Delphi methodology in healthcare research: How to decide its appropriateness

Identifying neonatal transport research priorities: a modified Delphi consensus

OBJECTIVES

With increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport research questions as prioritised by parents and healthcare professionals (HCPs).

DESIGN

Key stakeholders participated in a modified three-stage Delphi consensus process. Research questions were identified and submitted through two survey stages before the final priority setting workshop.

PARTICIPANTS

Parents of babies who received neonatal care, neonatal HCPs and stakeholders.

OUTCOME

Identify the top 10 research priorities for neonatal transport.

RESULTS

Overall, 269 survey responses from HCPs/stakeholders (n=161) and parents (n=108) were analysed from two survey rounds. Consensus was reached on 22 of 43 research priorities for the final priority setting workshop. The agreed top research priorities covered the domains of: (1) Pain assessment and management, (2) Long-term neurological outcomes, (3) Impact of transfer on birth-related brain injury, (4) Investigating risk of transport, (5) Safety restraints for infants, (6) Optimal temperature management, (7) Respiratory management and outcomes, (8) Benchmarking of important of transport measures, (9) Understanding transport environmental exposures, (10) Mental health and burden of transfer on families.

CONCLUSION

We have identified the top research questions for neonatal transport through an extensive process actively engaging parents, HCPs and key stakeholders. Targeted funding and research resources, directed towards addressing these prioritised research areas, will inform evidence-based practices and international frameworks specific to neonatal transport, helping minimise research waste and ultimately improve outcomes for these high-risk infants and their families.

Barriers and Facilitators of Patient Engagement Activities to Improve Patient Safety in Healthcare Organizations: A Delphi-Based Expert Survey

Purpose

In order to obtain sustainable healthcare, engagement of patients in patient safety improvement is vital. Drawing upon a multi-perspective approach, this study aimed to investigate perspectives of patients and healthcare professionals on key implementation factors (ie, barriers and facilitators) for effective patient engagement (PE) in healthcare organizations to improve patient safety.

Patients and Methods

A two-round Delphi technique comprising semi-structured interviews and an online survey was applied to consolidate the individual perspectives of stakeholders and establish consensus on factors (expected, potential or experienced) that facilitate or mitigate successful implementation of PE in healthcare organizations (ie, all types, including hospital and outpatient medical practices). Adult, German-speaking experts in patient safety or PE (ie, with professional background or personal experience) were eligible to participate. Purposive and convenience sampling for inclusion of different healthcare professionals and patient representatives was established. Thirty-four panelists participated in data collection.

Results

We identified eight key barriers and seven facilitators for effective patient engagement in healthcare organizations. Time constraints and perceived low effectiveness of patient engagement activities were deemed as most critical barriers. Supportive organizational culture, education and training opportunities, and clearly nominated responsibilities for patient feedback and engagement were rated as the most important facilitators. There were no statistically significant differences in the ratings between patient representatives and healthcare professionals.

Conclusion

Our findings contribute to a deeper understanding of real-world implementation factors for effective patient engagement in healthcare organizations in Germany to improve patient safety. Our insights may further inform recommendations for future development and implementation of effective patient involvement in healthcare organizations, especially for similar countries with low levels of PE.

Trial Registration

German Clinical Trials Register (ID: DRKS00031837).

Defining harmful news reporting on community firearm violence: A modified Delphi consensus study

Community firearm violence (CFV), including fatal and non-fatal shootings that result from interpersonal violence, disproportionately harms people from marginalized racial groups. News reporting on CFV can further exacerbate these harms. However, examining the effects of harmful news reporting on CFV on individuals, communities, and society is hindered by the lack of a consensus definition of harmful reporting on CFV. In this study, we aimed to define harmful reporting on CFV. We used a modified, three-round Delphi process to achieve consensus among diverse stakeholders. Round 1 sought to assess consensus on 12 potentially harmful news content elements for three levels of harm (individual, community, and society). Round 2 invited panelists to rate the severity of each news content element at each level of harm. Round 3 asked panelists to agree or disagree with the panel's median severity rating of each element at each level of harm. Twenty-one panelists were recruited from three expertise groups (lived experience of CFV, journalism practice, scholarship) and all panelists completed all three rounds. In Round 1, no negative consensus was achieved for any of the proposed news content elements. In Round 2, panelists assigned moderate to severe harm ratings for all but two news content elements, and median harm ratings for each element varied across the different levels of harm. In Round 3, panelists reported high levels of agreement for each harm rating at each level. This modified Delphi process yielded a definition of the 12 elements that comprise harmful news reporting on CFV and severity ratings of harm caused by each element at each level according to expert consensus. Future work will use these results to evaluate and intervene on harmful reporting on CFV. Reducing harm from reporting on CFV can help address this health disparity and support evidence-based approaches to this urgent public health issue.

Assessing the need for a doctor of philosophy (Ph.D.) degree in Endodontics: perspective and implication for advancing dental education and research in Saudi Arabia

AIM

This study aims to evaluate the necessity and feasibility of integrating a Doctor of Philosophy (Ph.D.) degree into Endodontic programs at the Faculty of Dentistry King Abdulaziz University, (KAUFD), Jeddah, Saudi Arabia, and to gather insights from key stakeholders regarding the value and necessity of a Ph.D. in enhancing the field of Endodontics.

MATERIALS AND METHODS

An online questionnaire link was distributed among potential Ph.D. candidates and key decision-makers in Endodontics in Saudi Arabia through social media and emails to members of the Saudi Endodontic Society and the Saudi Endodontic Journal. The questionnaire assessed demographics, professional background, interest in Ph.D. programs, program preferences, perceived need for Ph.D. programs in various sectors, and university selection criteria. Data were analyzed using IBM SPSS Statistics (Version 23).

RESULTS

141 responses were received. Most respondents were aged 31-40, with an almost equal gender distribution. In terms of current position, a significant number were Endodontic consultants (35.7%) and Endodontic residents/Master students (28.6%) (P = 0.006). Additionally, a considerable proportion of probable prospective students had less than 5 years of expertise (45.7%) (p = 0.013), and the highest degree held by many was a bachelor's degree (35.7%) (P = 0.007). Key considerations for prospective students were program duration, Saudi Commission for Health Specialists (SCFHS) recognition, part-time options, and cost. The importance of acquiring research skills, such as learning new research technologies and gaining publication experience, was also highlighted.

CONCLUSION

The findings strongly suggest a need for a Ph.D. program in Endodontics in Saudi Arabia. The results provide valuable insights for developing a program that aligns with potential candidates' and key stakeholders' needs and preferences, thereby advancing Endodontic research and education within the country.

Pediatricians at the forefront of child mental health? A Delphi method exploration

BACKGROUND

Rising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a key position to improve access to care. The Delphi method was employed as an initial step toward redefining the role of pediatricians and the re-design of pediatric responses within Israeli primary mental health care.

METHOD

Ninety-two experts, including pediatricians, psychiatrists, mental health and child-development professionals, and parents of children with emotional-behavioral challenges participated in a three-round Delphi study. A survey including 6 topics (37 items, 9 demographic questions) was distributed, probing the envisioned role of pediatricians in children's mental health care.

RESULTS

There was strong endorsement between experts regarding pediatricians' potential roles in risk identification, parental guidance, psycho-education, and health policy isuues such as referrals to mental health professionals, and the need for training in this domain. However, discord arose concerning changes in the service framework and pediatricians' role in psychiatric drug prescription. The majority agreed on the necessity of close support from mental health experts, despite differing in the form it should take.

CONCLUSIONS

This study underscores the critical need for mental health training among pediatricians and advocates for a structured, consensus-driven model to bolster early detection and initial treatment of mental health issues in children. The findings highlight the potential for leveraging this model to drive health policy changes and improve service delivery in pediatric mental health care, and might inform other health systems considering extending pediatricians' roles. By equipping pediatricians with essential competencies, this approach can broaden mental health service delivery and reduce stigma. Aligning the model with expert consensus paves the way for impactful policy reform, enhancing pediatricians' roles in mental health risk identification and intervention, and advancing child health services.

Modified Delphi Study to Establish Consensus About Child Neurology Residency Education: Next-Gen Training

BACKGROUND AND OBJECTIVES

Rapid advances in diagnostics and treatments are shifting child neurology practice, but child neurology training requirements have been much slower to change. Previous literature confirms strong support for modernization, but no formal consensus exists regarding maintaining or changing training. We aimed to develop a holistic consensus regarding the optimal training pathway and requirements using a modified Delphi process.

