21694759

How to use the nominal group and Delphi techniques.

PubMed

McMillan, Sara S; King, Michelle; Tully, Mary P

2016-06-01

Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how 'consensus' is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of 'experts.' Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.

Scoping reviews: time for clarity in definition, methods, and reporting.

PubMed

Colquhoun, Heather L; Levac, Danielle; O'Brien, Kelly K; Straus, Sharon; Tricco, Andrea C; Perrier, Laure; Kastner, Monika; Moher, David

2014-12-01

The scoping review has become increasingly popular as a form of knowledge synthesis. However, a lack of consensus on scoping review terminology, definition, methodology, and reporting limits the potential of this form of synthesis. In this article, we propose recommendations to further advance the field of scoping review methodology. We summarize current understanding of scoping review publication rates, terms, definitions, and methods. We propose three recommendations for clarity in term, definition and methodology. We recommend adopting the terms "scoping review" or "scoping study" and the use of a proposed definition. Until such time as further guidance is developed, we recommend the use of the methodological steps outlined in the Arksey and O'Malley framework and further enhanced by Levac et al. The development of reporting guidance for the conduct and reporting of scoping reviews is underway. Consistency in the proposed domains and methodologies of scoping reviews, along with the development of reporting guidance, will facilitate methodological advancement, reduce confusion, facilitate collaboration and improve knowledge translation of scoping review findings. Copyright © 2014 Elsevier Inc. All rights reserved.

Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document

PubMed Central

2014-01-01

Background There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making. Methods The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document. Results Recommendations were developed for “using available data” and “future clinical studies”. The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. Conclusion The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design. PMID:24885146

A modified Delphi translation strategy and challenges of International Classification for Nursing Practice (ICNP®).

PubMed

Hou, I-Ching; Chang, Polun; Chan, Hui-Ya; Dykes, Patricia C

2013-05-01

Standardized terminology is an important infrastructure component of the electronic health record. ICNP(®) is a systemic coding system that can support the development of nursing information systems. Translation of the standardized terminology preferred terms into local terms is an important first step in the translation process. The purpose of this case report is to describe the translation strategy used and challenges faced in translating ICNP(®) Version 2 preferred terms from English to traditional Chinese. A modified Delphi strategy using forward translation and expert consensus was conducted to facilitate semantic and cultural translation and validation of the ICNP(®) and to make the process generalizable. A nursing informatics expert completed the initial forward translation. Five nursing experts with rich clinical and academic experiences joined this process and validated the initial translation. The nursing experts' consensus was then used to finalize the traditional Chinese terms. A total of 1863 preferred terms from the ICNP(®) Version 2 were translated from English into traditional Chinese. Majority agreement from two or more nursing experts was achieved for 98.3% (n=1832) of the preferred term translations. Less than 2% (n=31) of terms had no majority agreement. Translation challenges include the following: (1) changes in code structure of preferred terms from the ICNP(®) β2 version to Verson 2, (2) inability to identify resources to complete the translation that fully met ICNP recommendations for terminology translators, (3) ambiguous preferred term descriptions, and (4) ambiguous preferred term names. Most of the ICNP(®) Version 2 preferred terms were translated from English into traditional Chinese with majority consensus. For the terms without consensus, we recommend that all synonyms be included in the ICNP(®) translation. In countries like Taiwan where nursing education occurs in English, it is recommended that English terms are displayed along with the translated official language to help nurses to interpret and use the terminology correctly. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Organizational readiness for knowledge translation in chronic care: a Delphi study.

PubMed

Attieh, Randa; Gagnon, Marie-Pierre; Estabrooks, Carole A; Légaré, France; Ouimet, Mathieu; Vazquez, Patricia; Nuño, Roberto

2014-11-08

Health-care organizations need to be ready prior to implement evidence-based interventions. In this study, we sought to achieve consensus on a framework to assess the readiness of health-care organizations to implement evidence-based interventions in the context of chronic care. We conducted a web-based modified Delphi study between March and May 2013. We contacted 76 potentially eligible international experts working in the fields of organizational readiness (OR), knowledge translation (KT), and chronic care to comment upon the 76 elements resulting from our proposed conceptual map. This conceptual map was based on a systematic review of the existing frameworks of Organizational Readiness for Change (ORC) in health-care. We developed a conceptual map that proposed a set of core concepts and their associated 17 dimensions and 59 sub-dimensions. Experts rated their agreement concerning the applicability and importance of ORC elements on a 5-point Likert scale, where 1 indicates total disagreement and 5 indicates total agreement. Two rounds were needed to get a consensus from the experts. Consensus was a priori defined as strong (≥75%) or moderate (60-74%). Simple descriptive statistics was used. In total, 14 participants completed the first round and 10 completed the two rounds. Panel members reached consensus on the applicability and importance of 6 out of 17 dimensions and 28 out of 59 sub-dimensions to assess OR for KT in the context of chronic care. A strong level of consensus (≥75%) was attained on the Organizational contextual factors, Leadership/participation, Organizational support, and Motivation dimensions. The Organizational climate for change and Change content dimensions reached a moderate consensus (60-74%). Experts also reached consensus on 28 out of 59 sub-dimensions to assess OR for KT. Twenty-one sub-dimensions reached a strong consensus (≥75%) and seven a moderate consensus (60-74%). This study results provided the most important and applicable dimensions and sub-dimensions for assessing OR-KT in the context of chronic care. They can be used to guide the design of an assessment tool to improve knowledge translation in the field of chronic care.

Consensus Algorithms for Networks of Systems with Second- and Higher-Order Dynamics

NASA Astrophysics Data System (ADS)

Fruhnert, Michael

This thesis considers homogeneous networks of linear systems. We consider linear feedback controllers and require that the directed graph associated with the network contains a spanning tree and systems are stabilizable. We show that, in continuous-time, consensus with a guaranteed rate of convergence can always be achieved using linear state feedback. For networks of continuous-time second-order systems, we provide a new and simple derivation of the conditions for a second-order polynomials with complex coefficients to be Hurwitz. We apply this result to obtain necessary and sufficient conditions to achieve consensus with networks whose graph Laplacian matrix may have complex eigenvalues. Based on the conditions found, methods to compute feedback gains are proposed. We show that gains can be chosen such that consensus is achieved robustly over a variety of communication structures and system dynamics. We also consider the use of static output feedback. For networks of discrete-time second-order systems, we provide a new and simple derivation of the conditions for a second-order polynomials with complex coefficients to be Schur. We apply this result to obtain necessary and sufficient conditions to achieve consensus with networks whose graph Laplacian matrix may have complex eigenvalues. We show that consensus can always be achieved for marginally stable systems and discretized systems. Simple conditions for consensus achieving controllers are obtained when the Laplacian eigenvalues are all real. For networks of continuous-time time-variant higher-order systems, we show that uniform consensus can always be achieved if systems are quadratically stabilizable. In this case, we provide a simple condition to obtain a linear feedback control. For networks of discrete-time higher-order systems, we show that constant gains can be chosen such that consensus is achieved for a variety of network topologies. First, we develop simple results for networks of time-invariant systems and networks of time-variant systems that are given in controllable canonical form. Second, we formulate the problem in terms of Linear Matrix Inequalities (LMIs). The condition found simplifies the design process and avoids the parallel solution of multiple LMIs. The result yields a modified Algebraic Riccati Equation (ARE) for which we present an equivalent LMI condition.

Developing a guideline for clinical trial protocol content: Delphi consensus survey

PubMed Central

2012-01-01

Background Recent evidence has highlighted deficiencies in clinical trial protocols, having implications for many groups. Existing guidelines for randomized clinical trial (RCT) protocol content vary substantially and most do not describe systematic methodology for their development. As one of three prespecified steps for the systematic development of a guideline for trial protocol content, the objective of this study was to conduct a three-round Delphi consensus survey to develop and refine minimum content for RCT protocols. Methods Panellists were identified using a multistep iterative approach, met prespecified minimum criteria and represented key stakeholders who develop or use clinical trial protocols. They were asked to rate concepts for importance in a minimum set of items for RCT protocols. The main outcome measures were degree of importance (scale of 1 to 10; higher scores indicating higher importance) and level of consensus for items. Results were presented as medians, interquartile ranges, counts and percentages. Results Ninety-six expert panellists participated in the Delphi consensus survey including trial investigators, methodologists, research ethics board members, funders, industry, regulators and journal editors. Response rates were between 88 and 93% per round. Overall, panellists rated 63 of 88 concepts of high importance (of which 50 had a 25th percentile rating of 8 or greater), 13 of moderate importance (median 6 or 7) and 12 of low importance (median less than or equal to 5) for minimum trial protocol content. General and item-specific comments and subgroup results provided valuable insight for further discussions. Conclusions This Delphi process achieved consensus from a large panel of experts from diverse stakeholder groups on essential content for RCT protocols. It also highlights areas of divergence. These results, complemented by other empirical research and consensus meetings, are helping guide the development of a guideline for protocol content. PMID:23006145

Use of cultural consensus analysis to evaluate expert feedback of median safety.

PubMed

Kim, Tae-Gyu; Donnell, Eric T; Lee, Dongmin

2008-07-01

Cultural consensus analysis is a statistical method that can be used to assess participant responses to survey questions. The technique concurrently estimates the knowledge of each survey participant and estimates the culturally correct answer to each question asked, based on the existence of consensus among survey participants. The main objectives of this paper are to present the cultural consensus methodology and apply it to a set of median design and safety survey data that were collected using the Delphi method. A total of 21 Delphi survey participants were asked to answer research questions related to cross-median crashes. It was found that the Delphi panel had agreeable opinions with respect to the association of average daily traffic (ADT) and heavy vehicle percentage combination on the risk of cross-median crashes; relative importance of additional factors, other than ADT, median width, and crash history that may contribute to cross-median crashes; and, the relative importance of geometric factors that may be associated with the likelihood of cross-median crashes. Therefore, the findings from the cultural consensus analysis indicate that the expert panel selected to participate in the Delphi survey shared a common knowledge pool relative to the association between median design and safety. There were, however, diverse opinions regarding median barrier type and its preferred placement location. The panel showed a higher level of knowledge on the relative importance regarding the association of geometric factors on cross-median crashes likelihood than on other issues considered. The results of the cultural consensus analysis of the present median design and safety survey data could be used to design a focused field study of median safety.

The trials methodological research agenda: results from a priority setting exercise.

PubMed

Tudur Smith, Catrin; Hickey, Helen; Clarke, Mike; Blazeby, Jane; Williamson, Paula

2014-01-23

Research into the methods used in the design, conduct, analysis, and reporting of clinical trials is essential to ensure that effective methods are available and that clinical decisions made using results from trials are based on the best available evidence, which is reliable and robust. An on-line Delphi survey of 48 UK Clinical Research Collaboration registered Clinical Trials Units (CTUs) was undertaken. During round one, CTU Directors were asked to identify important topics that require methodological research. During round two, their opinion about the level of importance of each topic was recorded, and during round three, they were asked to review the group's average opinion and revise their previous opinion if appropriate. Direct reminders were sent to maximise the number of responses at each round. Results are summarised using descriptive methods. Forty one (85%) CTU Directors responded to at least one round of the Delphi process: 25 (52%) responded in round one, 32 (67%) responded in round two, 24 (50%) responded in round three. There were only 12 (25%) who responded to all three rounds and 18 (38%) who responded to both rounds two and three. Consensus was achieved amongst CTU Directors that the top three priorities for trials methodological research were 'Research into methods to boost recruitment in trials' (considered the highest priority), 'Methods to minimise attrition' and 'Choosing appropriate outcomes to measure'. Fifty other topics were included in the list of priorities and consensus was reached that two topics, 'Radiotherapy study designs' and 'Low carbon trials', were not priorities. This priority setting exercise has identified the research topics felt to be most important to the key stakeholder group of Directors of UKCRC registered CTUs. The use of robust methodology to identify these priorities will help ensure that this work informs the trials methodological research agenda, with a focus on topics that will have most impact and relevance.

The trials methodological research agenda: results from a priority setting exercise

PubMed Central

2014-01-01

Background Research into the methods used in the design, conduct, analysis, and reporting of clinical trials is essential to ensure that effective methods are available and that clinical decisions made using results from trials are based on the best available evidence, which is reliable and robust. Methods An on-line Delphi survey of 48 UK Clinical Research Collaboration registered Clinical Trials Units (CTUs) was undertaken. During round one, CTU Directors were asked to identify important topics that require methodological research. During round two, their opinion about the level of importance of each topic was recorded, and during round three, they were asked to review the group’s average opinion and revise their previous opinion if appropriate. Direct reminders were sent to maximise the number of responses at each round. Results are summarised using descriptive methods. Results Forty one (85%) CTU Directors responded to at least one round of the Delphi process: 25 (52%) responded in round one, 32 (67%) responded in round two, 24 (50%) responded in round three. There were only 12 (25%) who responded to all three rounds and 18 (38%) who responded to both rounds two and three. Consensus was achieved amongst CTU Directors that the top three priorities for trials methodological research were ‘Research into methods to boost recruitment in trials’ (considered the highest priority), ‘Methods to minimise attrition’ and ‘Choosing appropriate outcomes to measure’. Fifty other topics were included in the list of priorities and consensus was reached that two topics, ‘Radiotherapy study designs’ and ‘Low carbon trials’, were not priorities. Conclusions This priority setting exercise has identified the research topics felt to be most important to the key stakeholder group of Directors of UKCRC registered CTUs. The use of robust methodology to identify these priorities will help ensure that this work informs the trials methodological research agenda, with a focus on topics that will have most impact and relevance. PMID:24456928

Building Bridge between Learning and Positive Emotion: How to Apply Emotional Factor in Instructional Designing Process?

ERIC Educational Resources Information Center

Park, Sanghoon

2004-01-01

For millennia, emotional states have been viewed as avoidable impediments to rational thinking (Ellis & Newton, 2000). Several reasons have been pointed out. The lack of consensus of the definition on emotion that tend to conflict with each other was suggested as a main reason (Price, 1998). Also the difficulty of research methodology such as…

Taking Stock of 40 Years of Research on Mathematical Learning Disability: Methodological Issues and Future Directions

ERIC Educational Resources Information Center

Lewis, Katherine E.; Fisher, Marie B.

2016-01-01

Although approximately 5-8% of students have a mathematical learning disability (MLD), researchers have yet to develop a consensus operational definition. To examine how MLD has been identified and what mathematics topics have been explored, the authors conducted a systematic review of 165 studies on MLD published between 1974 and 2013. To move…

Comparing alternatives for increasing sampling intensity in forest inventories

Treesearch

J. Blackard; P. Patterson

2014-01-01

Each of the U.S. Forest Service’s Forest Inventory and Analysis (FIA) regions has an occasional need to intensify the national sampling grid. A variety of methodologies exist within the various FIA regions and National Forest Systems regions for constructing plot intensifications, and there is no consensus on a national procedure The primary objectives of this paper...

Mapping Learning and Game Mechanics for Serious Games Analysis

ERIC Educational Resources Information Center

Arnab, Sylvester; Lim, Theodore; Carvalho, Maira B.; Bellotti, Francesco; de Freitas, Sara; Louchart, Sandy; Suttie, Neil; Berta, Riccardo; De Gloria, Alessandro

2015-01-01

Although there is a consensus on the instructional potential of Serious Games (SGs), there is still a lack of methodologies and tools not only for design but also to support analysis and assessment. Filling this gap is one of the main aims of the Games and Learning Alliance (http://www.galanoe.eu) European Network of Excellence on Serious Games,…

The clustering of galaxies in the completed SDSS-III Baryon Oscillation Spectroscopic Survey: combining correlated Gaussian posterior distributions

DOE PAGES

Sánchez, Ariel G.; Grieb, Jan Niklas; Salazar-Albornoz, Salvador; ...

2016-09-30

The cosmological information contained in anisotropic galaxy clustering measurements can often be compressed into a small number of parameters whose posterior distribution is well described by a Gaussian. Here, we present a general methodology to combine these estimates into a single set of consensus constraints that encode the total information of the individual measurements, taking into account the full covariance between the different methods. We also illustrate this technique by applying it to combine the results obtained from different clustering analyses, including measurements of the signature of baryon acoustic oscillations and redshift-space distortions, based on a set of mock cataloguesmore » of the final SDSS-III Baryon Oscillation Spectroscopic Survey (BOSS). Our results show that the region of the parameter space allowed by the consensus constraints is smaller than that of the individual methods, highlighting the importance of performing multiple analyses on galaxy surveys even when the measurements are highly correlated. Our paper is part of a set that analyses the final galaxy clustering data set from BOSS. The methodology presented here is used in Alam et al. to produce the final cosmological constraints from BOSS.« less

[Practice guidelines for pain management in Mexico].

