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Foreman B, Kapinos G, Wainwright MS, Ngwenya LB, O'Phelan KH, LaRovere KL, Kirschen MP, Appavu B, Lazaridis C, Alkhachroum A, Maciel CB, Amorim E, Chang JJ, Gilmore EJ, Rosenthal ES, Park S. Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process. Crit Care Med 2023; 51:1740-1753. [PMID: 37607072 PMCID: PMC11036878 DOI: 10.1097/ccm.0000000000006016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM). DESIGN A three-round Delphi consensus process. SETTING Electronic surveys and virtual meeting. SUBJECTS Participants with broad MNM expertise from adult and pediatric intensive care backgrounds. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM-both invasive and noninvasive-for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation. CONCLUSIONS We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.
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Affiliation(s)
- Brandon Foreman
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH
| | - Gregory Kapinos
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark S Wainwright
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Laura B Ngwenya
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | | | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matthew P Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Brian Appavu
- Departments of Child Health and Neurology, Phoenix Children's, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Christos Lazaridis
- Departments of Neurology and Neurosurgery, University of Chicago, Chicago, IL
| | | | - Carolina B Maciel
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
- Department of Neurology, University of Miami, Miami, FL
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Departments of Child Health and Neurology, Phoenix Children's, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
- Departments of Neurology and Neurosurgery, University of Chicago, Chicago, IL
- Departments of Neurology and Neurosurgery, University of Florida, Tampa, FL
- Department of Neurology, University of Utah, Salt Lake City, UT
- Department of Neurology, Yale University, New Haven, CT
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
- Department of Critical Care and Georgetown University, Department of Neurology, MedStar Washington Hospital Center, Washington, DC
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Departments of Neurology and Biomedical Informatics, Columbia University, New York, NY
| | - Edilberto Amorim
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Jason J Chang
- Department of Critical Care and Georgetown University, Department of Neurology, MedStar Washington Hospital Center, Washington, DC
| | | | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Soojin Park
- Departments of Neurology and Biomedical Informatics, Columbia University, New York, NY
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Ceschin A, Petracco Á, Borges E, Cordts EB, Nakagawa HM, Souza MDCBD, Caldas MMP, Busso NE, Sá PGD, Monteleone PAA, Ferriani RA. Delphi consensus on add-ons and social midia in Assisted Reproductive Technology. JBRA Assist Reprod 2023. [PMID: 37850861 DOI: 10.5935/1518-0557.20230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
This article reports the annals of a national consensus meeting on add-ons and social networks in Assisted Reproduction Techniques (ART). The panel of experts has developed a set of consensus points and this document is intended to be referenced as a national consensus to allow social networks and add-ons to be used in ART, following the standards of the Code of Medical Ethics and the Federal Council of Medicine, in a safe ethical and responsible way.