METHODS

The authors invited 48 child neurologists as panelists, intentionally selecting to represent the diverse geography, practice type, subspecialties, and other demographics of child neurologists practicing in the United States. Panelists participated in an anonymized modified Delphi study with 4 rounds evaluating statements regarding current training requirements, core rotation durations, and mandatory subspecialty rotations with the option to agree or disagree. Statements were derived from current Accreditation Council of Graduate Medical Education, American Board of Psychiatry and Neurology, and American Board of Pediatrics requirements for child neurology training and recent literature. Statements that did not reach a predefined level of consensus (≥75% agreement or disagreement on a 7-point Likert scale) were re-queried or modified for subsequent rounds. Panelists had access to all previous anonymized results and comments. The final modifications were presented in round 4 as a comprehensive training proposal.

RESULTS

Twenty-seven panelists agreed to participate, with most completing all 4 rounds. In round 1, consensus was reached on 45 of 118 (38%) items; round 2, 28 of 87 (32%); round 3, 16 of 25 (64%); and round 4, 1 of 1 (100%). There was consensus regarding the age scope of practice and certain subspecialties that should be required, but no initial consensus regarding time-based requirements. By round 4, consensus emerged for the following rotations-months: neonatal and pediatric intensive care-4, adolescent medicine-0.5, emergency medicine-1.5, inpatient pediatrics-3, outpatient pediatrics-3.5, inpatient child neurology-9.5, outpatient child neurology-6, inpatient adult neurology-3, outpatient adult neurology-2, genetics-2, EEG/neurophysiology-2, neuroimaging-1, child psychiatry-1, and electives-7.5. The consensus schedule consists of 46.5 total months of requirements.

DISCUSSION

This study suggests that, despite diverging views prevalent among child neurologists, a diverse panel can, through a multiround Delphi process, arrive at consensus regarding many core features of the child neurology training structure and certification requirements.

A consensus definition of creativity in surgery: A Delphi study protocol

INTRODUCTION

Clear definitions are essential in science, particularly in the study of abstract phenomena like creativity. Due to its inherent complexity and domain-specific nature, the study of creativity has been complicated, as evidenced by the various definitions used to describe it and the multitude of tools which claim to measure it. Surgery is a safety-critical profession where creativity could be useful in navigating unforeseen problems and circumstances, as well as developing new innovations to improve patient outcomes. To validly and reliably study creativity in surgery, a surgery-specific definition is required. We aim to develop a consensus definition of creativity in surgery, utilizing the existing creativity literature and surgeon input.

METHODS AND ANALYSIS

The objective of this study is to generate a consensus definition of creativity in surgery. We will first conduct a focus group comprised of 4-12 highly experienced surgeons to generate knowledge on surgeons' perceptions, attitudes and beliefs about creativity in surgery, collect real-world examples of creativity in surgery, and obtain opinions on the existing definitions of creativity in the literature. The selection of focus group participants will be performed using purposive sampling of the chairs and/or chiefs of each surgical sub-specialty at our home institution. Several questions relating to creativity in surgery will be posed to the focus group, to be rated using a 7-point Likert scale and used as prompts for group discussion. We will also search MEDLINE, PsycINFO and EMBASE to find definitions of creativity in the scientific literature. Six definitions, chosen based on citation frequency and relevancy to surgery, will be presented to the focus group for ranking and discussion. Lastly, in addition to novelty and effectiveness, which are widely accepted as necessary components of creativity, the focus group will be asked to consider the necessity of other components for creativity in surgery, sourced from the scientific literature. Descriptive and thematic analyses are planned for the quantitative and qualitative data, respectively. The results of the focus group will be incorporated in the drafting of five definitions of creativity in surgery, which will be presented as initial Delphi statements in the Delphi study. For the Delphi panel, we will perform non-probability purposive sampling of surgeons and surgeon trainees at our home institution, with a minimum panel size of 12. Panellists will be asked to select the definition of creativity most relevant to surgery, with each Delphi round electronically delivered. After each round, the steering committee will meet to review the results and adjust the statements for the next round based on the feedback. A maximum of 5 rounds will be performed, or until consensus is reached (≥75% agreement). Recruitment is scheduled to begin on 1 August 2024.

ETHICS AND DISSEMINATION

All focus group and panellists will be given written and verbal information on the study and provide signed, informed consent. We plan to publish the results of our study in a creativity science- or surgery-focused journal to disseminate the results of our study to relevant stakeholders. We also plan to present the results of our research at local, national, and international conferences.

Conflicting Definitions of Self-Regulation in Occupational Therapy: A Scoping Review

AIMS

To understand how occupational therapy literature conceptualizes, discusses, describes, implies, and operationalizes self-regulation.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and JBI methodology guided the review. MEDLINE, Embase, CINAHL, PsychInfo and ERIC databases were searched with studies from 2000 - June 2023 deemed eligible. Two reviewers extracted data with results presented in figurative, tabular, and narrative synthesis. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklist for systematic reviews. Content analysis of construct descriptions was conducted.

RESULTS

A total 4159 articles were screened for eligibility, and eighty-one assessed at full text. Nine additional studies were retrieved through hand-searching. Sixty-four studies were included and underwent critical appraisal. Content analysis revealed five self-regulation constructs and associated terms in the occupational therapy literature, including self-regulation, executive function, emotion regulation, interoception and social-emotional learning.

CONCLUSIONS

Five distinct self-regulation constructs were analyzed in the occupational therapy literature, with various terms used to describe and define these. Self-regulation and executive function were often described as linked constructs. Similarly, lack of congruence between self-regulation measures, identified interventions and the underlying self-regulation construct was identified.

Pre-hospital management of penetrating neck injuries: derivation of an algorithm through a National Modified Delphi

BACKGROUND

Timely and effective pre-hospital management of penetrating neck injuries (PNI) is critical to improve patient outcomes. Pre-hospital interventions in patients with PNI can be especially challenging due to the anatomical injury site coupled with a resource-limited environment. Nationally, in the United Kingdom, no consensus statement or expert agreed guidance exists on how to best manage PNI in the pre-hospital setting.

METHOD

We conducted a national modified e-Delphi study with subject matter experts (SMEs) from multiple professional specialities with experience in the management of PNI. Pre-identified SMEs were contacted and consented prior to participation allowing for a remotely conducted Delphi using REDCap and Microsoft Teams. In Round 1, statements drawn from the literature base were distributed to all SMEs. Round 2 comprised a facilitated and structured discussion of the statements and then an online survey provided final ratification in Round 3. Of the participating SMEs consensus was set a priori at 70%.

RESULTS

Of the 67 pre-identified SMEs, 28 participated, resulting in a response rate of 42%. From the first two rounds, 19 statements were derived with every statement achieving consensus in Round 3. Subsequently, an algorithm for the pre-hospital management of PNI was developed and agreed with SME consensus.

CONCLUSION

Curation of national consensus statements from SMEs aims to provide principles and guidance for PNI management in a complicated patient group where pre-hospital evidence is lacking. Multi-professional national consensus on the best approach to manage these injuries alongside a novel PNI management algorithm aims to optimise time critical care and by extension improve patient outcomes.

Protocol to develop strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery in a selected district of Zimbabwe

Village Health Workers (VHWs) in Zimbabwe complement the healthcare staff in primary health care delivery. In 2015 the Ministry of Health streamlined services offered by the VHWs with the VHW Strengthening Plan to improve the effectiveness of the program. However, these continue to offer services not addressing the current and emerging health problems. This three-phased study seeks to develop strategies to improve the effectiveness and efficiency of VHWs in service delivery. Systematic literature review shall be used to develop a conceptual framework to guide the development of VHWs service delivery strategies. Exploratory sequential mixed methods design shall explore VHWs roles in primary health care. A survey in the first stage shall collect qualitative data from 45 purposely selected healthcare workers and VHWs using interviews and then thematically analyzed with MAXQDA. The variables generated will have a cross-sectional survey used to collect quantitative data from 134 VHWs and analyzed on SPSS. The SWOT and basic logic models shall be used to develop strategies validated by the Delphi Technique and Key Stakeholders. Informed consent will be maintained in the study with findings published in journals and presentation symposiums. This protocol was approved by the University of Venda Research Ethics Committee (Registration FHS/23/pH/11/0709).