PubMed

Guevara-López, Uriah; Covarrubias-Gómez, Alfredo; Rodríguez-Cabrera, Rafael; Carrasco-Rojas, Antonio; Aragón, Griselda; Ayón-Villanueva, Hortensia

2007-01-01

It has been documented that pain, in its diverse modalities, is the most common cause of medical attention in Mexico. Due to the increased frequency, pain management has been under consideration in health programs. On the other hand, inadequate pain management can cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has been no agreement to establish better diagnostic and therapeutic methods. Three consensus groups were reunited in different times; those were integrated by medical experts from private and public institutions and form diverse states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of painful conditions. Following the methodology used for other consensus groups, diverse meetings were held to review medical evidence about the assessment and treatment of acute, perioperative and cancer pain. A series of recommendations were obtained and classified according to their methodological strength. As a result of these meetings, a series of recommendations based on the medical evidence were obtained. These recommendations are outlined in three practice guidelines that are intended to allow Mexican practitioners to provide optimal management for painful conditions.

Measurement properties of questionnaires assessing participation in children and adolescents with a disability: a systematic review.

PubMed

Rainey, Linda; van Nispen, Ruth; van der Zee, Carlijn; van Rens, Ger

2014-12-01

To critically appraise the measurement properties of questionnaires measuring participation in children and adolescents (0-18 years) with a disability. Bibliographic databases were searched for studies evaluating the measurement properties of self-report or parent-report questionnaires measuring participation in children and adolescents (0-18 years) with a disability. The methodological quality of the included studies and the results of the measurement properties were evaluated using a checklist developed on consensus-based standards. The search strategy identified 3,977 unique publications, of which 22 were selected; these articles evaluated the development and measurement properties of eight different questionnaires. The Child and Adolescent Scale of Participation was evaluated most extensively, generally showing moderate positive results on content validity, internal consistency, reliability and construct validity. The remaining questionnaires also demonstrated positive results. However, at least 50 % of the measurement properties per questionnaire were not (or only poorly) assessed. Studies of high methodological quality, using modern statistical methods, are needed to accurately assess the measurement properties of currently available questionnaires. Moreover, consensus is required on the definition of the construct 'participation' to determine content validity and to enable meaningful interpretation of outcomes.

Appropriate Use Criteria in Dermatopathology: Initial Recommendations from the American Society of Dermatopathology.

PubMed

Vidal, Claudia I; Armbrect, Eric A; Andea, Aleodor A; Bohlke, Angela K; Comfere, Nneka I; Hughes, Sarah R; Kim, Jinah; Kozel, Jessica A; Lee, Jason B; Linos, Konstantinos; Litzner, Brandon R; Missall, Tricia A; Novoa, Roberto A; Sundram, Uma; Swick, Brian L; Hurley, M Yadira; Alam, Murad; Argenyi, Zsolt; Duncan, Lyn M; Elston, Dirk M; Emanuel, Patrick O; Ferringer, Tammie; Fung, Maxwell A; Hosler, Gregory A; Lazar, Alexander J; Lowe, Lori; Plaza, Jose A; Prieto, Victor G; Robinson, June K; Schaffer, Andras; Subtil, Antonio; Wang, Wei-Lien

2018-04-21

Appropriate use criteria (AUC) provide physicians guidance in test selection, can affect health care delivery, reimbursement policy, and physician decision-making. The American Society of Dermatopathology (ASDP), with input from the American Academy of Dermatology (AAD) and the College of American Pathologists (CAP), sought to develop AUC in dermatopathology. The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology. With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios (CS) involving 12 ancillary studies (AS). Consensus was reached for 188 (89%) CS, with 93 (44%) considered "usually appropriate", 52 (25%) "rarely appropriate", and 43 (20%) "uncertain appropriateness". The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. The ultimate decision of when to order specific test rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendation of appropriateness - AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research. Copyright © 2018. Published by Elsevier Inc.

The alcohol hangover research group consensus statement on best practice in alcohol hangover research.

PubMed

Verster, Joris C; Stephens, Richard; Penning, Renske; Rohsenow, Damaris; McGeary, John; Levy, Dan; McKinney, Adele; Finnigan, Frances; Piasecki, Thomas M; Adan, Ana; Batty, G David; Fliervoet, Lies A L; Heffernan, Thomas; Howland, Jonathan; Kim, Dai-Jin; Kruisselbrink, L Darren; Ling, Jonathan; McGregor, Neil; Murphy, René J L; van Nuland, Merel; Oudelaar, Marieke; Parkes, Andrew; Prat, Gemma; Reed, Nick; Slutske, Wendy S; Smith, Gordon; Young, Mark

2010-06-01

Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies.

Immunological research in clinical psychiatry: report on the consensus debate during the 7th Expert Meeting on Psychiatry and Immunology.

PubMed

Arolt, V; Rothermundt, M; Peters, M; Leonard, B

2002-01-01

There is convincing evidence that cytokines are involved in the physiology and pathophysiology of brain function and interact with different neurotransmitter and neuroendocrine pathways. The possible involvement of the immune system in the neurobiological mechanisms that underlie psychiatric disorders has attracted increasing attention in recent years. Thus in the last decade, numerous clinical studies have demonstrated dysregulated immune functions in patients with psychiatric disorders. Such findings formed the basis of the 7th Expert Meeting on Psychiatry and Immunology in Muenster, Germany, where a consensus symposium was held to consider the strengths and weaknesses of current research in psychoneuroimmunology. Following a general overview of the field, the following topics were discussed: (1) methodological problems in laboratory procedures and recruitment of clinical samples; (2) the importance of pre-clinical research and animal models in psychiatric research; (3) the problem of statistical vs biological relevance. It was concluded that, despite a fruitful proliferation of research activities throughout the last decade, the continuous elaboration of methodological standards including the implementation of hypothesis-driven research represents a task that is likely to prove crucial for the future development of immunology research in clinical psychiatry.

Macroeconomic effects on mortality revealed by panel analysis with nonlinear trends.

PubMed

Ionides, Edward L; Wang, Zhen; Tapia Granados, José A

2013-10-03

Many investigations have used panel methods to study the relationships between fluctuations in economic activity and mortality. A broad consensus has emerged on the overall procyclical nature of mortality: perhaps counter-intuitively, mortality typically rises above its trend during expansions. This consensus has been tarnished by inconsistent reports on the specific age groups and mortality causes involved. We show that these inconsistencies result, in part, from the trend specifications used in previous panel models. Standard econometric panel analysis involves fitting regression models using ordinary least squares, employing standard errors which are robust to temporal autocorrelation. The model specifications include a fixed effect, and possibly a linear trend, for each time series in the panel. We propose alternative methodology based on nonlinear detrending. Applying our methodology on data for the 50 US states from 1980 to 2006, we obtain more precise and consistent results than previous studies. We find procyclical mortality in all age groups. We find clear procyclical mortality due to respiratory disease and traffic injuries. Predominantly procyclical cardiovascular disease mortality and countercyclical suicide are subject to substantial state-to-state variation. Neither cancer nor homicide have significant macroeconomic association.

Macroeconomic effects on mortality revealed by panel analysis with nonlinear trends

PubMed Central

Ionides, Edward L.; Wang, Zhen; Tapia Granados, José A.

2013-01-01

Many investigations have used panel methods to study the relationships between fluctuations in economic activity and mortality. A broad consensus has emerged on the overall procyclical nature of mortality: perhaps counter-intuitively, mortality typically rises above its trend during expansions. This consensus has been tarnished by inconsistent reports on the specific age groups and mortality causes involved. We show that these inconsistencies result, in part, from the trend specifications used in previous panel models. Standard econometric panel analysis involves fitting regression models using ordinary least squares, employing standard errors which are robust to temporal autocorrelation. The model specifications include a fixed effect, and possibly a linear trend, for each time series in the panel. We propose alternative methodology based on nonlinear detrending. Applying our methodology on data for the 50 US states from 1980 to 2006, we obtain more precise and consistent results than previous studies. We find procyclical mortality in all age groups. We find clear procyclical mortality due to respiratory disease and traffic injuries. Predominantly procyclical cardiovascular disease mortality and countercyclical suicide are subject to substantial state-to-state variation. Neither cancer nor homicide have significant macroeconomic association. PMID:24587843

Modified Delphi Investigation of Motor Development and Learning in Physical Education Teacher Education

ERIC Educational Resources Information Center

Ross, Susan; Metcalf, Amanda; Bulger, Sean M.; Housner, Lynn D.

2014-01-01

Purpose: As the scope of motor development and learning knowledge has successfully broadened over the years, there is an increased need to identify the content and learning experiences that are essential in preparing preservice physical educators. The purpose of this study was to generate expert consensus regarding the most critical motor…

Curriculum Elements of a Politically Liberal Education in a Developing Democracy

ERIC Educational Resources Information Center

Çelik, Rasit

2016-01-01

A previous study has justified the idea that a politically liberal conception of formal education can be applied in a developing democracy if such a society has reached a narrow overlapping consensus on its education system or modifies its education system from a minimally coercive perspective. This study further considers the fundamental question…

A consensus-based framework for design, validation, and implementation of simulation-based training curricula in surgery.

PubMed

Zevin, Boris; Levy, Jeffrey S; Satava, Richard M; Grantcharov, Teodor P

2012-10-01

Simulation-based training can improve technical and nontechnical skills in surgery. To date, there is no consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. The aim of this study was to define such principles and formulate them into an interoperable framework using international expert consensus based on the Delphi method. Literature was reviewed, 4 international experts were queried, and consensus conference of national and international members of surgical societies was held to identify the items for the Delphi survey. Forty-five international experts in surgical education were invited to complete the online survey by ranking each item on a Likert scale from 1 to 5. Consensus was predefined as Cronbach's α ≥0.80. Items that 80% of experts ranked as ≥4 were included in the final framework. Twenty-four international experts with training in general surgery (n = 11), orthopaedic surgery (n = 2), obstetrics and gynecology (n = 3), urology (n = 1), plastic surgery (n = 1), pediatric surgery (n = 1), otolaryngology (n = 1), vascular surgery (n = 1), military (n = 1), and doctorate-level educators (n = 2) completed the iterative online Delphi survey. Consensus among participants was achieved after one round of the survey (Cronbach's α = 0.91). The final framework included predevelopment analysis; cognitive, psychomotor, and team-based training; curriculum validation evaluation and improvement; and maintenance of training. The Delphi methodology allowed for determination of international expert consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. These principles were formulated into a framework that can be used internationally across surgical specialties as a step-by-step guide for the development and validation of future simulation-based training curricula. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A More Flexible Approach to Valuing Flexibility

DTIC Science & Technology

2011-04-01

remaining life of the program? Almost certainly. Next is the cost assessment step. This is executed in the context of whatever design options we...methodology is essentially a modifi- cation of the current life cycle model and is premised on the notion that the need for capabili- ty changes in a program...valuing the inherent ability of a system or design to accommodate change. The proposed methodology is essentially a modifi-cation of the current life

Rice MEL2, the RNA recognition motif (RRM) protein, binds in vitro to meiosis-expressed genes containing U-rich RNA consensus sequences in the 3'-UTR.

PubMed

Miyazaki, Saori; Sato, Yutaka; Asano, Tomoya; Nagamura, Yoshiaki; Nonomura, Ken-Ichi

2015-10-01

Post-transcriptional gene regulation by RNA recognition motif (RRM) proteins through binding to cis-elements in the 3'-untranslated region (3'-UTR) is widely used in eukaryotes to complete various biological processes. Rice MEIOSIS ARRESTED AT LEPTOTENE2 (MEL2) is the RRM protein that functions in the transition to meiosis in proper timing. The MEL2 RRM preferentially associated with the U-rich RNA consensus, UUAGUU[U/A][U/G][A/U/G]U, dependently on sequences and proportionally to MEL2 protein amounts in vitro. The consensus sequences were located in the putative looped structures of the RNA ligand. A genome-wide survey revealed a tendency of MEL2-binding consensus appearing in 3'-UTR of rice genes. Of 249 genes that conserved the consensus in their 3'-UTR, 13 genes spatiotemporally co-expressed with MEL2 in meiotic flowers, and included several genes whose function was supposed in meiosis; such as Replication protein A and OsMADS3. The proteome analysis revealed that the amounts of small ubiquitin-related modifier-like protein and eukaryotic translation initiation factor3-like protein were dramatically altered in mel2 mutant anthers. Taken together with transcriptome and gene ontology results, we propose that the rice MEL2 is involved in the translational regulation of key meiotic genes on 3'-UTRs to achieve the faithful transition of germ cells to meiosis.

International Expert Panel Consensus Guidelines for Structure and Delivery of Qigong Exercise for Cancer Care Programming

PubMed Central

Klein, Penelope; Picard, George; Schneider, Roger; Oh, Byeongsang

2017-01-01

Integrative oncology, including Qigong, is a relatively new concept in modern healthcare. Evidence of benefits of Qigong in cancer survivors is emerging. As such, several cancer centers, world-wide, have introduced Qigong as part of integrative medicine within supportive cancer care programming. Qigong exercise programming content and quality varies among institutions due to lack of standard guidelines and, at present, relies solely on the instructor’s skills, knowledge, personal preferences and clinical experience. Development of consensus guidelines recommending the basic structure and delivery of Qigong programming in cancer care can potentiate quality assurance and reduce risk of harm. This applied qualitative research utilized a modified Delphi approach to formulate consensus guidelines. Guidelines were developed through discussions among an international expert panel (N = 13) with representation from Australia, Canada, Ireland, and the United States. Panel communication was predominantly conducted by email and occurred from November 2016 through February 2017. Expert panel work resulted in the generation of a work product: Qigong in Cancer Care Guidelines: A Working Paper including: (a) Consensus Guidelines for structure and delivery of Qigong exercise for Cancer care programming; (b) Consensus guidelines for instructor competence for teaching Qigong exercise for cancer care classes; (c) Screening tool for safe participation in Qigong exercise; (d) Class participant instructions for maintaining safety during Qigong exercise; and (e) Advice from the field. Generation of these resources is the first step in establishing recommendations for ‘best practice’ in the area of Qigong for cancer care programming.

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

PubMed

Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn

2016-07-01

To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. © 2016 John Wiley & Sons Ltd.

An updated Asia Pacific Consensus Recommendations on colorectal cancer screening.

PubMed

Sung, J J Y; Ng, S C; Chan, F K L; Chiu, H M; Kim, H S; Matsuda, T; Ng, S S M; Lau, J Y W; Zheng, S; Adler, S; Reddy, N; Yeoh, K G; Tsoi, K K F; Ching, J Y L; Kuipers, E J; Rabeneck, L; Young, G P; Steele, R J; Lieberman, D; Goh, K L

2015-01-01

Since the publication of the first Asia Pacific Consensus on Colorectal Cancer (CRC) in 2008, there are substantial advancements in the science and experience of implementing CRC screening. The Asia Pacific Working Group aimed to provide an updated set of consensus recommendations. Members from 14 Asian regions gathered to seek consensus using other national and international guidelines, and recent relevant literature published from 2008 to 2013. A modified Delphi process was adopted to develop the statements. Age range for CRC screening is defined as 50-75 years. Advancing age, male, family history of CRC, smoking and obesity are confirmed risk factors for CRC and advanced neoplasia. A risk-stratified scoring system is recommended for selecting high-risk patients for colonoscopy. Quantitative faecal immunochemical test (FIT) instead of guaiac-based faecal occult blood test (gFOBT) is preferred for average-risk subjects. Ancillary methods in colonoscopy, with the exception of chromoendoscopy, have not proven to be superior to high-definition white light endoscopy in identifying adenoma. Quality of colonoscopy should be upheld and quality assurance programme should be in place to audit every aspects of CRC screening. Serrated adenoma is recognised as a risk for interval cancer. There is no consensus on the recruitment of trained endoscopy nurses for CRC screening. Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

PubMed

McKenzie, Emily; Potestio, Melissa L; Boyd, Jamie M; Niven, Daniel J; Brundin-Mather, Rebecca; Bagshaw, Sean M; Stelfox, Henry T

2017-12-01

Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process.