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Affiliation(s)
- Alvaro Ceschin
- Feliccità - Instituto de fertilidade, Curitiba, PR, Brazil
| | | | - Edson Borges
- Fertility Medical Group, São Paulo, SP, Brazil
- Associação Instituto Sapientiae, São Paulo, SP, Brazil
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Waters M, Dobry A, Le ST, Shinkai K, Beachkofsky TM, Davis MDP, Dominguez AR, Kroshinsky D, Markova A, Micheletti RG, Mostaghimi A, Pasieka HB, Rosenbach M, Seminario-Vidal L, Trinidad J, Albrecht J, Altman EM, Arakaki R, Ardern-Jones M, Bridges AG, Cardones AR, Chadha AA, Chen JK, Chen ST, Cheng K, Daveluy S, DeNiro KL, Harp J, Keller JJ, King B, Korman AM, Lowenstein EJ, Luxenberg E, Mancuso JB, Mauskar MM, Milam P, Motaparthi K, Nelson CA, Nguyen CV, Nutan F, Ortega-Loayza AG, Patel T, Rahnama-Moghadam S, Rekhtman S, Rojek NW, Sarihan M, Shaigany S, Sharma TR, Shearer SM, Shields BE, Strowd LC, Tartar DM, Thomas C, Wanat KA, Walls AC, Zaba LC, Ziemer CM, Maverakis E, Kaffenberger BH. Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise. JAMA Dermatol 2023; 159:772-777. [PMID: 37256599 PMCID: PMC10838134 DOI: 10.1001/jamadermatol.2023.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Affiliation(s)
- Margo Waters
- The Ohio State University College of Medicine, Columbus
| | - Allison Dobry
- Department of Dermatology, University of California, San Francisco
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Arturo R Dominguez
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | | | - Alina Markova
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert G Micheletti
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helena B Pasieka
- Departments of Dermatology, Uniformed Services University, Bethesda, Maryland
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Misha Rosenbach
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - John Trinidad
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Joerg Albrecht
- Department of Medicine, Division of Dermatology, Cook County Health, Chicago, Illinois
| | - Emily M Altman
- Department of Dermatology, University of New Mexico Health Sciences Center, Albuquerque
| | - Ryan Arakaki
- Department of Dermatology, University of California, San Francisco
| | | | - Alina G Bridges
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Angad A Chadha
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jennifer K Chen
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Jesse J Keller
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | - Eve J Lowenstein
- Department of Dermatology, SUNY Downstate Medical Center and Kings County Medical Center, Oceanside, New York
| | - Erin Luxenberg
- Department of Dermatology, Hennepin Healthcare, Minneapolis, Minnesota
| | | | - Melissa M Mauskar
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Philip Milam
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fnu Nutan
- Department of Dermatology, Virginia Commonwealth University Medical Center, Richmond
| | | | - Tejesh Patel
- Department of Dermatology, University of Tennessee Health Science Center, Memphis
| | | | - Sergey Rekhtman
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine
| | - Mansi Sarihan
- Department of Dermatology, Valleywise Health-Creighton University, University of Arizona, Mayo Clinic, Phoenix, Arizona
| | - Sheila Shaigany
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sabrina M Shearer
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cristina Thomas
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Andrew C Walls
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Carolyn M Ziemer
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill
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Iqbal N, Astrid MJHM, Merel L K, Gillian K, Rebecca W, Ugo G, Phil J T, Stéphanie O B. AFCOS: The Development of a Cryptoglandular Anal Fistula Core Outcome Set. Ann Surg 2023; 277:e1045-e1050. [PMID: 35815887 PMCID: PMC10082062 DOI: 10.1097/sla.0000000000005462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a cryptoglandular Anal Fistula Core Outcome Set: a minimum set of outcomes that should be measured in all studies of cryptoglandular anal fistula treatment. BACKGROUND Variability in the outcomes that are reported in studies of cryptoglandular anal fistula treatment hampers systematic evidence synthesis to identify the best treatment. METHODS This study followed guidance from the Core Outcome Measures in Effectiveness Trials initiative and consisted of three stages: (1) generation of candidate outcomes through systematic review of the literature and qualitative patient interviews; (2) prioritization of outcomes by key stakeholders, including patients, surgeons, gastroenterologists, and radiologists in an online Delphi consensus process; and (3) determination of the final Core Outcome Set (COS) in a consensus meeting attended by patients and clinicians. RESULTS Sixty-four outcomes were presented in the first Delphi survey round. A total of 191 participants from over 30 countries ranked these outcomes according to their importance in defining treatment success (57.6% surgeons and gastroenterologists, 8.9% radiologists, and 33.5% patients). After two rounds, 53 outcomes were identified as important and discussed in the consensus meeting attended by 10 patients and 12 clinicians. A final 10 outcomes were voted into the COS: clinical fistula healing, radiological healing, recurrence, development of additional fistulas, fistula symptoms, incontinence, psychological impact of treatment, complications and reinterventions, patient satisfaction, and quality of life. CONCLUSION The final COS represents an international, multidisciplinary, patient-centered attempt to establish consistency in fistula research, with a substantial focus on patient priorities for treatment.