Challenges and opportunities in newly diagnosed glioblastoma in the United Kingdom: A Delphi panel

Background

Glioblastoma is the deadliest primary malignant brain tumor in adults with limited treatment options and an average survival time of 12-18 months in the United Kingdom. In addition, glioblastoma has a highly detrimental impact on physical, cognitive, and emotional well-being, leaving substantial unmet needs for patients and caregivers. This study aimed to identify unmet needs in people with newly diagnosed glioblastoma and opportunities to mitigate them.

Methods

Utilizing Delphi methodology, an initial roundtable discussion with patient advocacy experts from 5 brain tumor organizations in the United Kingdom informed the development of 2 rounds of surveys across 9 domains (diagnosis, treatment, integrated care, support beyond treatment, quality of life, access to new treatments, access to trials, measures to ease the burden, and impact of COVID-19). Consensus was predefined as ≥70% agreement.

Results

A total of 17 Delphi panelists (glioblastoma patients, caregivers, and patient representatives) completed the first round of questionnaires and 26 completed the second. Consensus was reached on 16/21 questions (76.2%) and 7/9 domains. Panelists reached a consensus on key questions including the high frequency of diagnosis via emergency departments, the lack of effective personalized treatments and holistic care, the high caregiver burden, the lack of awareness and availability of access to clinical trials, and the negative impact of COVID-19 on glioblastoma care.

Conclusions

Significant unmet needs exist for newly diagnosed glioblastoma patients in the United Kingdom, highlighting the demand for increased research funding, comprehensive patient care, caregiver support, enhanced awareness and access to clinical trials, and new treatments.

2024 Standardization of Polysomnography Reports - A Consensus of the Brazilian Sleep Association

Introduction  The absence of standardized reporting for sleep medicine exams across different laboratories can lead to misinterpretation, diagnostic inconsistencies, and suboptimal treatment strategies. This document seeks to establish guidelines for the development of sleep study reports, covering recordings from studies of types 1 to 4, and represents the official position of Associação Brasileira do Sono (ABS; Brazilian Sleep Association) on the standardization of polysomnography (PSG) and cardiorespiratory polygraphies. Materials and Methods  The recommendations for the items to be reported in PSG records were developed by means of a Delphi study, comprised of two voting rounds. In each round, participants had to vote regarding the appropriateness of items to be reported in type-1 to -4 sleep studies, rating them as recommended , optional , or not recommended . The consensus threshold was set at 66% in each voting round, or 75% for the combined responses of recommended and optional . Results  The panel was comprised of 29 experts. After 2 voting rounds and subsequent deliberations by the steering committee, 352 items were included in the final set of recommendations. Consensus was achieved for 339 items (96.3%), of which 145 (41.2%) were classified as recommended , 154 as optional (43.8%), 35 as not recommended (9.9%), and 5 as not allowed (1.4%). No consensus was reached for 13 items (3.7%). The items recommended in this consensus are detailed in the main text. Conclusion  These guidelines provide comprehensive recommendations for reporting diagnostic tests in sleep medicine.

Expert opinion on use of vagus nerve stimulation therapy in the management of pediatric epilepsy: A Delphi consensus study

PURPOSE

To provide consensus-based recommendations for use of vagus nerve stimulation (VNS) therapy in the management of pediatric epilepsy.

METHODS

Delphi methodology with two rounds of online survey was used to build consensus. A steering committee developed 43 statements related to pediatric epilepsy and the use of VNS therapy, which were evaluated by a panel of 12 neurologists/neurosurgeons with expertise in pediatric epilepsy, who graded their agreement with each statement on a scale of 1 ("I do not agree at all") to 5 ("I strongly agree"). For each statement, consensus was established if ≥70% of the agreement scores were 4 or 5 and <30% were 1 or 2 in the final survey.

RESULTS

Twenty-four statements regarding the need for seizure reduction in pediatric epilepsy, the recommended treatment algorithm, the benefits and safety of VNS therapy, management of side effects of VNS therapy, patient selection for VNS therapy, and the use, dosing, and titration of VNS therapy achieved consensus. VNS and other neuromodulation therapies should be considered for pediatric patients with drug-resistant epilepsy who are not candidates for resective surgery, or who do not remain seizure free after resective surgery. When VNS therapy is initiated, the target dose range should be achieved via the fastest and safest titration schedule for each patient. Scheduled programming can be helpful in dose titration.

CONCLUSION

The expert consensus statements represent the panelists' collective opinion on the best practice use of VNS therapy to optimize outcomes in the management of pediatric epilepsy.

Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology

BACKGROUND

Opioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks.

OBJECTIVE

This project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings.

METHODS

The e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements.

RESULTS

A diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years' professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3.

CONCLUSIONS

Community pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.

Lung cancer (internet-based) Delphi (LUCiD): A modified eDelphi consensus process to establish Australasian clinical quality indicators for thoracic cancer

BACKGROUND AND OBJECTIVE

Approximately 16,000 new cases of lung cancer are diagnosed each year in Australia and Aotearoa New Zealand, and it is the leading cause of cancer death in the region. Unwarranted variation in lung cancer care and outcomes has been described for many years, although clinical quality indicators to facilitate benchmarking across Australasia have not been established. The purpose of this study was to establish clinical quality indicators applicable to lung and other thoracic cancers across Australia and Aotearoa New Zealand.

METHODS

Following a literature review, a modified three round eDelphi consensus process was completed between October 2022 and June 2023. Participants included clinicians from all relevant disciplines, patient advocates, researchers and other stakeholders, with representatives from all Australian states and territories and Aotearoa New Zealand. Consensus was set at a threshold of 70%, with the first two rounds conducted as online surveys, and the final round held as a hybrid in person and virtual consensus meeting.

RESULTS

The literature review identified 422 international thoracic oncology indicators, and a total of 71 indicators were evaluated over the course of the Delphi consensus. Ultimately, 27 clinical quality indicators reached consensus, covering the continuum of thoracic oncologic care from diagnosis to first line treatment. Indicators benchmarking supportive care were poorly represented. Attendant numeric quality standards were developed to facilitate benchmarking.

CONCLUSION

Twenty-seven clinical quality indicators relevant to thoracic oncology care in Australasia were developed. Real world implementation will now be explored utilizing a prospective dataset collected across Australia.

A roadmap towards standardized neuroimaging approaches for human thalamic nuclei

The thalamus has a key role in mediating cortical-subcortical interactions but is often neglected in neuroimaging studies, which mostly focus on changes in cortical structure and activity. One of the main reasons for the thalamus being overlooked is that the delineation of individual thalamic nuclei via neuroimaging remains controversial. Indeed, neuroimaging atlases vary substantially regarding which thalamic nuclei are included and how their delineations were established. Here, we review current and emerging methods for thalamic nuclei segmentation in neuroimaging data and consider the limitations of existing techniques in terms of their research and clinical applicability. We address these challenges by proposing a roadmap to improve thalamic nuclei segmentation in human neuroimaging and, in turn, harmonize research approaches and advance clinical applications. We believe that a collective effort is required to achieve this. We hope that this will ultimately lead to the thalamic nuclei being regarded as key brain regions in their own right and not (as often currently assumed) as simply a gateway between cortical and subcortical regions.

A Framework for Measuring Neighborhood Walkability for Older Adults-A Delphi Consensus Study

While mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. The expert workshop and the review led to an extensive list of potential indicators, which we hope will be useful in future research. Those indicators were then adapted and rated in a three-stage Delphi expert survey. A fourth additional Delphi round was conducted to assess the relevance of each indicator for the different frailty levels, namely "robust," "pre-frail," and "frail." Between 20 and 28 experts participated in each round of the Delphi survey. The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: "Built environment and transport infrastructure," "Accessibility and meeting places," and "Attractiveness and sense of security." For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.

Research prioritization in hernia surgery: a modified Delphi ACHQC and VHOC expert consensus

PURPOSE

Numerous clinical practice guidelines and consensus statements have been published in hernia surgery, however, there is still a need for high-quality evidence to address remaining unanswered questions. The aim of this study was to conduct research priority setting through a modified Delphi process to identify a list of top research priorities in hernia surgery.

METHODS

A structured literature review of clinical practice guidelines was performed by the steering committee. Topics considered clinically significant, practical to study and lacking strong evidence were extracted and refined into a comprehensive list, then entered into a two-round Delphi survey for prioritization at the Abdominal Core Health Quality Collaborative (ACHQC) Quality Improvement Summit. In round 1, participants were instructed to select any topic that should be prioritized for future research. Topics were ranked according to the proportion of votes and the 25 highest-ranking topics were included in the second round. In round 2, participants were instructed to select only the top 10 topics for research prioritization.