PubMed

Carr, Norman J; Cecil, Thomas D; Mohamed, Faheez; Sobin, Leslie H; Sugarbaker, Paul H; González-Moreno, Santiago; Taflampas, Panos; Chapman, Sara; Moran, Brendan J

2016-01-01

Pseudomyxoma peritonei (PMP) is a complex disease with unique biological behavior that usually arises from appendiceal mucinous neoplasia. The classification of PMP and its primary appendiceal neoplasia is contentious, and an international modified Delphi consensus process was instigated to address terminology and definitions. A classification of mucinous appendiceal neoplasia was developed, and it was agreed that "mucinous adenocarcinoma" should be reserved for lesions with infiltrative invasion. The term "low-grade appendiceal mucinous neoplasm" was supported and it was agreed that "cystadenoma" should no longer be recommended. A new term of "high-grade appendiceal mucinous neoplasm" was proposed for lesions without infiltrative invasion but with high-grade cytologic atypia. Serrated polyp with or without dysplasia was preferred for tumors with serrated features confined to the mucosa with an intact muscularis mucosae. Consensus was achieved on the pathologic classification of PMP, defined as the intraperitoneal accumulation of mucus due to mucinous neoplasia characterized by the redistribution phenomenon. Three categories of PMP were agreed-low grade, high grade, and high grade with signet ring cells. Acellular mucin should be classified separately. It was agreed that low-grade and high-grade mucinous carcinoma peritonei should be considered synonymous with disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis, respectively. A checklist for the pathologic reporting of PMP and appendiceal mucinous neoplasms was also developed. By adopting the classifications and definitions that were agreed, different centers will be able to use uniform terminology that will allow meaningful comparison of their results.

Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study.

PubMed

Zhou, Yufeng; Cui, Yan; Wang, Hong; Wang, Fang; Lu, Chao; Shen, Yan

2016-09-01

Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0-5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as: the rating mean was>3 and the coefficient of variation (CV) was<0.5. Consensus for each item in the second round was defined as CV<0.3. Consensus among experts was defined as: P value of Kendall's coefficient of concordance ( W )<0.05. After three rounds of consultation, a two-part tool was developed: the Immune Status Scale (ISS) and the Checklist of Risk Factors of Infection (CRFI). There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool's efficacy. © 2016 the Journal of Biomedical Research. All rights reserved.

Canadian Consensus Conference on Osteoporosis, 2006 Update

PubMed Central

Brown, Jacques P.; Fortier, Michel

2016-01-01

Objective To provide guidelines for the health care provider on the diagnosis and clinical management of postmenopausal osteoporosis. Outcomes Strategies for identifying and evaluating high-risk individuals, the use of bone mineral density (BMD) and bone turnover markers in assessing diagnosis and response to management, and recommendations regarding nutrition, physical activity, and the selection of pharmacologic therapy to prevent and manage osteoporosis. Evidence MEDLINE and the Cochrane database were searched for articles in English on subjects related to osteoporosis diagnosis, prevention, and management from March 2001 to April 2005. The authors critically reviewed the evidence and developed the recommendations according to the Journal of Obstetrics and Gynaecology Canada’s methodology and consensus development process. Values The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report. Sponsors The development of this consensus guideline was supported by unrestricted educational grants from Berlex Canada Inc., Lilly Canada, Merck Frosst, Novartis, Novogen, Novo Nordisk, Proctor and Gamble, Schering Canada, and Wyeth Canada. PMID:16626523

2014 consensus statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver).

PubMed

Davis, Jennifer C; Verhagen, Evert; Bryan, Stirling; Liu-Ambrose, Teresa; Borland, Jeff; Buchner, David; Hendriks, Marike R C; Weiler, Richard; Morrow, James R; van Mechelen, Willem; Blair, Steven N; Pratt, Mike; Windt, Johann; al-Tunaiji, Hashel; Macri, Erin; Khan, Karim M

2014-06-01

This article describes major topics discussed from the 'Economics of Physical Inactivity Consensus Workshop' (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Phenomenology and classification of dystonia: a consensus update

PubMed Central

Albanese, Alberto; Bhatia, Kailash; Bressman, Susan B.; DeLong, Mahlon R.; Fahn, Stanley; Fung, Victor S.C.; Hallett, Mark; Jankovic, Joseph; Jinnah, H.A.; Klein, Christine; Lang, Anthony E.; Mink, Jonathan W.; Teller, Jan K.

2013-01-01

This report describes the consensus outcome of an international panel consisting of investigators with years of experience in this field that reviewed the definition and classification of dystonia. Agreement was obtained based on a consensus development methodology during three in-person meetings and manuscript review by mail. Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned and twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Dystonia is classified along two axes: clinical characteristics, including age at onset, body distribution, temporal pattern and associated features (additional movement disorders or neurological features), and etiology, which includes nervous system pathology and inheritance. The clinical characteristics fall into several specific dystonia syndromes that help to guide diagnosis and treatment. We provide here a new general definition of dystonia and propose a new classification. We encourage clinicians and researchers to use these innovative definition and classification and test them in the clinical setting on a variety of patients with dystonia. PMID:23649720

[Consensus on the legibility criteria of health education leaflets].

PubMed

Barrio-Cantalejo, I; Simón-Lorda, P; Jiménez, M Melguizo; Ruiz, A Molina

2011-01-01

To identify the most relevant aspects that guarantee the readability, clarity and simplicity of written health education materials. Delphi methodology in order to reach a state of consensus among health education experts on criteria of legibility in the design and publication of informative material and literature. Seventeen experts reached agreement on the principal recommendations for ensuring the legibility of health education materials. They were as follows: a) text content and layout: to structure the text using a title or subtitle, message explanation and conclusion; b) text construction: to use simple and concise sentences, diagrams and examples, and graphically highlighting the principal ideas; c) lexical comprehension: to use simple words and avoid technical language and abbreviations; d) typography: to use an easy-to-read font. There is a high degree of consensus regarding the way health education materials should be drawn up. This list of recommendations could be used as an instrument for reviewing and improving the design of health education materials. In general, it is recommended to identify the users of the leaflets and involve them in the writing and design.

Cultural stereotypes of disabled and non-disabled men and women: consensus for global category representations and diagnostic domains.

PubMed

Nario-Redmond, Michelle R

2010-09-01

Despite the fact that disabled people comprise a heterogeneous social group, cross-impairment cultural stereotypes reflect a consistent set of beliefs used to characterize this population as dependent, incompetent, and asexual. Using a free-response methodology, stereotypical beliefs about disabled men (DM) and women (DW) were contrasted against the stereotypes of their non-disabled counterparts illustrating the dimensions considered most diagnostic of each group. Results revealed that both disabled and non-disabled participants expressed consensus about the contents of group stereotypes that exaggerate traditional gender role expectations of the non-disabled while minimizing perceived differences between DM and DW. Implications for the field of stereotyping and prejudice, and the individual and system justifying functions of cultural stereotypes are discussed.

Development of a list of high-risk operations for patients 65 years and older.

PubMed

Schwarze, Margaret L; Barnato, Amber E; Rathouz, Paul J; Zhao, Qianqian; Neuman, Heather B; Winslow, Emily R; Kennedy, Gregory D; Hu, Yue-Yung; Dodgion, Christopher M; Kwok, Alvin C; Greenberg, Caprice C

2015-04-01

No consensus exists regarding the definition of high-risk surgery in older adults. An inclusive and precise definition of high-risk surgery may be useful for surgeons, patients, researchers, and hospitals. To develop a list of high-risk operations. Retrospective cohort study and modified Delphi procedure. The setting included all Pennsylvania acute care hospitals (Pennsylvania Health Care Cost Containment Council [PHC4] April 1, 2001, to December 31, 2007) and a nationally representative sample of US acute care hospitals (Nationwide Inpatient Sample [NIS], Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality January 1, 2001, to December 31, 2006). Patients included were those 65 years and older admitted to PHC4 hospitals and those 18 years and older admitted to NIS hospitals. We identified International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes associated with at least 1% inpatient mortality in the PHC4. We used a modified Delphi procedure with 5 board-certified surgeons to further refine this list by excluding nonoperative procedures and operations that were unlikely to be the proximate cause of mortality and were instead a marker of critical illness (eg, tracheostomy). We then cross-validated this list of ICD-9-CM codes in the NIS. Modified Delphi procedure consensus of at least 4 of 5 panelists and proportion agreement in the NIS. Among 4,739,522 admissions of patients 65 years and older in the PHC4, a total of 2,569,589 involved a procedure, encompassing 2853 unique procedures. Of 1130 procedures associated with a crude inpatient mortality of at least 1%, 264 achieved consensus as high-risk operations by the modified Delphi procedure. The observed inpatient mortality in the NIS was at least 1% for 227 of 264 procedures (86%) in patients 65 years and older. The pooled inpatient mortality for these identified high-risk procedures performed on patients 65 years and older was double the pooled inpatient mortality for correspondingly identified high-risk operations for patients younger than 65 years (6% vs 3%). We developed a list of procedure codes to identify high-risk surgical procedures in claims data. This list of high-risk operations can be used to standardize the definition of high-risk surgery in quality and outcomes-based studies and to design targeted clinical interventions.

Patellar Instability Management: A Survey of the International Patellofemoral Study Group.

PubMed

Liu, Joseph N; Steinhaus, Michael E; Kalbian, Irene L; Post, William R; Green, Daniel W; Strickland, Sabrina M; Shubin Stein, Beth E

2017-10-01

Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities. To discover a consensus within treatment controversies in patellofemoral instability among experienced knee surgeons with a specific interest in the patellofemoral joint. Expert opinion; Level of evidence, 5. A 3-step modified Delphi technique was used to establish a consensus. A 34-question, case-based online survey regarding patellofemoral instability was distributed to all active members of the International Patellofemoral Study Group. Consensus statements were generated if at least 66% of the respondents agreed and then redistributed to the same panel. Modifications to the consensus statements were made based on the iterative feedback process until no discordance was encountered in the third stage. Eight consensus statements were achieved. Nonoperative management is the current standard of care for a first-time dislocation in the absence of an osteochondral fragment or loose body requiring excision (100% agreement). In patients with a first-time dislocation with an operative osteochondral fracture requiring excision or repair, patellar instability should be addressed concurrently (89% agreement). Recurrent instability should be treated surgically, with most surgeons favoring medial reconstruction (77%-86% agreement). While there is general agreement that bony procedures should be performed to correct underlying bony deformities, there is no consensus regarding the most appropriate type of procedure performed. Lateral release should not be performed in isolation for the treatment of patellar instability (89% agreement). Despite the consensus generated in this study, our current understanding remains limited by a lack of high-level evidence as well as the numerous complex variables influencing treatment decision making. High-quality, multicenter randomized controlled trials, particularly those directly comparing specific surgical treatment methods while controlling for underlying risk factors, are needed to address these areas of uncertainty.

Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel.

PubMed

Wirrell, Elaine C; Laux, Linda; Donner, Elizabeth; Jette, Nathalie; Knupp, Kelly; Meskis, Mary Anne; Miller, Ian; Sullivan, Joseph; Welborn, Michelle; Berg, Anne T

2017-03-01

To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process. An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies for genetic testing and Dravet syndrome-specific therapies, and (3) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique.

PubMed

O'Neill, Nancy; Dogar, Omara; Jawad, Mohammed; Kellar, Ian; Kanaan, Mona; Siddiqi, Kamran

2018-01-05

Waterpipe smoking is addictive and harmful. The determinants of waterpipe smoking may differ from those of cigarette smoking; therefore, behavioral approaches to support quitting may also differ between these two tobacco products. While some evidence exists on effective behavioral change techniques (BCTs) to facilitate cigarette smoking cessation, there is little research on waterpipe smoking cessation. Twenty-four experts were selected from the author lists of peer-reviewed, randomized controlled trials on waterpipe smoking cessation. They were invited to two rounds of a consensus development exercise using modified Delphi technique. Experts ranked 55 BCTs categorized further into those that promote; "awareness of harms of waterpipe smoking and advantages of quitting" (14), "preparation and planning to quit" (29), and "relapse prevention and sustaining an ex-smoker identity" (12) on their potential effectiveness. Kendall's W statistics was used to assess agreement. Fifteen experts responded in round 1 and 14 completed both rounds. A strong consensus was achieved for BCTs that help in "relapse prevention and sustaining ex-smoker identity" (w = 0.7; p < .001) and a moderate for those that promote "awareness of harms of waterpipe smoking and advantages of quitting" (w = 0.6; p < .001) and "preparation and planning to quit" (w = 0.6; p < .001). Providing information on the consequences of waterpipe smoking and its cessation, assessing readiness and ability to quit, and making people aware of the withdrawal symptoms, were the three highest-ranking BCTs. Based on expert consensus, an inventory of BCTs ordered for their potential effectiveness can be useful for health professionals offering cessation support to waterpipe smokers. Waterpipe smoking is addictive, harmful, and gaining global popularity, particularly among youth. An expert consensus on behavior change techniques, likely to be effective in supporting waterpipe smokers to quit, has practice and research implications. Smoking cessation advisors can use these techniques to counsel waterpipe smokers who wish to quit. Behavioral and public health scientists can also use these to develop and evaluate behavioral support interventions for this client group. © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comparing the Methodologies in ASTM G198 Using Combined Hygrothermal-Corrosion Modeling

Treesearch

Samuel L. Zelinka

2013-01-01

ASTM G198, “Standard test method for determining the relative corrosion performance of driven fasteners in contact with treated wood,” was accepted by consensus and published in 2011. The method has two different exposure conditions for determining fastener corrosion performance in treated wood. The first method places the wood and embedded fasteners in a...

Quality of Work Life: Theoretical and Methodological Problems, and Presentation of a New Model and Measuring Instrument

ERIC Educational Resources Information Center

Martel, Jean-Pierre; Dupuis, Gilles

2006-01-01

Purpose: Ever since the concept of Quality of Work Life (QWL) was first used over 30 years ago, a range of definitions and theoretical constructs have succeeded each other with the aim of mitigating the many problems facing the concept. A historical overview of the concept of QWL is presented here. Given the lack of consensus concerning the…

Dietary fibre: The scientific search for an ideal definition and methodology of analysis, and its physiological importance as a carrier of bioactive compounds.

PubMed

Macagnan, Fernanda Teixeira; da Silva, Leila Picolli; Hecktheuer, Luisa Helena

2016-07-01

There is a growing need for a global consensus on the definition of dietary fibre and the use of appropriate methodologies for its determination in different food matrices. Oligosaccharides (prebiotic effect) and bioactive compounds (antioxidant effect) are important constituents of dietary fibre, which enhance its beneficial effects in the body, such as those related to maintaining intestinal health. These dietary components need to be quantified and addressed in conjunction with fibre in nutritional studies due to the close relationship between them and their common destiny in the human body. This review discusses updates to the concept of dietary fibre, with an emphasis on biological and methodological aspects, and highlights the physiological importance of fibre as a carrier of bioactive compounds. Copyright © 2016 Elsevier Ltd. All rights reserved.

Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

PubMed

Mountjoy, M; Junge, A; Alonso, J M; Clarsen, B; Pluim, B M; Shrier, I; van den Hoogenband, C; Marks, S; Gerrard, D; Heyns, P; Kaneoka, K; Dijkstra, H P; Khan, K M

2016-05-01

Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Achieving high quality standards in laparoscopic colon resection for cancer: A Delphi consensus-based position paper.

PubMed

Lorenzon, Laura; Biondi, Alberto; Carus, Thomas; Dziki, Adam; Espin, Eloy; Figueiredo, Nuno; Ruiz, Marcos Gomez; Mersich, Tamas; Montroni, Isacco; Tanis, Pieter J; Benz, Stefan Rolf; Bianchi, Paolo Pietro; Biebl, Matthias; Broeders, Ivo; De Luca, Raffaele; Delrio, Paolo; D'Hondt, Mathieu; Fürst, Alois; Grosek, Jan; Guimaraes Videira, Jose Flavio; Herbst, Friedrich; Jayne, David; Lázár, György; Miskovic, Danilo; Muratore, Andrea; Helmer Sjo, Ole; Scheinin, Tom; Tomazic, Ales; Türler, Andreas; Van de Velde, Cornelius; Wexner, Steven D; Wullstein, Christoph; Zegarski, Wojciech; D'Ugo, Domenico

2018-04-01

To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field. A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training. Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity). The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: a Delphi approach.