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Affiliation(s)
- Nusrat Iqbal
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, UK
| | - Machielsen J H M Astrid
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre+, The Netherlands
- Faculty of Health, Medicine & Life Sciences, Maastricht University, The Netherlands
| | - Kimman Merel L
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, The Netherlands
| | | | | | - Grossi Ugo
- Tertiary Referral Pelvic Floor and Incontinence Centre, Regional Hospital Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Italy
| | - Tozer Phil J
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, UK
| | - Breukink Stéphanie O
- Department of Surgery and Colorectal Surgery, NUTRIM, School of Nutrition and Translational Research in Metabolism, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, The Netherlands
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Vrancken SM, Borger van der Burg BL, DuBose JJ, Glaser JJ, Hörer TM, Hoencamp R. Advanced bleeding control in combat casualty care: An international, expert-based Delphi consensus. J Trauma Acute Care Surg 2022; 93:256-264. [PMID: 35067523 PMCID: PMC9323555 DOI: 10.1097/ta.0000000000003525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemorrhage from truncal and junctional injuries is responsible for the vast majority of potentially survivable deaths in combat casualties, causing most of its fatalities in the prehospital arena. Optimizing the deployment of the advanced bleeding control modalities required for the management of these injuries is essential to improve the survival of severely injured casualties. This study aimed to establish consensus on the optimal use and implementation of advanced bleeding control modalities in combat casualty care. METHODS A Delphi method consisting of three rounds was used. An international expert panel of military physicians was selected by the researchers to complete the Delphi surveys. Consensus was reached if 70% or greater of respondents agreed and if 70% or greater responded. RESULTS Thirty-two experts from 10 different nations commenced the process and reached consensus on which bleeding control modalities should be part of the standard equipment, that these modalities should be available at all levels of care, that only trained physicians should be allowed to apply invasive bleeding control modalities, but all medical and nonmedical personnel should be allowed to apply noninvasive bleeding control modalities, and on the training requirements for providers. Consensus was also reached on the necessity of international registries and guidelines, and on certain indications and contraindications for resuscitative endovascular balloon occlusion of the aorta (REBOA) in military environments. No consensus was reached on the role of a wound clamp in military settings and the indications for REBOA in patients with chest trauma, penetrating axillary injury or penetrating neck injury in combination with thoracoabdominal injuries. CONCLUSION Consensus was reached on the contents of a standard bleeding control toolbox, where it should be available, providers and training requirements, international registries and guidelines, and potential indications for REBOA in military environments.
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Affiliation(s)
- Suzanne M. Vrancken
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
| | - Boudewijn L.S. Borger van der Burg
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
| | - Joseph J. DuBose
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
| | - Jacob J. Glaser
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
| | - Tal M. Hörer
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
| | - Rigo Hoencamp
- From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands
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Salway S, Yazici E, Khan N, Ali P, Elmslie F, Thompson J, Qureshi N. How should health policy and practice respond to the increased genetic risk associated with close relative marriage? results of a UK Delphi consensus building exercise. BMJ Open 2019; 9:e028928. [PMID: 31289086 PMCID: PMC6615806 DOI: 10.1136/bmjopen-2019-028928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To explore professional and lay stakeholder views on the design and delivery of services in the area of consanguinity and genetic risk. (2) To identify principles on which there is sufficient consensus to warrant inclusion in a national guidance document. (3) To highlight differences of opinion that necessitate dialogue. (4) To identify areas where further research or development work is needed to inform practical service approaches. DESIGN Delphi exercise. Three rounds and one consensus conference. SETTING UK, national, web-based and face-to-face. PARTICIPANTS Recruitment via email distribution lists and professional networks. 42 participants with varied professional and demographic backgrounds contributed to at least one round of the exercise. 29 people participated in statement ranking across both rounds 2 and 3. RESULTS Over 700 individual statements were generated in round 1 and consolidated into 193 unique statements for ranking in round 2, with 60% achieving 80% or higher agreement. In round 3, 74% of statements achieved 80% or higher agreement. Consensus conference discussions resulted in a final set of 148 agreed statements, providing direction for both policy-makers and healthcare professionals. 13 general principles were agreed, with over 90% agreement on 12 of these. Remaining statements were organised into nine themes: national level leadership and coordination, local level leadership and coordination, training and competencies for healthcare and other professionals, genetic services, genetic literacy, primary care, referrals and coordination, monitoring and evaluation and research. Next steps and working groups were also identified. CONCLUSIONS There is high agreement among UK stakeholders on the general principles that should shape policy and practice responses in this area: equity of access, cultural competence, coordinated inter-agency working, co-design and empowerment and embedded evaluation. The need for strong national leadership to ensure more efficient sharing of knowledge and promotion of more equitable and consistent responses across the country is emphasised.