RESULTS

Eleven clinical practice guidelines were reviewed. Eighty-seven topics were extracted by the steering committee and submitted for prioritization. After the first round, 25 of the highest-ranking topics were determined and included in the second round. A final list of 11 research questions was identified. The hernia types with the most research interest were inguinal and epigastric/umbilical hernias. Other topics of high interest were the management of diastasis recti, primary versus mesh repairs and expectant management versus surgical repair.

CONCLUSION

Our study provides a research agenda generated through expert consensus that may be used in the prioritization of the design and funding of clinical trials in hernia surgery.

Rice bran arabinoxylan compound as a natural product for cancer treatment - an evidence-based assessment of the effects and mechanisms

CONTEXT

Rice bran arabinoxylan compound (RBAC) is a natural immunomodulator with anticancer properties.

OBJECTIVE

This study critically evaluates the available evidence on the biological pathways of RBAC and its effects on cancer treatment.

METHODS

This secondary analysis of a scoping review includes studies evaluating the mechanisms of RBAC on healthy or malignant cells, animal models, or humans for cancer prevention or treatment. Data from randomized controlled trials on survival and quality of life outcomes were subjectd to meta analysis.

RESULTS

The evidence synthesis was based on 38 articles. RBAC exhibited antitumor properties by promoting apoptosis and restoring immune function in cancer patients to enhance inflammatory and cytotoxic responses to block tumorigenesis. RBAC works synergistically with chemotherapeutic agents by upregulating drug transport. In a clinical trial, combining RBAC with chemoembolization in treating liver cancer showed improved response, reduced recurrence rates, and prolonged survival. RBAC also augments the endogenous antioxidant system to prevent oxidative stress and protect against radiation side effects. In addition, RBAC has chemoprotective effects. Animals and humans have exhibited reduced toxicity and side effects from chemotherapy. Meta analysis indicates that RBAC treatment increases the survival odds by 4.02-times (95% CI: 1.67, 9.69) in the first year and 2.89-times (95% CI: 1.56, 5.35) in the second year.

CONCLUSION

RBAC is a natural product with immense potential in cancer treatment. Additional research is needed to characterize, quantify, and standardize the active ingredients in RBAC responsible for the anticancer effects. More well-designed, large-scale clinical trials are required to substantiate the treatment efficacies further.

Insights from an Italian Delphi panel: exploring resistance to first-generation somatostatin receptor ligands and guiding second-line medical therapies in acromegaly management

PURPOSE

First-line medical therapy for acromegaly management includes first-generation somatostatin receptor ligands (fgSRLs), but resistance limits their use. Despite international guidelines, the choice of second-line therapy is debated.

METHODS

We aim to discuss resistance to fgSRLs, identify second-line therapy determinants and assess glycemia's impact to provide valuable insights for acromegaly management in clinical practice. A group of Italian endocrinologists expert in the pituitary field participated in a two-round Delphi panel between July and September 2023. The Delphi questionnaire encompassed a total of 75 statements categorized into three sections: resistance to fgSRLs therapy and predictors of response; determinants for the selection of second-line therapy; the role of glycemia in the therapeutic management. The statements were rated on a 6-point Likert scale.

RESULTS

Fifty-nine (79%) statements reached a consensus. IGF-1 levels resulted central for evaluating resistance to fgSRLs, that should be defined considering also symptomatic clinical response, degree of tumor shrinkage and complications, using clinician- and patient-reported outcome tools available. Factors to be evaluated for the choice of second-line medical therapy are hyperglycemia-that should be managed as in non-acromegalic patients-tumor remnant, resistant headache and compliance. Costs do not represent a main determinant in the choice of second-line medical treatment.

CONCLUSION

The experts agreed on a holistic management approach to acromegaly. It is therefore necessary to choose currently available highly effective second-line medical treatment (pegvisomant and pasireotide) based on the characteristics of the patients.

A Narrative Review of the Clinical, Humanistic, and Economic Value of Pembrolizumab-Based Immunotherapy for the Treatment of Breast and Gynecologic Cancers

Breast and gynecologic cancers are common across the world and are associated with substantial societal and economic burden. Pembrolizumab was among the first immune checkpoint inhibitors targeting programmed cell death protein 1 to be approved for the treatment of patients with triple-negative breast cancer, cervical cancer, and endometrial cancer. Recent clinical trials have established pembrolizumab regimens as a standard of care treatment for these tumor types. Clinical data are further supported by patient-reported outcome, cost-effectiveness, and real-world evidence. Pembrolizumab monotherapy and combination regimens do not negatively influence health-related quality of life and are cost-effective relative to comparators. Ongoing phase 3 studies with pembrolizumab will expand the current understanding of its use in breast and gynecologic cancers. Several of these studies are in patients with early-stage disease with the hope of curing patients. The main objective of this review is to summarize the clinical, humanistic, and economic value of pembrolizumab in these settings and to describe the future challenges for patients, caregivers, clinicians, and payers.

Approach to Mycosis Fungoides in children: Consensus-based recommendations

BACKGROUND

Pediatric Mycosis fungoides (MF) management extrapolates from adult guidelines, despite differing clinical aspects. Recommendations are essential to address unique challenges in this distinct patient group.

OBJECTIVE

This project aims to derive consensus recommendations for pediatric MF management.

METHODS

Experts from pediatric dermatology, general dermatology, dermatopathology, and pediatric hematology-oncology (N = 83) were invited to contribute to consensus recommendations. The process involved 3 electronic Delphi rounds, concluding with a final consensus meeting using a modified Nominal Group Technique for unresolved items.

RESULTS

Consensus included more clinical severity measures than tumor-node-metastasis-blood staging: pruritus, functional or esthetic impairment (eg, palms, soles, genitalia), quality of life impact, and psychological aspects (eg, embarrassment, anxiety, depression), plus parental anxiety. Ten recommendations were made for managing early and advanced pediatric MF. Disagreement emerged in choosing therapies beyond stage I of the disease.

DISCUSSION

This multinational initiative aimed to standardize optimal pediatric MF management and successfully generated consensus recommendations. Additional work is needed for structured, prospective protocols in advanced-stage pediatric MF.

LIMITATIONS

Lack of pediatric hematologists-oncologists and patients' representatives.

CONCLUSION

Documentation of extended clinical severity and outcome measures is recommended. Addressing the need for structured protocols in advanced-stage pediatric MF and implementing systematic, prospective data collection is crucial.

A competency framework for simulation facilitation in low-resource settings: a modified Delphi study

BACKGROUND

Skilled facilitators are essential to drive effective simulation training in healthcare. Competency-based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context-sensitive priorities developed with practitioners working in low-resource settings.

METHODS

We aimed to develop a core competency framework for healthcare simulation facilitation in low-resource settings using a modified Delphi process. We drew on the domain expertise of members of the Vital Anaesthesia Simulation Training Community of Practice, with the study guided by a four-member steering group experienced in the conduct of simulation in low-resource settings. In survey round 1, participants (n = 54) were presented with an initial competency set derived from a previous qualitative study and co-created a set of 57 competencies for effective simulation facilitation in low-resource settings. In survey round 2, participants (n = 52) ranked competencies by relevance into three performance categories: techniques; artistry; and values. In survey round 3, participants (n = 50) ranked competencies on their importance. The steering group collated results and presented a draft core competency framework. In survey round 4, participants (n = 50) voted with 98% agreement that this framework represented the most relevant and important competencies for effective facilitation of simulation sessions in low-resource settings.

RESULTS

The final 32-item framework encompasses core competencies found in existing standards and includes important new concepts such as demonstration of cultural sensitivity; humility; ability to recognise and respond to potential language barriers; facilitation team collaboration; awareness of logistics; and contingency planning.

DISCUSSION

This competency-based framework highlights specific practices required for effective simulation facilitation in low-resource settings. Further work is required to refine and validate this tool to train simulation facilitators to deliver effective training to improve patient safety.

How should we fund integrated primary care for children in Australia? A resource allocation study

OBJECTIVES

Integrated primary care provides health and social care services to intervene early and support children and families. Funding of integrated care is a barrier to care provision, but evidence is limited for which funding models are most appropriate. Our study aimed to provide expert judgement on what funding model, or mix of models, are most likely effective for integrating primary care for families with children aged 0-12 years in Australia.

METHODS

We conducted a resource allocation survey to value funding models for integrated care. Participants were purposively sampled experts in primary health, social care and mental health care. Six funding types were included in the study. Outcome measures included ranking of funding model preferences and qualitative analysis from open-ended questions.