PubMed

Palter, Vanessa N; Graafland, Maurits; Schijven, Marlies P; Grantcharov, Teodor P

2012-03-01

Although task training on virtual reality (VR) simulators has been shown to transfer to the operating room, to date no VR curricula have been described for advanced laparoscopic procedures. The purpose of this study was to develop a proficiency-based VR technical skills curriculum for laparoscopic colorectal surgery. The Delphi method was used to determine expert consensus on which VR tasks (on the LapSim simulator) are relevant to teaching laparoscopic colorectal surgery. To accomplish this task, 19 international experts rated all the LapSim tasks on a Likert scale (1-5) with respect to the degree to which they thought that a particular task should be included in a final technical skills curriculum. Results of the survey were sent back to participants until consensus (Cronbach's α >0.8) was reached. A cross-sectional design was utilized to define the benchmark scores for the identified tasks. Nine expert surgeons completed all identified tasks on the "easy," "medium," and "hard" settings of the simulator. In the first round of the survey, Cronbach's α was 0.715; after the second round, consensus was reached at 0.865. Consensus was reached for 7 basic tasks and 1 advanced suturing task. Median expert time and economy of movement scores were defined as benchmarks for all curricular tasks. This study used Delphi consensus methodology to create a curriculum for an advanced laparoscopic procedure that is reflective of current clinical practice on an international level and conforms to current educational standards of proficiency-based training. Copyright © 2012 Mosby, Inc. All rights reserved.

Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research

PubMed Central

McCann, Liza J; Pilkington, Clarissa A; Huber, Adam M; Ravelli, Angelo; Appelbe, Duncan; Kirkham, Jamie J; Williamson, Paula R; Aggarwal, Amita; Christopher-Stine, Lisa; Constantin, Tamas; Feldman, Brian M; Lundberg, Ingrid; Maillard, Sue; Mathiesen, Pernille; Murphy, Ruth; Pachman, Lauren M; Reed, Ann M; Rider, Lisa G; van Royen-Kerkof, Annet; Russo, Ricardo; Spinty, Stefan; Wedderburn, Lucy R

2018-01-01

Objectives This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. Methods A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. Results A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Conclusions Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases. PMID:29084729

Development of Consensus Treatment Plans for Juvenile Localized Scleroderma

PubMed Central

Li, Suzanne C.; Torok, Kathryn S.; Pope, Elena; Dedeoglu, Fatma; Hong, Sandy; Jacobe, Heidi T.; Rabinovich, C. Egla; Laxer, Ronald M.; Higgins, Gloria C.; Ferguson, Polly J.; Lasky, Andrew; Baszis, Kevin; Becker, Mara; Campillo, Sarah; Cartwright, Victoria; Cidon, Michael; Inman, Christi J; Jerath, Rita; O'Neil, Kathleen M.; Vora, Sheetal; Zeft, Andrew; Wallace, Carol A.; Ilowite, Norman T.; Fuhlbrigge, Robert C

2013-01-01

Objective To develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile localized scleroderma (jLS). Background jLS is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies have been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment of have made it difficult to compare approaches and identify optimal therapy. Methods A core group of pediatric rheumatologists, dermatologists and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for jLS using consensus methods/nominal group techniques. Recommendations were validated in two face-to-face conferences with a larger group of practitioners with expertise in jLS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the U.S and Canada. Results Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (67% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with jLS. Conclusions Using consensus methodology, we have developed standardized treatment plans and assessment methods for jLS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of jLS. PMID:22505322

French national consensus clinical guidelines for the management of ulcerative colitis.

PubMed

Peyrin-Biroulet, Laurent; Bouhnik, Yoram; Roblin, Xavier; Bonnaud, Guillaume; Hagège, Hervé; Hébuterne, Xavier

2016-07-01

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of multifactorial etiology that primarily affects the colonic mucosa. The disease progresses over time, and clinical management guidelines should reflect its dynamic nature. There is limited evidence supporting UC management in specific clinical situations, thus precluding an evidence-based approach. To use a formal consensus method - the nominal group technique (NGT) - to develop a clinical practice expert opinion to outline simple algorithms and practices, optimize UC management, and assist clinicians in making treatment decisions. The consensus was developed by an expert panel of 37 gastroenterologists from various professional organizations with experience in UC management using the qualitative and iterative NGT, incorporating deliberations based on the European Crohn's and Colitis Organisation recommendations, recent reviews of scientific literature, and pertinent discussion topics developed by a steering committee. Examples of clinical cases for which there are limited evidence-based data from clinical trials were used. Two working groups proposed and voted on treatment algorithms that were then discussed and voted for by the nominal group as a whole, in order to reach a consensus. A clinical practice guideline covering management of the following clinical situations was developed: (i) moderate and severe UC; (ii) acute severe UC; (iii) pouchitis; (iv) refractory proctitis, in the form of treatment algorithms. Given the limited available evidence-based data, a formal consensus methodology was used to develop simple treatment guidelines for UC management in different clinical situations that is now accessible via an online application. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Competency-Based Framework and Continuing Education for Preparing a Skilled School Health Workforce for Asthma Care: The Colorado Experience

ERIC Educational Resources Information Center

Cicutto, Lisa; Gleason, Melanie; Haas-Howard, Christy; Jenkins-Nygren, Lynn; Labonde, Susan; Patrick, Kathy

2017-01-01

School health teams commonly address the needs of students with asthma, which requires specific knowledge and skills. To develop a skilled school health team, a competency-based framework for managing asthma in schools was developed. A modified Delphi with 31 panelists was completed. Consensus (=80% agreement) was reached for all 148 items…

Interpretation programming in the NYS Forest Preserve campgrounds: successful consensus building, partnership, and regional management

Treesearch

W. Douglas Fitzgerald

2001-01-01

The focus of this paper concerns how an established program was modified to better support the mission of the sponsoring agency. As an introduction, the NYS Forest Preserve and the Department of Environmental Conservation's role is discussed. .Formal educational programming has taken place in the Forest Preserve campgrounds since the 1930's. The present...

Identification of the Competencies Needed to Apply Social Marketing to Extension Programming: Results of a Delphi Study

ERIC Educational Resources Information Center

Warner, Laura A.; Stubbs, Eric; Murphrey, Theresa Pesl; Huynh, Phuong

2016-01-01

The purpose of this study was to identify the specific competencies needed to apply social marketing, a promising approach to behavior change, to Extension programming. A modified Delphi study was used to achieve group consensus among a panel of experts on the skills, characteristics, and knowledge needed to successfully apply this behavior change…

Policy options for responding to the growing challenge from obesity (PorGrow) in Poland.

PubMed

Szponar, L; Ciok, J; Dolna, A; Oltarzewski, M

2007-05-01

To explore the perspectives of stakeholders towards a range of policy options to respond to obesity in Poland, a multi-criteria mapping method was used. During structured interviews, stakeholders were invited to appraise policy options by reference to criteria of their own choosing. They also provided relative weightings to their criteria, generating overall rankings of the policy options in relation to each other. Efficacy, feasibility and societal benefits were the groups of criteria deemed most important. There was most consensus in favour of options related to health education, particularly in schools, compared with options that aimed at modifying the environment to prevent obesity, i.e. options around physical activity, modifying the supply and demand for food products, and information-related options. There was little support for technological solutions or institutional reforms. There was broad consensus that to reverse the rising trend in the incidence of obesity, it will be necessary to implement a portfolio of measures, but options related to behaviour change through education are most highly regarded. It will also be necessary to invest in improved surveillance and monitoring of Polish dietary practices, levels of physical activity and obesity in terms of data on height, weight and body mass indexes.

Development of the Learning Health System Researcher Core Competencies.

PubMed

Forrest, Christopher B; Chesley, Francis D; Tregear, Michelle L; Mistry, Kamila B

2017-08-04

To develop core competencies for learning health system (LHS) researchers to guide the development of training programs. Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings. The competencies were developed from August to December 2016 using qualitative methods. The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n = 19 members) consensus development meetings produced the final set of competencies. The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field. The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs. © Health Research and Educational Trust.

Ethical case deliberation and decision making.

PubMed

Gracia, Diego

2003-01-01

During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics.

EULAR recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis: focus on anti‐neutrophil cytoplasm antibody‐associated vasculitis

PubMed Central

Hellmich, Bernhard; Flossmann, Oliver; Gross, Wolfgang L; Bacon, Paul; Cohen‐Tervaert, Jan Willem; Guillevin, Loic; Jayne, David; Mahr, Alfred; Merkel, Peter A; Raspe, Heiner; Scott, David G I; Witter, James; Yazici, Hasan; Luqmani, Raashid A

2007-01-01

Objectives To develop the European League Against Rheumatism (EULAR) recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis. Methods An expert consensus group was formed consisting of rheumatologists, nephrologists and specialists in internal medicine representing five European countries and the USA, a clinical epidemiologist and representatives from regulatory agencies. Using an evidence‐based and expert opinion‐based approach in accordance with the standardised EULAR operating procedures, the group identified nine topics for a systematic literature search through a modified Delphi technique. On the basis of research questions posed by the group, recommendations were derived for conducting clinical studies and/or clinical trials in systemic vasculitis. Results Based on the results of the literature research, the expert committee concluded that sufficient evidence to formulate guidelines on conducting clinical trials was available only for anti‐neutrophil cytoplasm antibody‐associated vasculitides (AAV). It was therefore decided to focus the recommendations on these diseases. Recommendations for conducting clinical trials in AAV were elaborated and are presented in this summary document. It was decided to consider vasculitis‐specific issues rather than general issues of trial methodology. The recommendations deal with the following areas related to clinical studies of vasculitis: definitions of disease, activity states, outcome measures, eligibility criteria, trial design including relevant end points, and biomarkers. A number of aspects of trial methodology were deemed important for future research. Conclusions On the basis of expert opinion, recommendations for conducting clinical trials in AAV were formulated. Furthermore, the expert committee identified a strong need for well‐designed research in non‐AAV systemic vasculitides. PMID:17170053

Analytical criteria for performance characteristics of IgE binding methods for evaluating safety of biotech food products.

PubMed

Holzhauser, Thomas; Ree, Ronald van; Poulsen, Lars K; Bannon, Gary A

2008-10-01

There is detailed guidance on how to perform bioinformatic analyses and enzymatic degradation studies for genetically modified crops under consideration for approval by regulatory agencies; however, there is no consensus in the scientific community on the details of how to perform IgE serum studies. IgE serum studies are an important safety component to acceptance of genetically modified crops when the introduced protein is novel, the introduced protein is similar to known allergens, or the crop is allergenic. In this manuscript, we describe the characteristics of the reagents, validation of assay performance, and data analysis necessary to optimize the information obtained from serum testing of novel proteins and genetically modified (GM) crops and to make results more accurate and comparable between different investigations.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that might not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, to achieve the objective. Before the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Before the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items would need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional subitem was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

Methodological issues in the study of violence against women

PubMed Central

Ruiz‐Pérez, Isabel; Plazaola‐Castaño, Juncal; Vives‐Cases, Carmen

2007-01-01

The objective of this paper is to review the methodological issues that arise when studying violence against women as a public health problem, focusing on intimate partner violence (IPV), since this is the form of violence that has the greatest consequences at a social and political level. The paper focuses first on the problems of defining what is meant by IPV. Secondly, the paper describes the difficulties in assessing the magnitude of the problem. Obtaining reliable data on this type of violence is a complex task, because of the methodological issues derived from the very nature of the phenomenon, such as the private, intimate context in which this violence often takes place, which means the problem cannot be directly observed. Finally, the paper examines the limitations and bias in research on violence, including the lack of consensus with regard to measuring events that may or may not represent a risk factor for violence against women or the methodological problem related to the type of sampling used in both aetiological and prevalence studies. PMID:18000113

ACR appropriateness Criteria® second and third trimester bleeding.

PubMed

Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

2013-12-01

Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

PubMed

Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

2015-10-01

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. © 2015, American College of Rheumatology.

Abbreviations for device names: a proposed methodology with specific examples.

PubMed

Alam, Murad; Dover, Jeffrey S; Alam, Murad; Goldman, Mitchel P; Kaminer, Michael S; Orringer, Jeffrey; Waldorf, Heidi; Alam, Murad; Avram, Mathew; Cohen, Joel L; Draelos, Zoe Diana; Dover, Jeffrey S; Hruza, George; Kilmer, Suzanne; Lawrence, Naomi; Lupo, Mary; Metelitsa, Andrei; Nestor, Mark; Ross, E Victor

2013-04-01

Many devices used in dermatology lack generic names. If investigators use commercial device names, they risk the appearance of bias. Alternatively, reliance on ad-hoc names and abbreviations may confuse readers who do not recognize these. To develop a system for assigning abbreviations to denote devices commonly used in dermatology. Secondarily, to use this system to create abbreviations for FDA-approved neurotoxins and prepackaged injectable soft-tissue augmentation materials. The American Society for Dermatologic Surgery convened a Lexicon Task Force in March 2012. One charge of this Task Force was to develop criteria for assigning abbreviations to medical devices. A modified consensus process was used. Abbreviations to denote devices were to be: based on a standardized approach; transparent to the casual reader; markedly brief; and in all cases, different than the commercial names. Three-letter all caps abbreviations, some with subscripts, were assigned to denote each of the approved neurotoxins and fillers. A common system of abbreviations for medical devices in dermatology may avoid the appearance of bias while ensuring effective communication. The proposed system may be expanded to name other devices, and the ensuing abbreviations may be suitable for journal articles, continuing medical education lectures, or other academic or clinical purposes. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Emergency general surgery: definition and estimated burden of disease.

PubMed

Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

2013-04-01

Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

Self-Management for People with Multiple Sclerosis

PubMed Central

Fraser, Robert; Ehde, Dawn; Amtmann, Dagmar; Johnson, Kurt L.; Johnson, Erica; Kraft, George H.

2013-01-01

People with multiple sclerosis (MS) must manage the day-to-day effects of the disease on their lives. Self-management interventions may be helpful in this challenge. An international, multidisciplinary consensus conference was held on November 15, 2010, by the University of Washington's Rehabilitation Research and Training Center for Multiple Sclerosis (MS RRTC), with funding from the Consortium of Multiple Sclerosis Centers (CMSC) and the National Institute on Disability and Rehabilitation Research (NIDRR), to discuss the concept of self-management for people with MS. The specific goals of the consensus conference were as follows: 1) review the current research on self-management and related issues in chronic disability and specifically in MS; 2) review optimal research methodologies, outcome measurement tools, program planning frameworks, and dissemination strategies for self-management research; and 3) establish recommendations on the next steps necessary to develop, adapt, and test self-management interventions for people with MS. The consensus conference and this document are the initial steps toward achieving the stated goals. Participants in the consensus conference concluded that it is necessary to: 1) define an empirically based conceptual model of self-management for people with MS; 2) establish reliable and valid self-management outcome measures; 3) use best practices to validate models of self-management interventions; and 4) plan dissemination and knowledge translation of interventions once their effectiveness is established. PMID:24453769

Approaching Etuaptmumk--introducing a consensus-based mixed method for health services research.

PubMed

Chatwood, Susan; Paulette, Francois; Baker, Ross; Eriksen, Astrid; Hansen, Ketil Lenert; Eriksen, Heidi; Hiratsuka, Vanessa; Lavoie, Josée; Lou, Wendy; Mauro, Ian; Orbinski, James; Pabrum, Nathalie; Retallack, Hanna; Brown, Adalsteinn

2015-01-01

With the recognized need for health systems' improvements in the circumpolar and indigenous context, there has been a call to expand the research agenda across all sectors influencing wellness and to recognize academic and indigenous knowledge through the research process. Despite being recognized as a distinct body of knowledge in international forums and across indigenous groups, examples of methods and theories based on indigenous knowledge are not well documented in academic texts or peer-reviewed literature on health systems. This paper describes the use of a consensus-based, mixed method with indigenous knowledge by an experienced group of researchers and indigenous knowledge holders who collaborated on a study that explored indigenous values underlying health systems stewardship. The method is built on the principles of Etuaptmumk or two-eyed seeing, which aim to respond to and resolve the inherent conflicts between indigenous ways of knowing and the scientific inquiry that informs the evidence base in health care. Mixed methods' frameworks appear to provide a framing suitable for research questions that require data from indigenous knowledge sources and western knowledge. The nominal consensus method, as a western paradigm, was found to be responsive to embedding of indigenous knowledge and allowed space to express multiple perspectives and reach consensus on the question at hand. Further utilization and critical evaluation of this mixed methodology with indigenous knowledge are required.