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Affiliation(s)
- Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Edanur Yazici
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Nasaim Khan
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Parveen Ali
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Frances Elmslie
- South West Thames Regional Genetics Service, St George’s University Hospitals, London, UK
| | - Julia Thompson
- Children and Young People’s Public Health Team, Sheffield City Council, Sheffield, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, UK
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DuBois JM, Kraus EM, Gursahani K, Mikulec A, Bakanas E. Curricular priorities for business ethics in medical practice and research: recommendations from Delphi consensus panels. BMC Med Educ 2014; 14:235. [PMID: 25398388 PMCID: PMC4289297 DOI: 10.1186/1472-6920-14-235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/13/2014] [Indexed: 05/24/2023]
Abstract
BACKGROUND No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. METHODS In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). RESULTS Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. CONCLUSIONS The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.
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Affiliation(s)
- James M DuBois
- />Center for Clinical Research Ethics, Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Ave, Saint Louis, MO 63110 USA
| | - Elena M Kraus
- />Bander Center for Medical Business Ethics, Saint Louis University, Salus Center, 3545 Lafayette Ave, Saint Louis, MO 63104-1314 USA
| | - Kamal Gursahani
- />Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, 3635 Vista Avenue at Grand Blvd, Saint Louis, MO 63110 USA
| | - Anthony Mikulec
- />Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue at Grand Blvd, Saint Louis, MO 63110 USA
| | - Erin Bakanas
- />Department of Internal Medicine, Division of General Internal Medicine, 12 South FDT, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Saint Louis, MO 63104 USA
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Beerekamp MS, Haverlag R, Ubbink DT, Luitse JS, Ponsen KJ, Goslings JC. How to evaluate the quality of fracture reduction and fixation of the wrist and ankle in clinical practice: a Delphi consensus. Arch Orthop Trauma Surg 2011; 131:739-46. [PMID: 20967547 PMCID: PMC3095796 DOI: 10.1007/s00402-010-1198-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 11/25/2022]
Abstract
METHOD A Delphi study was conducted to obtain consensus on the most important criteria for the radiological evaluation of the reduction and fixation of the wrist and ankle. The Delphi study consisted of a bipartite online questionnaire, focusing on the interpretation of radiographs and CT scans of the wrist and the ankle. Questions addressed imaging techniques, aspects of the anatomy and fracture reduction and fixation. Agreement was expressed as the percentage of respondents with similar answers. Consensus was defined as an agreement of at least 90%. RESULTS In three Delphi rounds, respectively, 64, 74 and 62 specialists, consisting of radiologists, trauma and orthopaedic surgeons from the Netherlands responded. After three Delphi rounds, consensus was reached for three out of 14 (21%) imaging techniques proposed, 11 out of the 13 (85%) anatomical aspects and 13 of the 22 (59%) items for the fracture reduction and fixation. This Delphi consensus differs from existing scoring protocols in terms of the greater number of anatomical aspects and aspects of fracture fixation requiring evaluation and is more suitable in clinical practice due to a lower emphasis on measurements.
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Affiliation(s)
- M S Beerekamp
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, G4-137, 1105 AZ Amsterdam, The Netherlands.
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