RESULTS

Block-funding, alternative-payment-methods and incentive-payments were preferred models for integrated care individually and within a blended model. Fee-for-service, capitation and pay-for-performance were the least preferred models. There was agreement Fee-for-service may hinder integrating care.

CONCLUSIONS

A blended model, including alternative-payment-methods, incentive-payments and block-funding, were preferred models to best integrate care for child outcomes.

IMPLICATIONS FOR PUBLIC HEALTH

Determining how best to fund integrated primary care for children is a priority for decision-making in Australia, as fee-for-service is no longer considered appropriate.

Mentoring Fellows into Career Educators through a Multispecialty Clinician-Educator Course

Background

Subspecialty fellows are a unique group of trainees for whom there currently exist few opportunities to pursue formal training as clinician-educators, as singular fellowship programs often face significant obstacles to implementing such coursework.

Objective

To develop, implement, and assess a clinician-educator course for fellows from multiple subspecialty fellowships at a single large academic medical center.

Methods

Our course, entitled Fellow as Clinician-Educator, was initiated across numerous fellowship programs from August 2021 to April 2023 at University of California San Diego Health. The synchronous component of the curriculum included four half-day workshops targeting various clinician-educator subcompetencies. The course also included ongoing educational opportunities, longitudinal mentorship, and a medical education capstone project. Measures with pre and postcourse knowledge assessments and surveys were performed to evaluate the course's impact in this prospective observational cohort.

Results

Forty-six fellows enrolled in the course. Overall, there was statistically significant improvement in learners' confidence across 16 of 18 clinician-educator skills surveyed (P < 0.05). Participants demonstrated improvement in nine core topics for clinician-educators, achieving statistical significance for feedback (P = 0.0058), lecture slide design (P = 0.0006), and multimedia design principles (P = 0.0416). The course facilitated medical education scholarship in the form of 4 grant submissions, 7 manuscripts, 27 presented abstracts, and 24 curricular innovations.

Conclusion

Implementation of a multispecialty clinician-educator course for subspecialty fellows is feasible, effective, and facilitates academic scholarship in medical education. Such programs may also serve to circumnavigate many challenges that single fellowship programs face when attempting to pursue their own directed clinician-educator courses.

Identifying the top 10 priorities of adolescents with a physical disability regarding participation in physical activity: A Delphi study

AIM

To establish consensus among adolescents with a physical disability regarding their priorities for enhancing participation in physical activity and help inform the design of future interventions for participation in physical activity.

METHOD

We conducted a national multi-round Delphi study involving adolescents with a physical disability aged 13 to 17 years. Round 1 of the initial survey consisted of open-ended questions. Free-text responses were then analysed thematically, creating items categorized according to the family of participation-related constructs (fPRC). In round 2, participants rated the perceived importance of these items using a 5-point Likert scale. The top 10 priorities were constructed from the highest-ranked items.

RESULTS

One hundred and sixteen participants (mean age = 14 years 7 months, range = 13-17 years; 66 males; 58 with cerebral palsy; 43 wheelchair users) completed round 1; 108 items were included in round 2. Fifty-eight items were rated as either 'important' or 'really important' by 70% of participants. The top 10 priorities were rated as important or really important by 82% to 94% of participants with a mean Likert score of 4.40 (range = 4.25-4.63). Seven of the top 10 priorities were related to the environmental context of the fPRC. The other three were related to involvement and the related concept of preference.

INTERPRETATION

The priorities identified will help inform future physical activity interventions for adolescents with a physical disability.

Establishing consensus on lifestyle recommendations and behaviour change strategies to promote brain health-focussed care for multiple sclerosis: A modified e-Delphi study

INTRODUCTION

Brain health is a global priority for multiple sclerosis (MS) care. This study aimed to establish consensus on internationally applicable lifestyle recommendations and behaviour change strategies to promote lifelong brain health for people living with MS.

METHODS

A three-round, modified, e-Delphi survey was conducted. Lifestyle recommendations and behaviour change strategies were generated based on a review of the published literature, qualitative interviews, and expert feedback, respectively.

RESULTS

Sixty-nine experts participated, with a final response rate of 75 %. Experts were predominantly female (n = 50, 72 %), 30 to 59 years of age (n = 54, 78 %) and worked in an academic institution (n = 21, 50 %). A majority (n = 16, 80 %) of experts with lived experience had a relapsing-remitting phenotype. Starting with 15 lifestyle recommendations, we iteratively identified new recommendations and combined existing ones, achieving consensus on 17 lifestyle recommendations among experts from healthcare, academia, research and advocacy; 16 among experts with lived experience, and 14 behaviour change strategies, presented as separate frameworks.

CONCLUSIONS

An e-Delphi process has established lifestyle recommendations and identified behaviour change strategies to promote brain health-focussed care for MS. Reliance on these frameworks with detailed management recommendations may help to establish consistency in lifestyle behaviour management of MS, between and within healthcare systems.

Development of a core outcome set for recurrent acute and chronic pancreatitis: Results of a Delphi poll

BACKGROUND/OBJECTIVE

Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) lack effective therapies. There is no consensus or guidance on which endpoints or outcome measures should be used in clinical trials. This study aimed to develop a core outcome set aligned with both patient and provider priorities for RAP and CP. Utilizing the Outcomes Measures in Rheumatology (OMERACT) framework, a multi-stakeholder approach was adopted to identify and prioritize outcome domains.

METHODS

A two-round Delphi poll was conducted among four stakeholder groups: adult patients, parents and pediatric patients, adult health care providers and pediatric health care providers. Steering committee consensus further refined the core outcome domains, categorizing them as mandatory, important but optional, or research agenda domains, with full consensus achieved.

RESULTS

Pain severity, ability to participate in social roles and activities, pancreatitis related hospitalization/ER visits and acute pancreatitis flare-ups were recommended as mandatory outcome domains for future clinical trials in RAP/CP.

CONCLUSIONS

Using the OMERACT framework, we developed a core outcome set for RAP and CP. Future research will focus on identifying validated measures for each domain, facilitating standardized assessments across clinical trials.

Assessing evidence in translational chronobiology: The cases of Daylight Saving Time and road safety, and of school start times and sleep duration

One of the main challenges in translating chronobiology research into clinical practice is represented by differences in how basic scientists and clinicians evaluate evidence. The workshop "Assessing Evidence in Translational Chronobiology," which was held at the University of Surrey in June 2023, addressed this issue by bringing together basic scientists and clinicians to evaluate evidence on two specific topics: the impact of Daylight Saving Time (DST) on road traffic accidents and the relationship between delayed school start times (SSTs) and sleep duration in high school students. A comprehensive literature search was conducted for discussions during the workshop, which is presented in this review. The studies on both topics were analyzed from varying perspectives, including that of a chronobiologist and a transportation engineer for the DST-centered question, and that of a chronobiologist and an evidence-based medicine expert for the SSTs-centered question. The workshop audience, acting as a Delphi panel, attempted to produce statements/recommendations. It was concluded that most studies suggest that sleep duration benefits from delayed SSTs in high school, while less obvious results were obtained regarding the effect of DST on road safety.

Construction and psychometric validation in Spanish schoolchildren of a knowledge questionnaire on basic life support and Automated External Defibrillator (ConocES-BLS/AED) in Spain

The 60 % of cardiac arrests happen in the out-of-hospital setting. In 2023, the International Liaison Committee on Resuscitation issued a statement entitled "Children save lives", recommending the teaching of basic life support to children from the age of 12. However, we have not identified validated instruments that assess the level of knowledge of schoolchildren about BLS and AED.

OBJECTIVE

Construction and psychometric validation of a questionnaire to assess knowledge on Basic Life Support (BLS) and Automated External Defibrillator (AED) in primary to secondary school children.

METHOD

Cross-sectional descriptive study of validation of the questionnaire consisting of several phases: construction of the questionnaire on knowledge on BLS and AED (ConocES-BLS/AED), content validation, pilot test and psychometric validation.

RESULTS

The ConocES-SVB/AED questionnaire was constructed, content validation was carried out by 14 experts, the pilot test carried out on 105 students reported good reliability (0.84), and finally with the psychometric validation a questionnaire composed of 12 items was obtained and psychometrically validated using the Item Response Theory in a final sample of 182 participants. Adequate fit values and acceptable reliability (0.65) were obtained, demonstrating its usefulness to accurately measure the level of knowledge about SVB/AED maneuvers in schoolchildren.

CONCLUSIONS

The created and validated questionnaire provides educators with a fundamental resource to identify areas of lack of knowledge, improve and design effective educational interventions for schoolchildren on SVB/AED maneuvers.