Approaching Etuaptmumk – introducing a consensus-based mixed method for health services research

PubMed Central

Chatwood, Susan; Paulette, Francois; Baker, Ross; Eriksen, Astrid; Hansen, Ketil Lenert; Eriksen, Heidi; Hiratsuka, Vanessa; Lavoie, Josée; Lou, Wendy; Mauro, Ian; Orbinski, James; Pabrum, Nathalie; Retallack, Hanna; Brown, Adalsteinn

2015-01-01

With the recognized need for health systems’ improvements in the circumpolar and indigenous context, there has been a call to expand the research agenda across all sectors influencing wellness and to recognize academic and indigenous knowledge through the research process. Despite being recognized as a distinct body of knowledge in international forums and across indigenous groups, examples of methods and theories based on indigenous knowledge are not well documented in academic texts or peer-reviewed literature on health systems. This paper describes the use of a consensus-based, mixed method with indigenous knowledge by an experienced group of researchers and indigenous knowledge holders who collaborated on a study that explored indigenous values underlying health systems stewardship. The method is built on the principles of Etuaptmumk or two-eyed seeing, which aim to respond to and resolve the inherent conflicts between indigenous ways of knowing and the scientific inquiry that informs the evidence base in health care. Mixed methods’ frameworks appear to provide a framing suitable for research questions that require data from indigenous knowledge sources and western knowledge. The nominal consensus method, as a western paradigm, was found to be responsive to embedding of indigenous knowledge and allowed space to express multiple perspectives and reach consensus on the question at hand. Further utilization and critical evaluation of this mixed methodology with indigenous knowledge are required. PMID:26004427

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.

PubMed

Hanekom, Susan D; Brooks, Dina; Denehy, Linda; Fagevik-Olsén, Monika; Hardcastle, Timothy C; Manie, Shamila; Louw, Quinette

2012-02-06

Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.

Fuzzy Linear Programming and its Application in Home Textile Firm

NASA Astrophysics Data System (ADS)

Vasant, P.; Ganesan, T.; Elamvazuthi, I.

2011-06-01

In this paper, new fuzzy linear programming (FLP) based methodology using a specific membership function, named as modified logistic membership function is proposed. The modified logistic membership function is first formulated and its flexibility in taking up vagueness in parameter is established by an analytical approach. The developed methodology of FLP has provided a confidence in applying to real life industrial production planning problem. This approach of solving industrial production planning problem can have feedback with the decision maker, the implementer and the analyst.

Defining competency-based evaluation objectives in family medicine

PubMed Central

Lawrence, Kathrine; Allen, Tim; Brailovsky, Carlos; Crichton, Tom; Bethune, Cheri; Donoff, Michel; Laughlin, Tom; Wetmore, Stephen; Carpentier, Marie-Pierre; Visser, Shaun

2011-01-01

Abstract Objective To develop key features for priority topics previously identified by the College of Family Physicians of Canada that, together with skill dimensions and phases of the clinical encounter, broadly describe competence in family medicine. Design Modified nominal group methodology, which was used to develop key features for each priority topic through an iterative process. Setting The College of Family Physicians of Canada. Participants An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian family medicine context with respect to region, sex, language, community type, and experience. Methods The group used a modified Delphi process to derive a detailed operational definition of competence, using multiple iterations until consensus was achieved for the items under discussion. The group met 3 to 4 times a year from 2000 to 2007. Main findings The group analyzed 99 topics and generated 773 key features. There were 2 to 20 (average 7.8) key features per topic; 63% of the key features focused on the diagnostic phase of the clinical encounter. Conclusion This project expands previous descriptions of the process of generating key features for assessment, and removes this process from the context of written examinations. A key-features analysis of topics focuses on higher-order cognitive processes of clinical competence. The project did not define all the skill dimensions of competence to the same degree, but it clearly identified those requiring further definition. This work generates part of a discipline-specific, competency-based definition of family medicine for assessment purposes. It limits the domain for assessment purposes, which is an advantage for the teaching and assessment of learners. A validation study on the content of this work would ensure that it truly reflects competence in family medicine. PMID:21998245

Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer.

PubMed

Quan, May Lynn; Wells, Bryan J; McCready, David; Wright, Frances C; Fraser, Novlette; Gagliardi, Anna R

2010-02-01

Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure. We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review. The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level. A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.

Consensus in Gestational Diabetes MELLITUS: Looking for the Holy Grail.

PubMed

Agarwal, Mukesh M

2018-05-28

The world's pre-eminent diabetes, obstetric, endocrine, and health organizations advocate a plethora of diverse algorithms for the screening, diagnosis, management, and follow-up of gestational diabetes mellitus (GDM). Additionally, there are regional recommendations of local health societies. Several of these proposals for GDM are contentious because some of them were developed from unscientific studies, based on expert-opinion, catered to preserve resources, and subjectively modified for convenience. Due to the wide variety of choices available, the approach to GDM can be extremely diverse even within the same hospital. This lack of consensus creates major problems in addressing prevalence, complications, efficacy of treatment, and follow-up of GDM. Moreover, it becomes nearly impossible to compare the numerous studies. Furthermore, the lack of consensus confuses the health care providers of obstetric health who look to the experts for guidance. Therefore, a clear, objective, "evidence-based" global approach, which is simple, easy to follow, and validated by corroborative research, is crucial. We contend that, despite decades of research, a single acceptable global guideline is not yet on the horizon.

Expert consensus on facilitators and barriers to return-to-work following surgery for non-traumatic upper extremity conditions: a Delphi study.

PubMed

Peters, S E; Johnston, V; Ross, M; Coppieters, M W

2017-02-01

This Delphi study aimed to reach consensus on important facilitators and barriers for return-to-work following surgery for non-traumatic upper extremity conditions. In Round 1, experts ( n = 42) listed 134 factors, which were appraised in Rounds 2 and 3. Consensus (⩾85% agreement) was achieved for 13 facilitators (high motivation to return-to-work; high self-efficacy for return-to-work and recovery; availability of modified/alternative duties; flexible return-to-work arrangements; positive coping skills; limited heavy work exertion; supportive return-to-work policies; supportive supervisor/management; no catastrophic thinking; no fear avoidance to return-to-work; no fear avoidance to pain/activity; return to meaningful work duties; high job satisfaction) and six barriers (mood disorder diagnosis; pain/symptoms at more than one musculoskeletal site; heavy upper extremity exertions at work; lack of flexible return-to-work arrangements; lack of support from supervisor/management; high level of pain catastrophizing). Future prognostic studies are required to validate these biopsychosocial factors to further improve return-to-work outcomes. V.

Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis.

PubMed

Wyse, Jonathan M; Battat, Robert; Sun, Siyu; Saftoiu, Adrian; Siddiqui, Ali A; Leong, Ang Tiing; Arturo Arias, Brenda Lucia; Fabbri, Carlo; Adler, Douglas G; Santo, Erwin; Kalaitzakis, Evangelos; Artifon, Everson; Mishra, Girish; Okasha, Hussein Hassan; Poley, Jan Werner; Guo, Jintao; Vila, Juan J; Lee, Linda S; Sharma, Malay; Bhutani, Manoop S; Giovannini, Marc; Kitano, Masayuki; Eloubeidi, Mohamad Ali; Khashab, Mouen A; Nguyen, Nam Q; Saxena, Payal; Vilmann, Peter; Fusaroli, Pietro; Garg, Pramod Kumar; Ho, Sammy; Mukai, Shuntaro; Carrara, Silvia; Sridhar, Subbaramiah; Lakhtakia, Sundeep; Rana, Surinder S; Dhir, Vinay; Sahai, Anand V

2017-01-01

The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.

From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action.

PubMed

Michie, Susan; Carey, Rachel N; Johnston, Marie; Rothman, Alexander J; de Bruin, Marijn; Kelly, Michael P; Connell, Lauren E

2018-05-18

Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions. This research aims to develop and test a methodology for linking BCTs to their mechanisms of action. Study 1 (published explicit links): Hypothesised links between 93 BCTs (from the 93-item BCT taxonomy, BCTTv1) and mechanisms of action will be identified from published interventions and their frequency, explicitness and precision documented. Study 2 (expert-agreed explicit links): Behaviour change experts will identify links between 61 BCTs and 26 mechanisms of action in a formal consensus study. Study 3 (integrated matrix of explicit links): Agreement between studies 1 and 2 will be evaluated and a new group of experts will discuss discrepancies. An integrated matrix of BCT-mechanism of action links, annotated to indicate strength of evidence, will be generated. Study 4 (published implicit links): To determine whether groups of co-occurring BCTs can be linked to theories, we will identify groups of BCTs that are used together from the study 1 literature. A consensus exercise will be used to rate strength of links between groups of BCT and theories. A formal methodology for linking BCTs to their hypothesised mechanisms of action can contribute to the development and evaluation of behaviour change interventions. This research is a step towards developing a behaviour change 'ontology', specifying relations between BCTs, mechanisms of action, modes of delivery, populations, settings and types of behaviour.

Comparison between modified Misgav-Ladach and Pfannenstiel-Kerr techniques for Cesarean section: review of literature

PubMed Central

Vitale, Salvatore Giovanni; Marilli, Ilaria; Cignini, Pietro; Padula, Francesco; D’Emidio, Laura; Mangiafico, Lucia; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Cianci, Stefano; Biondi, Antonio; Giorlandino, Claudio

2014-01-01

In the last decades cesarean section rates increased in many countries becoming the most performed intraperitoneal surgical procedure. Despite its worldwide spread, a general consensus on the most appropriate technique to use has not yet been reached. The operative technique performed is made chiefly on the basis of the individual experience and preference of operators, the characteristics of patients, timing and urgency of intervention. We compared the two most known and used techniques, modified Misgav-Ladach and traditional Pfannenstiel-Kerr, and analyzed their impact on primary, short- and long-term outcomes and outcome related to health service use. PMID:26265999

Comparison between modified Misgav-Ladach and Pfannenstiel-Kerr techniques for Cesarean section: review of literature.

PubMed

Vitale, Salvatore Giovanni; Marilli, Ilaria; Cignini, Pietro; Padula, Francesco; D'Emidio, Laura; Mangiafico, Lucia; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Cianci, Stefano; Biondi, Antonio; Giorlandino, Claudio

2014-01-01

In the last decades cesarean section rates increased in many countries becoming the most performed intraperitoneal surgical procedure. Despite its worldwide spread, a general consensus on the most appropriate technique to use has not yet been reached. The operative technique performed is made chiefly on the basis of the individual experience and preference of operators, the characteristics of patients, timing and urgency of intervention. We compared the two most known and used techniques, modified Misgav-Ladach and traditional Pfannenstiel-Kerr, and analyzed their impact on primary, short- and long-term outcomes and outcome related to health service use.

The ethics of creating genetically modified children using genome editing.

PubMed

Ishii, Tetsuya

2017-12-01

To review the recent ethical, legal, and social issues surrounding human reproduction involving germline genome editing. Genome editing techniques, such as CRISPR/Cas9, have facilitated genetic modification in human embryos. The most likely purpose of germline genome editing is the prevention of serious genetic disease in offspring. However, complex issues still remain, including irremediable risks to fetuses and future generations, the role of women, the availability of alternatives, long-term follow-up, health insurance coverage, misuse for human enhancement, and the potential effects on adoption. Further discussions, a broad consensus, and appropriate regulations are required before human germline genome editing is introduced into the global society. Before germline genome editing is used for disease prevention, a broad consensus must be formed by carefully discussing its ethical, legal, and social issues.

Expert Opinion Is Necessary: Delphi Panel Methodology Facilitates a Scientific Approach to Consensus.

PubMed

Hohmann, Erik; Brand, Jefferson C; Rossi, Michael J; Lubowitz, James H

2018-02-01

Our current trend and focus on evidence-based medicine is biased in favor of randomized controlled trials, which are ranked highest in the hierarchy of evidence while devaluing expert opinion, which is ranked lowest in the hierarchy. However, randomized controlled trials have weaknesses as well as strengths, and no research method is flawless. Moreover, stringent application of scientific research techniques, such as the Delphi Panel methodology, allows survey of experts in a high quality and scientific manner. Level V evidence (expert opinion) remains a necessary component in the armamentarium used to determine the answer to a clinical question. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Use of expert consensus to improve atherogenic dyslipidemia management.

PubMed

Millán Núñez-Cortés, Jesús; Pedro-Botet, Juan; Brea-Hernando, Ángel; Díaz-Rodríguez, Ángel; González-Santos, Pedro; Hernández-Mijares, Antonio; Mantilla-Morató, Teresa; Pintó-Sala, Xavier; Simó, Rafael

2014-01-01

Although atherogenic dyslipidemia is a recognized cardiovascular risk factor, it is often underassessed and thus undertreated and poorly controlled in clinical practice. The objective of this study was to reach a multidisciplinary consensus for the establishment of a set of clinical recommendations on atherogenic dyslipidemia to optimize its prevention, early detection, diagnostic evaluation, therapeutic approach, and follow-up. After a review of the scientific evidence, a scientific committee formulated 87 recommendations related to atherogenic dyslipidemia, which were grouped into 5 subject areas: general concepts (10 items), impact and epidemiology (4 items), cardiovascular risk (32 items), detection and diagnosis (19 items), and treatment (22 items). A 2-round modified Delphi method was conducted to compare the opinions of a panel of 65 specialists in cardiology (23%), endocrinology (24.6%), family medicine (27.7%), and internal medicine (24.6%) on these issues. After the first round, the panel reached consensus on 65 of the 87 items discussed, and agreed on 76 items by the end of the second round. Insufficient consensus was reached on 3 items related to the detection and diagnosis of atherogenic dyslipidemia and 3 items related to the therapeutic goals to be achieved in these patients. The external assessment conducted by experts on atherogenic dyslipidemia showed a high level of professional agreement with the proposed clinical recommendations. These recommendations represent a useful tool for improving the clinical management of patients with atherogenic dyslipidemia. A detailed analysis of the current scientific evidence is required for those statements that eluded consensus. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

The National Clinical Assessment Tool for Medical Students in the Emergency Department (NCAT-EM)

PubMed Central

Jung, Julianna; Franzen, Douglas; Lawson, Luan; Manthey, David; Tews, Matthew; Dubosh, Nicole; Fisher, Jonathan; Haughey, Marianne; House, Joseph B.; Trainor, Arleigh; Wald, David A.; Hiller, Katherine

2018-01-01

Introduction Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variable process that presents unique challenges and opportunities. Currently, clerkship directors use institution-specific tools with unproven validity and reliability that may or may not address competencies valued most highly in the EM setting. Standardization of assessment practices and development of a common, valid, specialty-specific tool would benefit EM educators and students. Methods A two-day national consensus conference was held in March 2016 in the Clerkship Directors in Emergency Medicine (CDEM) track at the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly in Nashville, TN. The goal of this conference was to standardize assessment practices and to create a national clinical assessment tool for use in EM clerkships across the country. Conference leaders synthesized the literature, articulated major themes and questions pertinent to clinical assessment of students in EM, clarified the issues, and outlined the consensus-building process prior to consensus-building activities. Results The first day of the conference was dedicated to developing consensus on these key themes in clinical assessment. The second day of the conference was dedicated to discussing and voting on proposed domains to be included in the national clinical assessment tool. A modified Delphi process was initiated after the conference to reconcile questions and items that did not reach an a priori level of consensus. Conclusion The final tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM) is presented here. PMID:29383058

Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice.

PubMed

Cohn, David E; Havrilesky, Laura J; Osann, Kathryn; Lipscomb, Joseph; Hsieh, Susie; Walker, Joan L; Wright, Alexi A; Alvarez, Ronald D; Karlan, Beth Y; Bristow, Robert E; DiSilvestro, Paul A; Wakabayashi, Mark T; Morgan, Robert; Mukamel, Dana B; Wenzel, Lari

2015-09-01

To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy. A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers. The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%). Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia.

PubMed

Bai, Chunxue; Choi, Chang-Min; Chu, Chung Ming; Anantham, Devanand; Chung-Man Ho, James; Khan, Ali Zamir; Lee, Jang-Ming; Li, Shi Yue; Saenghirunvattana, Sawang; Yim, Anthony

2016-10-01

American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident.

PubMed

Vassallo, James; Smith, Jason E; Bruijns, Stevan R; Wallis, Lee A

2016-09-01

Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident. We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%. 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus. This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool. Copyright © 2016 Elsevier Ltd. All rights reserved.