Principles of the superior labrum and biceps complex: an expert consensus from the NEER Circle

BACKGROUND

The superior labrum and biceps complex is commonly implicated in shoulder pain and there remains discordance regarding the surgical management of superior labrum anterior to posterior (SLAP) tears. The purpose of this study was to establish an expert consensus regarding the management of superior labrum and biceps complex pathology.

METHODS

The NEER Circle is an organization of shoulder experts recognized for their service to the American Shoulder and Elbow Surgeons (ASES) society. Consensus among 92 identified experts was sought with a series of surveys pertaining to the management of superior labrum and biceps complex (SBC) pathology. The initial survey featured questions crafted to determine the experience of the panel in treating SBC pathology. The second survey was designed to elicit opinions concerning the diagnosis and treatment of SBC pathology. The third survey aimed to establish consensus across 48 scenarios, tasking panelists with categorizing 4 surgical modalities as either preferred, acceptable, or not acceptable. The available options included débridement, SLAP repair, biceps treatment, or a combined repair and biceps treatment. In the final survey, the panelists were tasked with diagnosing SBC pathologies by assessing arthroscopic footage and evaluating treatment options within 45 scenarios. A minimum of 80% agreement was required to attain consensus, designating a treatment as either preferred or unacceptable.

RESULTS

Response rates ranged from 52.2% to 58.7%. Discordance exists regarding aspects of the physical examination, patient history, imaging, nonoperative management, and the surgical approach in SBC injuries. Of the 78 clinical scenarios, 26 reached consensus agreement. Treating the biceps was the favored approach in older, more sedentary patients with evidence of biceps tendinopathy. Performing a SLAP repair was favored in scenarios depicting younger, more active patients with signs of an unstable biceps anchor or mechanical symptoms. A SLAP repair was typically contraindicated in the setting of an older patient, concomitant rotator cuff tear, and/or a prior failed SLAP repair. The management of overhead throwing athletes, particularly those that are professionals, remained controversial, although SLAP repair is generally favored in younger pitchers.

CONCLUSION

The optimal management of superior labrum and biceps complex pathology requires a systematic approach based on the individual's age, occupational demands, and functional requirements. Age was the predominant factor influencing surgical decision making. SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years. Little consensus was observed regarding the management of competitive athletes.

Updated consensus guidelines for management of moderate-to-severe atopic dermatitis in Singapore: Integrating biologics, Janus kinase inhibitors and conventional therapies

Introduction

Since 2016, several therapies have been approved for treating atopic dermatitis (AD) in Singapore, including biologics, oral Janus kinase (JAK) inhibitors and topical crisaborole. This study supplements the 2016 Singapore treatment guidelines for AD, focusing on newer therapies for moderate-to-severe disease, while revisiting older treatment regimens to accommodate changes in knowledge and practice.

Method

A modified Delphi panel was held, led by 2 co-chairs. The voting expert panel consisted of 12 dermatologists experienced in managing AD in Singapore. Delphi survey rounds were conducted between 24 July and 27 October 2023. Panellists indicated their agreement with drafted statements using a 5-point Likert scale. Consensus was defined as ≥80% agreement. An expert meeting was held to facilitate the consensus process between rounds 1 and 2 of voting.

Results

All expert panellists participated in both survey rounds, with a 100% response rate. Thirty-nine statements, classified into general principles, conventional treatments, biologics and JAK inhibitors, were proposed. Of these, 27 statements reached consensus at the end of round 1. After the expert meeting, 17 statements were included in round 2, of which 16 statements reached consensus. One statement did not reach consensus. Key updates are the inclusion of dupilumab and JAK inhibitors as potential first-line treatments for moderate-to-severe AD, in certain populations.

Conclusion

This modified Delphi study generated consensus among Singapore dermatology experts, to update treatment guidelines in moderate-to-severe atopic dermatitis. The consensus statements developed are intended to supplement the 2016 Singapore treatment guidelines for AD. Further revisions may be required when new evidence and/or treatments become available.

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method

BACKGROUND

Medication reconciliation is relevant in transitional care, however, given limited resources, it is necessary to identify the patients who benefit most from this activity.

AIM

To validate criteria to identify patients at high risk of medication errors undergoing major orthopedic surgery.

METHOD

Delphi Method in 3 phases, April-June 2023, to obtain consensus on the inclusion criteria, previously defined. Each expert rated criteria according to a 5-point Likert scale. Consensus was assumed in round 1 if the rate average was ≥4 (inclusion) or <2 (exclusion) and in rounds 2 and 3 if 50% of the responses were ≥4 (inclusion) or <2 (exclusion). It was possible to suggest the inclusion of new criteria.

RESULTS

10 experts from Faculties of Pharmacy and Medicine participated. In the first phase, consensus was reached on 18 criteria: polypharmacy, anticoagulants, oral chemotherapy (not hormone), immunosuppressants, antiretrovirals, antimyasthenics, insulin, corticoids, neuroleptics, antiarrhythmics, digoxin, carbamazepine, phenytoin, valproate, thyroid drugs, antiglaucoma, antiaggregants, and urgent surgery. Systemic antifungals and opioids were suggested. In the second phase, consensus was reached on 11 criteria: antiparkinsonics, beta-blockers, age ≥ 65 years, length of stay ≥5 days, lamotrigine, diuretics, antidepressants, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, anxiolytics, opioids, and systemic antifungals. In the last phase, 1 criterion reached consensus (sulfonylureas) and 1 criterion did not reach consensus (calcium channel blockers).

CONCLUSIONS

We develop and validate a list of 30 criteria to identify patients at high risk of experiencing medication errors undergoing major orthopedic surgery. These may help improve human resource management for clinical pharmacy activities by prioritizing patients who would benefit most.

Metabolomic Hallmarks of Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease

From a detailed review of 90 experimental and clinical metabolomic investigations of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), we have developed metabolomic hallmarks for both obesity and MASLD. Obesity studies were conducted in mice, rats, and humans, with consensus biomarker groups in plasma/serum being essential and nonessential amino acids, energy metabolites, gut microbiota metabolites, acylcarnitines and lysophosphatidylcholines (LPC), which formed the basis of the six metabolomic hallmarks of obesity. Additionally, mice and rats shared elevated cholesterol, humans and rats shared elevated fatty acids, and humans and mice shared elevated VLDL/LDL, bile acids and phosphatidylcholines (PC). MASLD metabolomic studies had been performed in mice, rats, hamsters, cows, geese, blunt snout breams, zebrafish, and humans, with the biomarker groups in agreement between experimental and clinical investigations being energy metabolites, essential and nonessential amino acids, fatty acids, and bile acids, which lay the foundation of the five metabolomic hallmarks of MASLD. Furthermore, the experimental group had higher LPC/PC and cholesteryl esters, and the clinical group had elevated acylcarnitines, lysophosphatidylethanolamines/phosphatidylethanolamines (LPE/PE), triglycerides/diglycerides, and gut microbiota metabolites. These metabolomic hallmarks aid in the understanding of the metabolic role played by obesity in MASLD development, inform mechanistic studies into underlying disease pathogenesis, and are critical for new metabolite-inspired therapies.

Developing the TIDieR-Rehab checklist: a modified Delphi process to extend the Template for Intervention Description and Replication (TIDieR) for rehabilitation intervention reporting

OBJECTIVES

Rehabilitation is essential for supporting the recovery from, and management of, a range of health conditions. However, interventions are often poorly reported in rehabilitation research, hindering advancement of the field. The Template for Intervention Description and Replication (TIDieR) checklist was developed to enhance the reporting of interventions, but does not specifically address the complexities and multifaceted nature of rehabilitation interventions. This study aimed to develop an extension of the TIDieR checklist to support better reporting of rehabilitation interventions.

DESIGN

A modified Delphi study overseen by a Steering Committee.

SETTING

Online.

PARTICIPANTS

Rehabilitation experts were purposively sampled for diversity in discipline, practice setting, area of expertise and geographical location.

METHODS

Participants (n=35) provided both quantitative and qualitative feedback on drafts of the TIDieR-Rehab through online surveys. Quantitative data was descriptively analysed by percentage of agreement, while qualitative data was analysed using conventional content analysis. Quantitative and qualitative findings were subsequently triangulated to facilitate iterative refinement of the TIDieR-Rehab.

RESULTS

Consensus was achieved after two rounds of the modified Delphi process. The TIDieR-Rehab checklist comprises seven original, three adapted and 12 new reporting items, and is supported by a supplementary manual. Specific enhancements include more detailed descriptions of the study population (Who) and timing of the intervention (When), the planned intervention dosage (How much, How challenging and Regression/Progression), person-centred care (Personalisation) and negative undesired effects (Harms) which were considered critical for the comprehensive reporting of rehabilitation interventions.

CONCLUSION

The TIDieR-Rehab checklist marks a significant advancement in enhancing and standardising the reporting of rehabilitation interventions. By offering a structured format for detailing complex rehabilitation interventions, the TIDieR-Rehab supports improvements in reporting quality to promote research replication and support the translation of research findings into clinical practice. Future research should validate the TIDieR-Rehab checklist across a variety of intervention types and clinical contexts.

Development of a minimum data set for long COVID: a Delphi study protocol

INTRODUCTION

Previous consensus-based long COVID research has focused on establishing research priorities, developing clinical definitions, core outcomes and a list of recommendations of patient-reported outcome measures that can be used to assess and characterise long COVID. Complementing and extending this work, the proposed study will bring together diverse knowledge users to prioritise concepts of care, quality of life and symptoms to inform a national patient registry on long COVID.

METHODS AND ANALYSIS

We will conduct a Delphi process involving Canadians with lived experiences and/or professional expertise with long COVID (including clinicians, policymakers, caregivers and community leaders). A pool of long COVID survey questions has been established through an environmental scan; these questions were coded by topic and will be presented via a series of online, anonymous survey questionnaires to a diverse cohort of 100 participants. Over the course of three Delphi rounds, participants will prioritise and recommend topics related to care, quality of life and symptoms. We will use the prioritised topics to develop a list of core questions as a minimum data set to standardise data collection and inform a national patient registry on long COVID in Canada.

ETHICS AND DISSEMINATION

This study has been approved by the University of Saskatchewan Behavioural Research Ethics Board (BEH #4296). Findings will be shared at national conferences and will be published in an open-access peer-reviewed journal. In addition, the minimum data set will be shared with key knowledge users as recommendations to inform a national long COVID patient registry.

Content validity of the questionnaire considering opinions of the Finnish physicians on euthanasia and assisted suicide

Despite numerous surveys conducted across the world considering assisted death, content validity evaluations of the survey questionnaires are seldom published. Likewise, there is no previous research about the content validity of the survey "Finnish physicians´ attitudes and opinions on euthanasia and physician-assisted suicide" conducted by the Finnish Medical Association. The aim of this study was to assess the content validity of the survey questionnaire. To study this, a purposive sample of physicians was recruited. Firstly, the participants were interviewed to bring up their interpretations and assessments considering the relevance, comprehensibility, and measurement scale suitability of the questions. Secondly, the participants assessed the revised study questionnaire. Altogether 16 physicians participated in the study. Although the relevance and comprehensibility of the questions were assessed to be high-level, parallel interpretations of the contents were discovered. We suggest content validity research to be essential when developing a questionnaire on assisted death. Our results could be helpful when planning future surveys about this challenging topic.

Implementation strategies to overcome barriers to early mobilisation practices in Zimbabwean and South African public sector ICUs: A Delphi study

Background

Barriers to early mobilisation in healthcare settings encompass various factors, including practical challenges, accountability and the crucial role of leadership.

Objectives

To gain consensus from multidisciplinary team members in South African (SA) and Zimbabwean public sector hospitals to formulate implementation strategies addressing identified barriers for early mobilisation.

Methods

An online two-round modified Delphi study including 23 experts from SA and Zimbabwe was undertaken. The implementation strategies were aligned with the Consolidated Framework for Implementation Research that outlines five areas impacting implementation.

Results

The expert panel included intensive care unit (ICU) clinicians, academics and managers, who participated in both Delphi rounds. The median years of ICU experience was 8.5 (range 5 - 17) years, with 16 (80.0%) having a general ICU background. The panel reached consensus on several strategies to standardise early mobilisation practices in ICUs, including defining specific early mobilisation activities, appointing champion leaders, ensuring timely management of fractures, promoting patient admission to specialised units, creating dedicated physiotherapy positions, and providing skills training for staff responsible for implementing early mobilisation activities in ICUs.

Conclusion

The strategies developed represent an important step toward implementation of early mobilisation in routine ICU patient care.

Contribution of the study

This study provides implementation strategies, aligned with the Consolidated Framework for Implementation Research, to overcome barriers to early patient mobilisation in public sector ICUs. These strategies emanate from consensus reached by a panel of experts and serve as the first step in guiding clinicians towards developing and implementing early mobilisation protocols for their units to promote better-quality patient care in daily clinical practice.

Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations

BACKGROUND

Laser hemorrhoidoplasty (LHP) has emerged as a novel, minimally invasive technique for managing symptomatic hemorrhoids, gaining popularity among clinicians. Despite its increasing adoption, significant variations exist in the application of LHP across different practices.

PURPOSE

The aim of these recommendations was to spell out some basic principles and recommendations for performing a standard LHP procedure.

METHODS

The Recommendation Development Group (RDG) consisting of surgeons with experience in LHP were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above.

RESULTS

The RDG developed 21 recommendations that were voted upon by 49 panelists. Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus.

CONCLUSION

The RDP offers a comprehensive suite of guidelines to enhance the safety and efficacy of standard LHP procedures. Out of 21 detailed recommendations, 16 reached strong consensus, collectively addressing the full spectrum of LHP procedures-from laser settings and preoperative preparations to perioperative strategies and postoperative care. This coherent framework is anticipated not only to standardize but also to refine the LHP technique across the board, thereby elevating the management of symptomatic hemorrhoidal disease.

Health technology assessment framework for artificial intelligence-based technologies

OBJECTIVES

Artificial intelligence (AI)-based health technologies (AIHTs) have already been applied in clinical practice. However, there is currently no standardized framework for evaluating them based on the principles of health technology assessment (HTA).

METHODS

A two-round Delphi survey was distributed to a panel of experts to determine the significance of incorporating topics outlined in the EUnetHTA Core Model and twenty additional ones identified through literature reviews. Each panelist assigned scores to each topic. Topics were categorized as critical to include (scores 7-9), important but not critical (scores 4-6), and not important (scores 1-3). A 70 percent cutoff was used to determine high agreement.

RESULTS

Our panel of 46 experts indicated that 48 out of the 65 proposed topics are critical and should be included in an HTA framework for AIHTs. Among the ten most crucial topics, the following emerged: accuracy of the AI model (97.78 percent), patient safety (95.65 percent), benefit-harm balance evaluated from an ethical standpoint (95.56 percent), and bias in data (91.30 percent). Importantly, our findings highlight that the Core Model is insufficient in capturing all relevant topics for AI-based technologies, as 14 out of the additional 20 topics were identified as crucial.

CONCLUSION

It is imperative to determine the level of agreement on AI-relevant HTA topics to establish a robust assessment framework. This framework will play a foundational role in evaluating AI tools for the early diagnosis of dementia, which is the focus of the European project AI-Mind currently being developed.

Developing injury prevention programmes for ladies Gaelic football: a Delphi study

BACKGROUND

High injury rates are evident in the community sport of ladies Gaelic football, and the costs associated with these injuries have major implications for players and the governing body. Injury prevention programmes have been designed but are not being widely adopted. This study aimed to elicit the expert opinion of academics and practitioners on the content and format of injury prevention programmes for ladies Gaelic football.

METHODS

Twenty-four experts from the areas of coaching science, injury prevention, athletic therapy and physiotherapy took part in this three-round Delphi study. Each round contained multiple-choice, Likert scale and open-ended questions. For each question, consensus was defined as 67% or greater agreement among experts.

RESULTS

The experts agreed that 17 components (eg, agility, balance) should be included in injury prevention programmes for ladies Gaelic football, with 12 considered vital for inclusion in most or every session. Programmes should require minimal/no equipment, be 10-15 min in duration and contain 3-4 versions of each exercise for progression and variation purposes. Experts recommended when certain components should be completed but generally agreed that programmes should be capable of being delivered throughout sessions. There was consensus among experts for 13 items (eg, pictures, exercise volume) to be included in full versions of programmes and six in condensed versions.

CONCLUSIONS

The outcomes of this study provide the foundation for the development of future injury prevention programmes for ladies Gaelic football. Combining these findings with the preferences of end-users throughout programme development may enhance the efficacy of future injury prevention programmes.