Elective Clinical Target Volumes for Conformal Therapy in Anorectal Cancer: A Radiation Therapy Oncology Group Consensus Panel Contouring Atlas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Myerson, Robert J.; Garofalo, Michael C.; El Naqa, Issam

2009-07-01

Purpose: To develop a Radiation Therapy Oncology Group (RTOG) atlas of the elective clinical target volume (CTV) definitions to be used for planning pelvic intensity-modulated radiotherapy (IMRT) for anal and rectal cancers. Methods and Materials: The Gastrointestinal Committee of the RTOG established a task group (the nine physician co-authors) to develop this atlas. They responded to a questionnaire concerning three elective CTVs (CTVA: internal iliac, presacral, and perirectal nodal regions for both anal and rectal case planning; CTVB: external iliac nodal region for anal case planning and for selected rectal cases; CTVC: inguinal nodal region for anal case planning andmore » for select rectal cases), and to outline these areas on individual computed tomographic images. The imaging files were shared via the Advanced Technology Consortium. A program developed by one of the co-authors (I.E.N.) used binomial maximum-likelihood estimates to generate a 95% group consensus contour. The computer-estimated consensus contours were then reviewed by the group and modified to provide a final contouring consensus atlas. Results: The panel achieved consensus CTV definitions to be used as guidelines for the adjuvant therapy of rectal cancer and definitive therapy for anal cancer. The most important difference from similar atlases for gynecologic or genitourinary cancer is mesorectal coverage. Detailed target volume contouring guidelines and images are discussed. Conclusion: This report serves as a template for the definition of the elective CTVs to be used in IMRT planning for anal and rectal cancers, as part of prospective RTOG trials.« less

Methodological considerations in cost of illness studies on Alzheimer disease

PubMed Central

2012-01-01

Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable. PMID:22963680

Transforming a municipal school sports programme through a critical communicative methodology: The role of the of advisory committee.

PubMed

Jiménez-Herranz, Borja; Manrique-Arribas, Juan C; López-Pastor, Víctor M; García-Bengoechea, Enrique

2016-10-01

This research applies a communicative methodology (CM) to the transformation and improvement of the Municipal Comprehensive School Sports Programme in Segovia, Spain (MCSSP), using egalitarian dialogue, based on validity rather than power claims to achieve intersubjectivity and arrive at consensus between all of the Programme's stakeholders through the intervention of an advisory committee (AC). The AC is a body comprising representatives of all stakeholder groups involved in the programme. During the 2013-2014 academic year the programme's AC met four times, operating as a communicative focus group (CFG). The meetings focused on: (1) excluding dimensions (barriers preventing transformation) and transforming dimensions (ways of overcoming barriers), (2) the programme's strengths, (3) the programme's weaknesses and specific actions to remedy them, and (4) the resulting conclusions which were then incorporated into the subsequent programme contract signed between the University and the Segovia Local Authority for 2014-2018. The key conclusions were: (1) the recommendations of the AC widen the range of perspectives and help the research team to make key decisions and (2) the use of CM to fully evaluate the programme and to reach a consensus on how to improve it proved very valuable. Copyright © 2016 Elsevier Ltd. All rights reserved.

DARE Train-the-Trainer Pedagogy Development Using 2-Round Delphi Methodology

PubMed Central

Kua, Phek Hui Jade; Soon, Swee Sung

2016-01-01

The Dispatcher-Assisted first REsponder programme aims to equip the public with skills to perform hands-only cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator (AED). By familiarising them with instructions given by a medical dispatcher during an out-of-hospital cardiac arrest call, they will be prepared and empowered to react in an emergency. We aim to formalise curriculum and standardise the way information is conveyed to the participants. A panel of 20 experts were chosen. Using Delphi methodology, selected issues were classified into open-ended and close-ended questions. Consensus for an item was established at a 70% agreement rate within the panel. Questions that had 60%–69% agreement were edited and sent to the panel for another round of voting. After 2 rounds of voting, 70 consensus statements were agreed upon. These covered the following: focus of CPR; qualities and qualifications of trainers; recognition of agonal breathing; head-tilt-chin lift; landmark for chest compression; performance of CPR when injuries are present; trainers' involvement in training lay people; modesty of female patients during CPR; AED usage; content of trainer's manual; addressing of questions and answers; updates-dissemination to trainers and attendance of refresher courses. Recommendations for pedagogy for trainers of dispatcher-assisted CPR programmes were developed. PMID:27660757

Accurate RNA consensus sequencing for high-fidelity detection of transcriptional mutagenesis-induced epimutations.

PubMed

Reid-Bayliss, Kate S; Loeb, Lawrence A

2017-08-29

Transcriptional mutagenesis (TM) due to misincorporation during RNA transcription can result in mutant RNAs, or epimutations, that generate proteins with altered properties. TM has long been hypothesized to play a role in aging, cancer, and viral and bacterial evolution. However, inadequate methodologies have limited progress in elucidating a causal association. We present a high-throughput, highly accurate RNA sequencing method to measure epimutations with single-molecule sensitivity. Accurate RNA consensus sequencing (ARC-seq) uniquely combines RNA barcoding and generation of multiple cDNA copies per RNA molecule to eliminate errors introduced during cDNA synthesis, PCR, and sequencing. The stringency of ARC-seq can be scaled to accommodate the quality of input RNAs. We apply ARC-seq to directly assess transcriptome-wide epimutations resulting from RNA polymerase mutants and oxidative stress.

MS-based analytical methodologies to characterize genetically modified crops.

PubMed

García-Cañas, Virginia; Simó, Carolina; León, Carlos; Ibáñez, Elena; Cifuentes, Alejandro

2011-01-01

The development of genetically modified crops has had a great impact on the agriculture and food industries. However, the development of any genetically modified organism (GMO) requires the application of analytical procedures to confirm the equivalence of the GMO compared to its isogenic non-transgenic counterpart. Moreover, the use of GMOs in foods and agriculture faces numerous criticisms from consumers and ecological organizations that have led some countries to regulate their production, growth, and commercialization. These regulations have brought about the need of new and more powerful analytical methods to face the complexity of this topic. In this regard, MS-based technologies are increasingly used for GMOs analysis to provide very useful information on GMO composition (e.g., metabolites, proteins). This review focuses on the MS-based analytical methodologies used to characterize genetically modified crops (also called transgenic crops). First, an overview on genetically modified crops development is provided, together with the main difficulties of their analysis. Next, the different MS-based analytical approaches applied to characterize GM crops are critically discussed, and include "-omics" approaches and target-based approaches. These methodologies allow the study of intended and unintended effects that result from the genetic transformation. This information is considered to be essential to corroborate (or not) the equivalence of the GM crop with its isogenic non-transgenic counterpart. Copyright © 2010 Wiley Periodicals, Inc.

In situ characterization of organo-modified and unmodified montmorillonite aqueous suspensions by UV-visible spectroscopy.

PubMed

Alin, Jonas; Rubino, Maria; Auras, Rafael

2015-10-15

UV-visible (UV-Vis) spectroscopy (Tyndall spectra) was applied and tested for its ability to measure organo-modified and unmodified montmorillonite (MMT) clays in aqueous suspensions. A full factorial design of experiments was used to study the influence of pH, NaCl and clay concentrations on the average particle size of the clay agglomerates. The methodology was evaluated by observing results that were consistent with previous research about the unmodified clay's behavior in aqueous suspensions. The results from this evaluation corresponded to accepted theories about the unmodified clay's behavior, indicating that the methodology is precise enough to distinguish the effects of the studied factors on these clay suspensions. The effect of clay concentration was related to the amount of ions per clay particle for the unmodified clay, but was not significant for the organo-modified MMT. The average particle size of the organo-modified MMT in suspension was significantly larger than that of the unmodified clay. Size of the organo-modified MMT agglomerates in suspension decreased in the presence of NaCl and at both high and low pH; this behavior was opposite to that of the unmodified clay. These results demonstrate that the UV-Vis methodology is well-suited for characterizing clay particle size in aqueous suspensions. The technique also is simple, rapid, and low-cost. Copyright © 2015 Elsevier Inc. All rights reserved.

Developing a Consensus-Driven, Core Competency Model to Shape Future Audio Engineering Technology Curriculum: A Web-Based Modified Delphi Study

ERIC Educational Resources Information Center

Tough, David T.

2009-01-01

The purpose of this online study was to create a ranking of essential core competencies and technologies required by AET (audio engineering technology) programs 10 years in the future. The study was designed to facilitate curriculum development and improvement in the rapidly expanding number of small to medium sized audio engineering technology…

Assistance Technology Research Center

DTIC Science & Technology

2003-02-01

and perhaps modifying - some social behaviors of people with autism . "* Leveraging ancillary funding from both NIDRR and NSF, Anthrotronix is three...to independence for many individuals with traumatic brain injury, stroke, and autism . This project will develop virtual environments, using the...pentapeptide consensus sequence of the human NMDA receptor NR2a and NR2b subunits. Magnetic resonance imaging (MRI) will be performed for evaluation of

Pressure system recertification at NASA-Langley Research Center

NASA Technical Reports Server (NTRS)

Hudson, C. M.; Ramsey, J. W., Jr.

1983-01-01

Langley Research Center pressure systems are being recertified to ensure safe operation of these systems. The procedures for recertifying these pressure systems are reviewed. Generally, the analysis and inspection requirements outlined in the appropriate national consensus codes are followed. In some instances where the requirements of these codes are not met. The systems are analyzed further, repaired, modified and/or tested to demonstrate their structural integrity.

Foreword: Proceedings From the First Annual Lumbar Total Disc Replacement Summit.

PubMed

Blumenthal, Scott; Buttermann, Glenn; Garcia, Rolando; Gornet, Matthew; Grunch, Betsy; Guyer, Richard; Janssen, Michael; Kimball, Brent; Lewis, Adam; Mesiwala, Ali; Miller, Lynn; Morreale, Joseph; Reed, William; Sandhu, Faheem; Shackleford, Ian; Yue, James; Zigler, Jack; OConnell, Brent; Ferko, Nicole; Hollmann, Sarah

2017-12-15

: This publication focuses on proceedings from the First Annual Lumbar Total Disc Replacement Summit, held October 25, 2016 in Boston, MA. The Summit brought together 17 thought leading surgeons who employed a modified-Delphi method to determine where consensus existed pertaining to the utilization of lumbar total disc replacement as a standard of care for a subpopulation of patients suffering from degenerative disc disease.

Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis.

PubMed

Ringold, Sarah; Weiss, Pamela F; Colbert, Robert A; DeWitt, Esi Morgan; Lee, Tzielan; Onel, Karen; Prahalad, Sampath; Schneider, Rayfel; Shenoi, Susan; Vehe, Richard K; Kimura, Yukiko

2014-07-01

There is no standardized approach to the initial treatment of polyarticular juvenile idiopathic arthritis (JIA) among pediatric rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available will result in better health outcomes for polyarticular JIA. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for use in clinical practice to facilitate such studies. A case-based survey was administered to CARRA members to identify the common treatment approaches for new-onset polyarticular JIA. Two face-to-face consensus conferences employed modified nominal group technique to identify treatment strategies, operational case definition, end points, and data elements to be collected. A core workgroup reviewed the relevant literature, refined plans, and developed medication dosing and monitoring recommendations. The initial case-based survey identified significant variability among treatment approaches for new-onset polyarticular JIA. We developed 3 CTPs based on treatment strategies for the first 12 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The CTPs include a step-up plan (nonbiologic disease-modifying antirheumatic drug [DMARD] followed by a biologic DMARD), an early combination plan (nonbiologic and biologic DMARD combined within a month of treatment initiation), and a biologic only plan. This approach was approved by 96% of the CARRA JIA Research Committee members attending the 2013 CARRA face-to-face meeting. Three standardized CTPs were developed for new-onset polyarticular JIA. Coupled with data collection at defined intervals, use of these CTPs will enable the study of their comparative effectiveness in an observational setting to optimize initial management of polyarticular JIA. Copyright © 2014 by the American College of Rheumatology.

The Global Spine Care Initiative: a consensus process to develop and validate a stratification scheme for surgical care of spinal disorders as a guide for improved resource utilization in low- and middle-income communities.

PubMed

Acaroğlu, Emre; Mmopelwa, Tiro; Yüksel, Selcen; Ayhan, Selim; Nordin, Margareta; Randhawa, Kristi; Haldeman, Scott

2017-10-16

The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeons known to be global opinion leaders. After creating a seed document of five hierarchical levels of surgical care, a four-step modified Delphi process (question validation, collection of factors, evaluation of factors, re-evaluation of factors) was performed. Of 78 invited experts, 19 participated in round 1, and of the 19, 14 participated in 2, and 12 in 3 and 4. Consensus was fairly heterogeneous for levels of care 2-4 (moderate resources). Only simple assessment methods based on the clinical skills of the medical personnel were considered feasible and safe in low-resource settings. Diagnosis, staging, and treatment were deemed feasible and safe in a specialized spine center. Accurate diagnostic workup was deemed feasible and safe for lower levels of care complexity (from level 3 upwards) compared to non-invasive procedures (level 4) and the full range of invasive procedures (level 5). This study introduces a five-level stratification scheme for the surgical care of spinal disorders. This stratification may provide input into the Global Spine Care Initiative care pathway that will be applied in medically underserved areas and low- and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.

[University studies plan in geriatric medicine developed using a modified Delphi technique].

PubMed

Vilches-Moraga, Arturo; Ariño-Blasco, Sergio; Verdejo-Bravo, Carlos; Mateos-Nozal, Jesús

2015-01-01

The increase in the number of frail elderly people has led to the necessity that all doctors of the future acquire sufficient knowledge on human ageing and the skills in the management of the patient of advanced age, as well as the diseases associated with ageing. Few countries offer geriatric medicine within undergraduate training. The purpose of the present project was to obtain a consensus between European geriatricians on the minimum requirements that medical students must achieve at the end of their university degree course. A modified Delphi process was used. Firstly, experts in education and geriatrics proposed a set of learning objectives based on a review of the literature. Three Delphi rounds were then performed, in which a panel of 49 experts representing 29 countries affiliated to the European Union of Medical Specialists took part. This enabled them to reach a consensus on a definitive study plan. The number of disagreements after the Delphi rounds 1 and 2 were 81 and 53, respectively. Full agreement was reached after the third round. The definitive study plan consisted of detailed objectives grouped under 10 general training objectives. A consensus has been reached between European geriatricians that sets specific training objectives for medical students. Great efforts will be required for the introduction of these requirements, given the variability there is in the quality of teaching in geriatrics. This study plan is a first step in helping to improve geriatrics teaching in faculties of medicine, and will also serve as a basis to make advances in the training in post-graduate geriatrics throughout Europe. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

[Applying the Modified Delphi Technique to Develop the Role of HIV Case Managers and Essential Nursing Competencies in HIV Care].

PubMed

Ko, Nai-Ying; Hsieh, Chia-Yin; Chen, Yen-Chin; Tsai, Chen-Hsi; Liu, Hsiao-Ying; Liu, Li-Fang

2015-08-01

Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.

Reporting Guidelines for Clinical Pharmacokinetic Studies: The ClinPK Statement.

PubMed

Kanji, Salmaan; Hayes, Meghan; Ling, Adam; Shamseer, Larissa; Chant, Clarence; Edwards, David J; Edwards, Scott; Ensom, Mary H H; Foster, David R; Hardy, Brian; Kiser, Tyree H; la Porte, Charles; Roberts, Jason A; Shulman, Rob; Walker, Scott; Zelenitsky, Sheryl; Moher, David

2015-07-01

Transparent reporting of all research is essential for assessing the validity of any study. Reporting guidelines are available and endorsed for many types of research but are lacking for clinical pharmacokinetic studies. Such tools promote the consistent reporting of a minimal set of information for end users, and facilitate knowledge translation of research. The objective of this study was to create a guideline to assist in the transparent and complete reporting of clinical pharmacokinetic studies. Preliminary content to be considered was identified from a systematic search of the literature and regulatory documents. Stakeholders were identified to participate in a modified Delphi exercise and a virtual meeting to generate consensus for items considered essential in the reporting of clinical pharmacokinetic studies. The proposed checklist was pilot tested on 100 recently published clinical pharmacokinetic studies. Overall and itemized compliance with the proposed guidance was determined for each study. Sixty-eight stakeholders from nine countries consented to participate. Four rounds of a modified Delphi survey and a series of small virtual meetings were required to generate consensus for a 24-item checklist considered to be essential to the reporting of clinical pharmacokinetic studies. When applied to the 100 most recently published clinical pharmacokinetic studies, 45 were determined to be compliant with at least 80 % of the checklist items. Explanatory text was prepared using examples of compliant reporting from these and other relevant studies. The reader's ability to judge the validity of pharmacokinetic research can be greatly compromised by the incomplete reporting of study information. Using consensus methods, we have developed a tool to guide transparent and accurate reporting of clinical pharmacokinetic studies. Endorsement and implementation of these guidelines by researchers, clinicians and journals would promote more consistent reporting of these studies and allow for better assessment of utility for clinical applications.