Multidisciplinary consensus-based statement on the current role of middle meningeal artery embolization (MMAE) in chronic SubDural hematoma (cSDH)

Introduction

Middle Meningeal Artery Embolization (MMAE) in patients with chronic SubDural Hematoma (cSDH) is a novel treatment approach, albeit the specific role of MMAE in the treatment of cSDH is not yet defined.

Research question

The aim of this work is to provide a consensus-based statement from a multidisciplinary panel on the current role of MMAE in patients with cSDH.

Materials and methods

A literature search was performed using the keywords MMAE and cSDH. Based on the available published data, the panel was asked if a consensus could be reached on the role of MMAE in both de novo as well as in recurrent cSDH.

Results

The panel reached a consensus on the current role of MMAE in both de novo- and recurrent cSDH, as well as in patients on antithrombotics and those with coagulopathy. MMAE should be considered in the following scenarios:1)As "stand-alone" treatment in de novo cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in patients on antithrombotics in whom the risk of suspension is considered unacceptably high,2)as "stand-alone" treatment in recurrent cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in those on antithrombotics in whom the risk of suspension is considered unacceptably high and3)as "adjunct to surgery" in all recurrent cSDH.

Discussion and conclusion

This statement is to be considered an expert consensus opinion of delegates representing key international medical societies of specialists involved in the care of cSDH patients.

Consensus definition of a radiologically healed fistula on magnetic resonance imaging in perianal Crohn's disease: an international Delphi study

INTRODUCTION

Perianal fistulising Crohn's disease (pfCD) is a distinct and debilitating phenotype seen in around one-third of patients with CD. Clinical trials in pfCD are increasingly using magnetic resonance imaging (MRI) criteria as a primary endpoint, but there is heterogeneity in the radiological definition of a healed perianal fistula that currently limits our ability to perform meaningful meta-analyses of studies. Our aim is to standardise outcomes through the generation of an international consensus definition of a radiologically healed fistula.

METHODS AND ANALYSIS

This international Delphi consensus study employs a two-part strategy.The first is a systematic review to identify a longlist of variables used to define radiological healing in pfCD. MRI-based indices used to score fistula severity and healing will be assessed for their methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The systematic review protocol will be conducted using COSMIN methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses.The second part will be an online Delphi consensus, guided by the results of the systematic review. Radiologists, gastroenterologists and colorectal surgeons with expertise in the management of pfCD will be invited to take part in two to three rounds of online surveys. Once an a priori threshold of >80% agreement is reached on individual radiological components used to define 'healing' and 'healed', a final meeting of key stakeholders will be organised to generate a consensus definition of a healed fistula.

ETHICS AND DISSEMINATION

The study has been deemed exempt from a formal Research Ethics Committee review as no patients will participate directly in the consensus process, given the technical nature of the research question. The study is registered with the local R&D department (Reference RD24/007). Publication of this study will help standardise radiological endpoint measurement in clinical trials of pfCD and improve the synthesis and meta-analysis of comparative studies.

PROSPERO REGISTRATION NUMBER

CRD42024504334.

Surgical Textbook Outcomes in the Era of Neoadjuvant Systemic Treatment for Skin Cancers

Recent years have brought new, highly effective systemic treatments to clinical practice, which can be used to treat patients with locally advanced or metastatic skin cancers. Using these regimens in neoadjuvant strategy influences surgical treatment by facilitating surgical resection, avoiding extensive resections with complex reconstructions and even omitting surgery in some cases. Integrating systemic therapy with surgery is ongoing and requires novel quality measures of surgical treatment to capture the clinical benefits of multidisciplinary strategies better. The Textbook Outcome (TO) is a novel measure of surgical quality, which captures the short-term outcomes of surgery and reflects long-term survival. Textbook Outcomes match a particular type of surgery, are intuitive to interpret, and may be widely applied in surgical oncology and general surgery. Therefore, this review aims to describe recent findings on neoadjuvant skin cancer treatment and their implications for surgical proceedings in the context of Textbook Outcomes.

Management Of Psychiatric Emergencies and Associated Comfort Among EMS Physicians in Lombardy, Italy: A Cross-Sectional Study

OBJECTIVES

The aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills.

METHODS

A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest).

RESULTS

A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001).

CONCLUSIONS

These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.

Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children

BACKGROUND

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

METHODS

The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

RESULTS

The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement.

CONCLUSION

This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

Developing a quality indicator system for evaluating internet plus home care nursing services based on the SERVQUAL model: a Delphi-analytic hierarchy process study

Background

In the context of global population aging and the rapid development of information technology, the demand for Internet Plus Home Care Nursing (Internet+ HCN) services have been on the rise, especially in China. Internet+ HCN services have the potential to maximize existing human resources to counter the shortage of medical healthcare services. However, at present, Internet+ HCN services are difficult to scale due to the lack of standardized service quality governance. Quality indicators for service evaluation of Internet+ HCN services are under-defined.

Objective

To develop a quality indicator system for evaluating Internet+ HCN services, and to shed theoretical light on assessing mHealth service quality from a user experience perspective.

Methods

An initial quality indicator system was established based on scenarios related to Internet+ HCN services. The Delphi Method was applied to modify the indicators according to experts' opinions, and the analytic hierarchy process (AHP) was applied to calculate the indicator weight. Finally, a quality indicator system for evaluating Internet+ HCN services was developed based on the SERVQUAL model.

Results

Altogether, 17 experts from relevant fields such as nursing education, clinical nursing, health management, and health informatics were consulted through email surveys. The response rates in both rounds of Delphi and the AHP were 100%. The average expert authority coefficients were 0.912 and 0.925 respectively in the two rounds of Delphi. Kendall's W, indicating variation coefficients, ranged from 0.262 to 0.265. Finally, a quality indicator system for evaluating Internet+ HCN services, comprising five primary indicators and 15 secondary indicators, was developed. Primary indicators and their AHP generated the following weights: assurance (0.245), reliability (0.240), tangibles (0.192), responsiveness (0.190), and empathy (0.132).

Conclusions

By measuring the services quality gap between user expectations and perceptions, the proposed SERVQUAL model-based quality indicator system shows potential in improving the quality of Internet+ HCN services through the perspective of user experiences.

Identifying the Needs of Paediatric-Friendly Care in Emergency Department: A Delphi Study

AIMS

To systematically analyse expert perspectives on paediatric-friendly care in the emergency department and establish specific indicators.

BACKGROUND

With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families.

DESIGN

A two-round modified Delphi method was used in this study.

METHODS

In this study, experts from clinical practice and academia assessed 56 paediatric-friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity.

RESULTS

Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency-friendly care needs were identified. For each need, the item-level content validity index exceeded 0.79 for importance and feasibility. The average scale-level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items).

CONCLUSION

Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well-equipped, safe environment in the emergency department.

RELEVANCE OF CLINICAL PRACTICE

This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care.

PATIENT/PUBLIC CONTRIBUTION

No direct patient, service user, caregiver or public involvement existed in this study.

Application of mathematical models on efficiency evaluation and intervention of medical institutions in China

BACKGROUND : The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard. METHODS : In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency.  RESULTS : Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41 min per day, reduce clinical service time by 25 min per day, and extend rest time by 70 min per day, while the quality indicators were all meeting the targets. CONCLUSION: By employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives.

Exploring Mental Health Issues and Priorities in Indonesia Through Qualitative Expert Consensus

Background

Mental health well-being is a fundamental human right. However, mental health awareness is not yet considered as a main priority for the government and public in Indonesia. Thus, there is an urgent need for Indonesians to fully comprehend the importance of raising mental health awareness.

Methods

A discussion among 45 experts in September until October 2023 was conducted by the Community Caucus Caring for Mental Health to raise an awareness of the importance of mental health in Indonesia. The results were reported as an expert consensus.

Results

The discussion acknowledged the urgency of managing mental health issue along with its five key drivers and three essences. It identified nine specific themes of mental health issues in Indonesia by focusing on four high-risk population groups. The consensus proposed multi-pronged recommendations, i.e., developing personalized mental health-related campaigns and movements, conducting mental health-relevant studies at clinical and community settings, incorporating of mental health awareness in teaching curriculum and family's discussion, innovating technology for screening and diagnosing mental health issues, as well as an providing mental health first-aid with wide access to all population.

Conclusion

The expert consensus concluded that Indonesians must start to prioritize mental health awareness and to provide sufficient resources to screen, diagnose and treat individuals with mental health disorders. The expert consensus identified nine specific themes of mental health issues in Indonesia and subsequently proposed multi-pronged recommendations with an aim to improve mental health awareness in Indonesia.