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean].

PubMed

Benavides, Fernando G; Merino-Salazar, Pamela; Cornelio, Cecilia; Assunção, Ada Avila; Agudelo-Suárez, Andrés A; Amable, Marcelo; Artazcoz, Lucía; Astete, Jonh; Barraza, Douglas; Berhó, Fabián; Milián, Lino Carmenate; Delclòs, George; Funcasta, Lorena; Gerke, Johanna; Gimeno, David; Itatí-Iñiguez, María José; Lima, Eduardo de Paula; Martínez-Iñigo, David; Medeiros, Adriane Mesquita de; Orta, Lida; Pinilla, Javier; Rodrigo, Fernando; Rojas, Marianela; Sabastizagal, Iselle; Vallebuona, Clelia; Vermeylen, Greet; Villalobos, Gloria H; Vives, Alejandra

2016-10-10

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Single-case research design in pediatric psychology: considerations regarding data analysis.

PubMed

Cohen, Lindsey L; Feinstein, Amanda; Masuda, Akihiko; Vowles, Kevin E

2014-03-01

Single-case research allows for an examination of behavior and can demonstrate the functional relation between intervention and outcome in pediatric psychology. This review highlights key assumptions, methodological and design considerations, and options for data analysis. Single-case methodology and guidelines are reviewed with an in-depth focus on visual and statistical analyses. Guidelines allow for the careful evaluation of design quality and visual analysis. A number of statistical techniques have been introduced to supplement visual analysis, but to date, there is no consensus on their recommended use in single-case research design. Single-case methodology is invaluable for advancing pediatric psychology science and practice, and guidelines have been introduced to enhance the consistency, validity, and reliability of these studies. Experts generally agree that visual inspection is the optimal method of analysis in single-case design; however, statistical approaches are becoming increasingly evaluated and used to augment data interpretation.

Publication Bias in Methodological Computational Research.

PubMed

Boulesteix, Anne-Laure; Stierle, Veronika; Hapfelmeier, Alexander

2015-01-01

The problem of publication bias has long been discussed in research fields such as medicine. There is a consensus that publication bias is a reality and that solutions should be found to reduce it. In methodological computational research, including cancer informatics, publication bias may also be at work. The publication of negative research findings is certainly also a relevant issue, but has attracted very little attention to date. The present paper aims at providing a new formal framework to describe the notion of publication bias in the context of methodological computational research, facilitate and stimulate discussions on this topic, and increase awareness in the scientific community. We report an exemplary pilot study that aims at gaining experiences with the collection and analysis of information on unpublished research efforts with respect to publication bias, and we outline the encountered problems. Based on these experiences, we try to formalize the notion of publication bias.

Post-traumatic Stress Symptoms in Post-ICU Family Members: Review and Methodological Challenges

PubMed Central

Petrinec, Amy B.; Daly, Barbara J.

2018-01-01

Family members of intensive care unit (ICU) patients are at risk for symptoms of post-traumatic stress disorder (PTSD) following ICU discharge. The aim of this systematic review is to examine the current literature regarding post-ICU family PTSD symptoms with an emphasis on methodological issues in conducting research on this challenging phenomenon. An extensive review of the literature was performed confining the search to English language studies reporting PTSD symptoms in adult family members of adult ICU patients. Ten studies were identified for review published from 2004–2012. Findings demonstrate a significant prevalence of family PTSD symptoms in the months following ICU hospitalization. However, there are several methodological challenges to the interpretation of existing studies and to the conduct of future research including differences in sampling, identification of risk factors and covariates of PTSD, and lack of consensus regarding the most appropriate PTSD symptom measurement tools and timing. PMID:25061017

[Controversial issues in economic evaluation (I): perspective and costs of Health Care interventions].

PubMed

Oliva, Juan; Brosa, Max; Espín, Jaime; Figueras, Montserrat; Trapero, Marta

2015-01-01

Economic evaluation of health care interventions has experienced a strong growth over the past decade and is increasingly present as a support tool in the decisions making process on public funding of health services and pricing in European countries. A necessary element using them is that agents that perform economic evaluations have minimum rules with agreement on methodological aspects. Although there are methodological issues in which there is a high degree of consensus, there are others in which there is no such degree of agreement being closest to the normative field or have experienced significant methodological advances in recent years. In this first article of a series of three, we will discuss on the perspective of analysis and assessment of costs in economic evaluation of health interventions using the technique Metaplan. Finally, research lines are proposed to overcome the identified discrepancies.

Information System Design Methodology Based on PERT/CPM Networking and Optimization Techniques.

ERIC Educational Resources Information Center

Bose, Anindya

The dissertation attempts to demonstrate that the program evaluation and review technique (PERT)/Critical Path Method (CPM) or some modified version thereof can be developed into an information system design methodology. The methodology utilizes PERT/CPM which isolates the basic functional units of a system and sets them in a dynamic time/cost…

Methodological Adaptations for Investigating the Perceptions of Language-Impaired Adolescents Regarding the Relative Importance of Selected Communication Skills

ERIC Educational Resources Information Center

Reed, Vicki A.; Brammall, Helen

2006-01-01

This article describes the systematic and detailed processes undertaken to modify a research methodology for use with language-impaired adolescents. The original methodology had been used previously with normally achieving adolescents and speech pathologists to obtain their opinions about the relative importance of selected communication skills…

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery.

PubMed

Holubar, Stefan D; Hedrick, Traci; Gupta, Ruchir; Kellum, John; Hamilton, Mark; Gan, Tong J; Mythen, Monty G; Shaw, Andrew D; Miller, Timothy E

2017-01-01

Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections. With input from a multidisciplinary, international group of experts and through a focused (non-systematic) review of the literature, and use of a modified Delphi method, we achieved consensus surrounding the topic of prevention of postoperative infection in the perioperative period for CRS patients. As a part of the first Perioperative Quality Initiative (POQI-1) workgroup meeting, we sought to develop a consensus statement describing a comprehensive, yet practical, approach for reducing postoperative infections, specifically for CRS within an ERP. Surgical site infection (SSI) is the most common postoperative infection. To reduce SSI, we recommend routine use of a combined isosmotic mechanical bowel preparation with oral antibiotics before elective CRS and that infection prevention strategies (also called bundles) be routinely implemented as part of colorectal ERPs. We recommend against routine use of abdominal drains. We also give consensus guidelines for reducing pneumonia, urinary tract infection, and central line-associated bloodstream infection (CLABSI).

Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome.

PubMed

Tremblay, Mark S; Aubert, Salomé; Barnes, Joel D; Saunders, Travis J; Carson, Valerie; Latimer-Cheung, Amy E; Chastin, Sebastien F M; Altenburg, Teatske M; Chinapaw, Mai J M

2017-06-10

The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors.

Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d'Urgenza e del Trauma).

PubMed

Costa, Gianluca; Ruscelli, Paolo; Balducci, Genoveffa; Buccoliero, Francesco; Lorenzon, Laura; Frezza, Barbara; Chirletti, Piero; Stagnitti, Franco; Miniello, Stefano; Stella, Francesco

2016-01-01

Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting. This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases. Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.

Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers.

PubMed

Matthews, M; Rathleff, M S; Claus, A; McPoil, T; Nee, R; Crossley, K; Vicenzino, B

2017-12-01

Patellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an individual. A systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis); or (2) modified patient outcome from a specific treatment (treatment effect modifiers). 6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality. The 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting sample size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses. Current evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus

PubMed Central

Rezaie, Ali; Buresi, Michelle; Lembo, Anthony; Lin, Henry; McCallum, Richard; Rao, Satish; Schmulson, Max; Valdovinos, Miguel; Zakko, Salam; Pimentel, Mark

2017-01-01

Objectives: Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Methods: Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Results: Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion. Conclusions: BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research. PMID:28323273

Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus.

PubMed

Rezaie, Ali; Buresi, Michelle; Lembo, Anthony; Lin, Henry; McCallum, Richard; Rao, Satish; Schmulson, Max; Valdovinos, Miguel; Zakko, Salam; Pimentel, Mark

2017-05-01

Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion. BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research.

Diagnosis and Management of Iliac Artery Endofibrosis: Results of a Delphi Consensus Study.

PubMed

2016-07-01

Iliac endofibrosis is a rare condition that may result in a reduction of blood flow to the lower extremity in young, otherwise healthy individuals. The data to inform everyday clinical management are weak and therefore a Delphi consensus methodology was used to explore areas of consensus and disagreement concerning the diagnosis and management of patients with suspected iliac endofibrosis. A three-round Delphi questionnaire approach was used among vascular surgeons, sports physicians, sports scientists, radiologists, and clinical vascular scientists with experience of treating this condition to explore diagnosis and clinical management issues for patients with suspected iliac artery endofibrosis. Analysis is based on 18 responses to round 2 and 14 responses to round 3, with agreement reported when 70% of respondents were in agreement. Initially there was agreement on the typical symptoms at presentation and the need for an exercise test in the diagnosis. Round 3 clarified that duplex ultrasound was a useful tool in the diagnosis of endofibrosis. There was consensus on the most appropriate type of surgery (endarterectomy and vein patch) and that endovascular interventions were inadvisable. The final round helped to inform aspects of the natural history and post-operative surveillance. Progression of the disease was likely with continued exercise but cessation may prevent progression. Surveillance after surgery is generally recommended yearly with at least a clinical assessment. There is broad agreement about the presenting symptoms and the investigations required to confirm (or exclude) the diagnosis of iliac endofibrosis. There was consensus on the surgical approach to repair. Disagreement existed about the specific diagnostic criteria that should be applied during non-invasive testing and about post-operative care and resumption of exercise. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

A High Density Consensus Map of Rye (Secale cereale L.) Based on DArT Markers

PubMed Central

Myśków, Beata; Stojałowski, Stefan; Heller-Uszyńska, Katarzyna; Góralska, Magdalena; Brągoszewski, Piotr; Uszyński, Grzegorz; Kilian, Andrzej; Rakoczy-Trojanowska, Monika

2011-01-01

Background Rye (Secale cereale L.) is an economically important crop, exhibiting unique features such as outstanding resistance to biotic and abiotic stresses and high nutrient use efficiency. This species presents a challenge to geneticists and breeders due to its large genome containing a high proportion of repetitive sequences, self incompatibility, severe inbreeding depression and tissue culture recalcitrance. The genomic resources currently available for rye are underdeveloped in comparison with other crops of similar economic importance. The aim of this study was to create a highly saturated, multilocus linkage map of rye via consensus mapping, based on Diversity Arrays Technology (DArT) markers. Methodology/Principal Findings Recombinant inbred lines (RILs) from 5 populations (564 in total) were genotyped using DArT markers and subjected to linkage analysis using Join Map 4.0 and Multipoint Consensus 2.2 software. A consensus map was constructed using a total of 9703 segregating markers. The average chromosome map length ranged from 199.9 cM (2R) to 251.4 cM (4R) and the average map density was 1.1 cM. The integrated map comprised 4048 loci with the number of markers per chromosome ranging from 454 for 7R to 805 for 4R. In comparison with previously published studies on rye, this represents an eight-fold increase in the number of loci placed on a consensus map and a more than two-fold increase in the number of genetically mapped DArT markers. Conclusions/Significance Through the careful choice of marker type, mapping populations and the use of software packages implementing powerful algorithms for map order optimization, we produced a valuable resource for rye and triticale genomics and breeding, which provides an excellent starting point for more in-depth studies on rye genome organization. PMID:22163026

Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology.

PubMed

Dijkstra, Frederieke A; Bosker, Robbert J I; Veeger, Nicolaas J G M; van Det, Marc J; Pierie, Jean Pierre E N

2015-09-01

While several procedural training curricula in laparoscopic colorectal surgery have been validated and published, none have focused on dividing surgical procedures into well-identified segments, which can be trained and assessed separately. This enables the surgeon and resident to focus on a specific segment, or combination of segments, of a procedure. Furthermore, it will provide a consistent and uniform method of training for residents rotating through different teaching hospitals. The goal of this study was to determine consensus on the key steps of laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy among experts in our University Medical Center and affiliated hospitals. This will form the basis for the INVEST video-assisted side-by-side training curriculum. The Delphi method was used for determining consensus on key steps of both procedures. A list of 31 steps for laparoscopic right hemicolectomy and 37 steps for laparoscopic sigmoid colectomy was compiled from textbooks and national and international guidelines. In an online questionnaire, 22 experts in 12 hospitals within our teaching region were invited to rate all steps on a Likert scale on importance for the procedure. Consensus was reached in two rounds. Sixteen experts agreed to participate. Of these 16 experts, 14 (88%) completed the questionnaire for both procedures. Of the 14 who completed the first round, 13 (93%) completed the second round. Cronbach's alpha was 0.79 for the right hemicolectomy and 0.91 for the sigmoid colectomy, showing high internal consistency between the experts. For the right hemicolectomy, 25 key steps were established; for the sigmoid colectomy, 24 key steps were established. Expert consensus on the key steps for laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy was reached. These key steps will form the basis for a video-assisted teaching curriculum.

Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research.

PubMed

McCann, Liza J; Pilkington, Clarissa A; Huber, Adam M; Ravelli, Angelo; Appelbe, Duncan; Kirkham, Jamie J; Williamson, Paula R; Aggarwal, Amita; Christopher-Stine, Lisa; Constantin, Tamas; Feldman, Brian M; Lundberg, Ingrid; Maillard, Sue; Mathiesen, Pernille; Murphy, Ruth; Pachman, Lauren M; Reed, Ann M; Rider, Lisa G; van Royen-Kerkof, Annet; Russo, Ricardo; Spinty, Stefan; Wedderburn, Lucy R; Beresford, Michael W

2018-02-01

This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016.

PubMed

Cederholm, Tommy; Jensen, Gordon L

2017-02-01

During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms and etiologies to support diagnosis. ASPEN emphasized where the parties agree; i.e. that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. A Core Working Committee of the Global Leadership Initiative on Malnutrition (GLIM) has been established (comprised of two representatives each from the 4 largest PEN-societies) that will lead consensus development in collaboration with a larger Working Group with broad global representation, using e-mail, telephone conferences, and face-to-face meetings during the up-coming ASPEN and ESPEN Congresses. Transparency and external input will be sought. Objectives include: 1. Consensus development around evidence-based criteria for broad application. 2. Promotion of global dissemination of the consensus criteria. 3. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD). Copyright © 2017 American Society for Parenteral and Enteral Nutrition, Elsevier Ltd, European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd.. All rights reserved.

Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting.

PubMed

Dickinson, Louise; Ahmed, Hashim U; Allen, Clare; Barentsz, Jelle O; Carey, Brendan; Futterer, Jurgen J; Heijmink, Stijn W; Hoskin, Peter J; Kirkham, Alex; Padhani, Anwar R; Persad, Raj; Puech, Philippe; Punwani, Shonit; Sohaib, Aslam S; Tombal, Bertrand; Villers, Arnauld; van der Meulen, Jan; Emberton, Mark

2011-04-01

Multiparametric magnetic resonance imaging (mpMRI) may have a role in detecting clinically significant prostate cancer in men with raised serum prostate-specific antigen levels. Variations in technique and the interpretation of images have contributed to inconsistency in its reported performance characteristics. Our aim was to make recommendations on a standardised method for the conduct, interpretation, and reporting of prostate mpMRI for prostate cancer detection and localisation. A consensus meeting of 16 European prostate cancer experts was held that followed the UCLA-RAND Appropriateness Method and facilitated by an independent chair. Before the meeting, 520 items were scored for "appropriateness" by panel members, discussed face to face, and rescored. Agreement was reached in 67% of 260 items related to imaging sequence parameters. T2-weighted, dynamic contrast-enhanced, and diffusion-weighted MRI were the key sequences incorporated into the minimum requirements. Consensus was also reached on 54% of 260 items related to image interpretation and reporting, including features of malignancy on individual sequences. A 5-point scale was agreed on for communicating the probability of malignancy, with a minimum of 16 prostatic regions of interest, to include a pictorial representation of suspicious foci. Limitations relate to consensus methodology. Dominant personalities are known to affect the opinions of the group and were countered by a neutral chairperson. Consensus was reached on a number of areas related to the conduct, interpretation, and reporting of mpMRI for the detection, localisation, and characterisation of prostate cancer. Before optimal dissemination of this technology, these outcomes will require formal validation in prospective trials. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Development of consensus treatment plans for juvenile localized scleroderma: a roadmap toward comparative effectiveness studies in juvenile localized scleroderma.

PubMed

Li, Suzanne C; Torok, Kathryn S; Pope, Elena; Dedeoglu, Fatma; Hong, Sandy; Jacobe, Heidi T; Rabinovich, C Egla; Laxer, Ronald M; Higgins, Gloria C; Ferguson, Polly J; Lasky, Andrew; Baszis, Kevin; Becker, Mara; Campillo, Sarah; Cartwright, Victoria; Cidon, Michael; Inman, Christi J; Jerath, Rita; O'Neil, Kathleen M; Vora, Sheetal; Zeft, Andrew; Wallace, Carol A; Ilowite, Norman T; Fuhlbrigge, Robert C

2012-08-01

Juvenile localized scleroderma (LS) is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies has been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment has made it difficult to compare approaches and identify optimal therapy. Our objective was to develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile LS. A core group of pediatric rheumatologists, dermatologists, and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for juvenile LS using consensus methods/nominal group techniques. Recommendations were validated in 2 face-to-face conferences with a larger group of practitioners with expertise in juvenile LS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the US and Canada. Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (66% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with juvenile LS. Using consensus methodology, we have developed standardized treatment plans and assessment methods for juvenile LS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of juvenile LS. Copyright © 2012 by the American College of Rheumatology.

Is physical exercise a multiple sclerosis disease modifying treatment?

PubMed

Motl, Robert W; Pilutti, Lara A

2016-08-01

There is consensus that exercise represents a behavioral approach for the restoration of function and management of symptoms among persons with multiple sclerosis (MS). The current paper provides a review on the topic of exercise and physical activity as MS-disease modifying treatments. Firstly, metrics for evaluating disease modification and progression in MS are described. Secondly, evidence for exercise as a MS-disease modifying therapy based on individual studies, literature reviews, and meta-analyses is summarized. Finally, the paper focuses on major limitations of the existing body of research. Expert commentary: Exercise and physical activity have been associated with reduced relapse rate, mobility disability and its progression, and lesion volume, and improved neuroperformance, particularly walking outcomes. This evidence provides a positive, yet preliminary, picture for exercise having possible effects on markers of disease modification and progression in MS.

A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

PubMed

Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

2014-12-01

General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Node-making process in network meta-analysis of nonpharmacological treatment are poorly reported.

PubMed

James, Arthur; Yavchitz, Amélie; Ravaud, Philippe; Boutron, Isabelle

2018-05-01

To identify methods to support the node-making process in network meta-analyses (NMAs) of nonpharmacological treatments. We proceeded in two stages. First, we conducted a literature review of guidelines and methodological articles about NMAs to identify methods proposed to lump interventions into nodes. Second, we conducted a systematic review of NMAs of nonpharmacological treatments to extract methods used by authors to support their node-making process. MEDLINE and Google Scholar were searched to identify articles assessing NMA guidelines or methodology intended for NMA authors. MEDLINE, CENTRAL, and EMBASE were searched to identify reports of NMAs including at least one nonpharmacological treatment. Both searches involved articles available from database inception to March 2016. From the methodological review, we identified and extracted methods proposed to lump interventions into nodes. From the systematic review, the reporting of the network was assessed as long as the method described supported the node-making process. Among the 116 articles retrieved in the literature review, 12 (10%) discussed the concept of lumping or splitting interventions in NMAs. No consensual method was identified during the methodological review, and expert consensus was the only method proposed to support the node-making process. Among 5187 references for the systematic review, we included 110 reports of NMAs published between 2007 and 2016. The nodes were described in the introduction section of 88 reports (80%), which suggested that the node content might have been a priori decided before the systematic review. Nine reports (8.1%) described a specific process or justification to build nodes for the network. Two methods were identified: (1) fit a previously published classification and (2) expert consensus. Despite the importance of NMA in the delivery of evidence when several interventions are available for a single indication, recommendations on the reporting of the node-making process in NMAs are lacking, and reporting of the node-making process in NMAs seems insufficient. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

PubMed

Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

2012-05-15

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

Phenomenology and classification of dystonia: a consensus update.

PubMed

Albanese, Alberto; Bhatia, Kailash; Bressman, Susan B; Delong, Mahlon R; Fahn, Stanley; Fung, Victor S C; Hallett, Mark; Jankovic, Joseph; Jinnah, Hyder A; Klein, Christine; Lang, Anthony E; Mink, Jonathan W; Teller, Jan K

2013-06-15

This report describes the consensus outcome of an international panel consisting of investigators with years of experience in this field that reviewed the definition and classification of dystonia. Agreement was obtained based on a consensus development methodology during 3 in-person meetings and manuscript review by mail. Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned and twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Dystonia is classified along 2 axes: clinical characteristics, including age at onset, body distribution, temporal pattern and associated features (additional movement disorders or neurological features); and etiology, which includes nervous system pathology and inheritance. The clinical characteristics fall into several specific dystonia syndromes that help to guide diagnosis and treatment. We provide here a new general definition of dystonia and propose a new classification. We encourage clinicians and researchers to use these innovative definition and classification and test them in the clinical setting on a variety of patients with dystonia. © 2013 Movement Disorder Society. © 2013 Movement Disorder Society.

[Regionalization of perinatal health care in the province of Santa Fe, Argentina].

PubMed

Simioni, Alberto Tomás; Llanos, Oraldo; Romero, Mariana; Ramos, Silvina; Brizuela, Vanessa; Abalos, Edgardo

2017-05-25

Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan. Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation. Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care (CONE). Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.

Recommendations for clinical practice and research in severe brain injury in intensive rehabilitation: the Italian Consensus Conference.

PubMed

De Tanti, A; Zampolini, M; Pregno, S

2015-02-01

The paper reports the final statements of the jury of a National Consensus Conference organized in November 2010 at Salsomaggiore (Parma) to draw up recommendations on the rehabilitation programs for acquired brain injury (sABI) patients in the intensive hospital phase. Because of the few clinical studies of good quality found by means of the literature research we choose a mixed approach: a systematic review of the published studies and a consensus conference in order to obtain recommendations that come from the clinical evidence and the expert opinion. The final recommendations of the jury, based on the best available evidence combined with clinical expertise and the experience of persons with disabilities and other stakeholders, cover 13 topics: 1) Management of paroxysmal manifestations (sympathetic storms); 2) management of neuroendocrine problems; 3) nutrition; 4) swallowing; 5) ventilation/respiration, 6) clinical and instrument diagnosis and prognosis of vegetative state (VS) and minimally conscious state (MCS), 7) rehabilitative and pharmacological facilitation of renewed contact with surroundings; 8) neurosurgical complications and hydrocephalus; 9) sensorimotor impairment and disability; 10) rehabilitation methods; 11) assessment and treatment of cognitive-behavioural impairment and disability; 12) methodology and organization of care; 13) involving family and caregivers in rehabilitation.

An evaluation of total starch and starch gelatinization methodologies in pelleted animal feed.

PubMed

Zhu, L; Jones, C; Guo, Q; Lewis, L; Stark, C R; Alavi, S

2016-04-01

The quantification of total starch content (TS) or degree of starch gelatinization (DG) in animal feed is always challenging because of the potential interference from other ingredients. In this study, the differences in TS or DG measurement in pelleted swine feed due to variations in analytical methodology were quantified. Pelleted swine feed was used to create 6 different diets manufactured with various processing conditions in a 2 × 3 factorial design (2 conditioning temperatures, 77 or 88°C, and 3 conditioning retention times, 15, 30, or 60 s). Samples at each processing stage (cold mash, hot mash, hot pelletized feed, and final cooled pelletized feed) were collected for each of the 6 treatments and analyzed for TS and DG. Two different methodologies were evaluated for TS determination (the AOAC International method 996.11 vs. the modified glucoamylase method) and DG determination (the modified glucoamylase method vs. differential scanning calorimetry [DSC]). For TS determination, the AOAC International method 996.11 measured lower TS values in cold pellets compared with the modified glucoamylase method. The AOAC International method resulted in lower TS in cold mash than cooled pelletized feed, whereas the modified glucoamylase method showed no significant differences in TS content before or after pelleting. For DG, the modified glucoamylase method demonstrated increased DG with each processing step. Furthermore, increasing the conditioning temperature and time resulted in a greater DG when evaluated by the modified glucoamylase method. However, results demonstrated that DSC is not suitable as a quantitative tool for determining DG in multicomponent animal feeds due to interferences from nonstarch transformations, such as protein denaturation.

Evaluation of AMSTAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions.

PubMed

Pollock, Michelle; Fernandes, Ricardo M; Hartling, Lisa

2017-03-23

Overviews of reviews (overviews) compile information from multiple systematic reviews (SRs) to provide a single synthesis of relevant evidence for decision-making. It is recommended that authors assess and report the methodological quality of SRs in overviews-for example, using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Currently, there is variation in whether and how overview authors assess and report SR quality, and limited guidance is available. Our objectives were to: examine methodological considerations involved in using AMSTAR to assess the quality of Cochrane and non-Cochrane SRs in overviews of healthcare interventions; identify challenges (and develop potential decision rules) when using AMSTAR in overviews; and examine the potential impact of considering methodological quality when making inclusion decisions in overviews. We selected seven overviews of healthcare interventions and included all SRs meeting each overview's inclusion criteria. For each SR, two reviewers independently conducted AMSTAR assessments with consensus and discussed challenges encountered. We also examined the correlation between AMSTAR assessments and SR results/conclusions. Ninety-five SRs were included (30 Cochrane, 65 non-Cochrane). Mean AMSTAR assessments (9.6/11 vs. 5.5/11; p < 0.001) and inter-rater reliability (AC1 statistic: 0.84 vs. 0.69; "almost perfect" vs. "substantial" using the Landis & Koch criteria) were higher for Cochrane compared to non-Cochrane SRs. Four challenges were identified when applying AMSTAR in overviews: the scope of the SRs and overviews often differed; SRs examining similar topics sometimes made different methodological decisions; reporting of non-Cochrane SRs was sometimes poor; and some non-Cochrane SRs included other SRs as well as primary studies. Decision rules were developed to address each challenge. We found no evidence that AMSTAR assessments were correlated with SR results/conclusions. Results indicate that the AMSTAR tool can be used successfully in overviews that include Cochrane and non-Cochrane SRs, though decision rules may be useful to circumvent common challenges. Findings support existing recommendations that quality assessments of SRs in overviews be conducted independently, in duplicate, with a process for consensus. Results also suggest that using methodological quality to guide inclusion decisions (e.g., to exclude poorly conducted and reported SRs) may not introduce bias into the overview process.

NREL module energy rating methodology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Whitaker, C.; Newmiller, J.; Kroposki, B.

1995-11-01

The goals of this project were to develop a tool for: evaluating one module in different climates; comparing different modules; provide a Q&D method for estimating periodic energy production; provide an achievable module rating; provide an incentive for manufacturers to optimize modules to non-STC conditions; and to have a consensus-based, NREL-sponsored activity. The approach taken was to simulate module energy for five reference days of various weather conditions. A performance model was developed.

Tularosa Basin Play Fairway Analysis: Methodology Flow Charts

DOE Data Explorer

Adam Brandt

2015-11-15

These images show the comprehensive methodology used for creation of a Play Fairway Analysis to explore the geothermal resource potential of the Tularosa Basin, New Mexico. The deterministic methodology was originated by the petroleum industry, but was custom-modified to function as a knowledge-based geothermal exploration tool. The stochastic PFA flow chart uses weights of evidence, and is data-driven.

An Enzyme-Mediated Methodology for the Site-Specific Radiolabeling of Antibodies Based on Catalyst-Free Click Chemistry

PubMed Central

Zeglis, Brian M.; Davis, Charles B.; Aggeler, Robert; Kang, Hee Chol; Chen, Aimei; Agnew, Brian J.; Lewis, Jason S.

2013-01-01

An enzyme- and click chemistry-mediated methodology for the site-selective radiolabeling of antibodies on the heavy chain glycans has been developed and validated. To this end, a model system based on the prostate specific membrane antigen-targeting antibody J591, the positron-emitting radiometal 89Zr, and the chelator desferrioxamine has been employed. The methodology consists of four steps: (1) the removal of sugars on the heavy chain region of the antibody to expose terminal N-acetylglucosamine residues; (2) the incorporation of azide-modified N-acetylgalactosamine monosaccharides into the glycans of the antibody; (3) the catalyst-free click conjugation of desferrioxamine-modified dibenzocyclooctynes to the azide-bearing sugars; and (4) the radiolabeling of the chelator-modified antibody with 89Zr. The site-selective labeling methodology has proven facile, reproducible, and robust, producing 89Zr-labeled radioimmunoconjguates that display high stability and immunoreactivity in vitro (>95%) in addition to high selective tumor uptake (67.5 ± 5.0 %ID/g) and tumor-to-background contrast in athymic nude mice bearing PSMA-expressing subcutaneous LNCaP xenografts. Ultimately, this strategy could play a critical role in the development of novel well-defined and highly immunoreactive radioimmunoconjugates for both the laboratory and clinic. PMID:23688208

A genosensor for detection of consensus DNA sequence of Dengue virus using ZnO/Pt-Pd nanocomposites.

PubMed

Singhal, Chaitali; Pundir, C S; Narang, Jagriti

2017-11-15

An electrochemical genosensor based on Zinc oxide/platinum-palladium (ZnO/Pt-Pd) modified fluorine doped tin oxide (FTO) glass plate was fabricated for detection of consensus DNA sequence of Dengue virus (DENV) using methylene blue (MB) as an intercalating agent. To achieve it, probe DNA (PDNA) was immobilized on the surface of ZnO/Pt-Pd nanocomposites modified FTO electrode. The synthesized nano-composites were characterized by high resolution transmission electron microscopy (HRTEM), energy dispersive X-ray analysis (EDX), atomic force microscopy (AFM), scanning electron microscopy (SEM), UV-Vis spectroscopy, X-ray diffraction (XRD) analysis and Fourier transform infra-red (FTIR) spectroscopy. This PDNA modified electrode (PDNA/ZnO/Pt-Pd/FTO) served as a signal amplification platform for the detection of the target hybridized DNA (TDNA). The hybridization between PDNA and TDNA was detected by reduction in current, generated by interaction of anionic mediator, i.e., methylene blue (MB) with free guanine (3'G) of ssDNA. The sensor showed a dynamic linear range of 1 × 10 -6 M to 100 × 10 -6 M with LOD as 4.3 × 10 -5 M and LOQ as 9.5 × 10 -5 M. Till date, majorly serotype specific biosensors for dengue detection have been developed. The genosensor reported here eliminates the possibility of false result as in case of serotype specific DNA sensor. This is the report where conserved sequences present in all the serotypes of Dengue virus has been employed for fabrication of a genosensor. Copyright © 2017 Elsevier B.V. All rights reserved.

Mapping Sites of O-Glycosylation and Fringe Elongation on Drosophila Notch*

PubMed Central

Harvey, Beth M.; Rana, Nadia A.; Moss, Hillary; Leonardi, Jessica; Jafar-Nejad, Hamed; Haltiwanger, Robert S.

2016-01-01

Glycosylation of the Notch receptor is essential for its activity and serves as an important modulator of signaling. Three major forms of O-glycosylation are predicted to occur at consensus sites within the epidermal growth factor-like repeats in the extracellular domain of the receptor: O-fucosylation, O-glucosylation, and O-GlcNAcylation. We have performed comprehensive mass spectral analyses of these three types of O-glycosylation on Drosophila Notch produced in S2 cells and identified peptides containing all 22 predicted O-fucose sites, all 18 predicted O-glucose sites, and all 18 putative O-GlcNAc sites. Using semiquantitative mass spectral methods, we have evaluated the occupancy and relative amounts of glycans at each site. The majority of the O-fucose sites were modified to high stoichiometries. Upon expression of the β3-N-acetylglucosaminyltransferase Fringe with Notch, we observed varying degrees of elongation beyond O-fucose monosaccharide, indicating that Fringe preferentially modifies certain sites more than others. Rumi modified O-glucose sites to high stoichiometries, although elongation of the O-glucose was site-specific. Although the current putative consensus sequence for O-GlcNAcylation predicts 18 O-GlcNAc sites on Notch, we only observed apparent O-GlcNAc modification at five sites. In addition, we performed mass spectral analysis on endogenous Notch purified from Drosophila embryos and found that the glycosylation states were similar to those found on Notch from S2 cells. These data provide foundational information for future studies investigating the mechanisms of how O-glycosylation regulates Notch activity. PMID:27268051

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines For Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J N; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, Ill, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.