Consensus Building Research Articles

Implementation of Extracorporeal CPR Programs for Out-of-Hospital Cardiac Arrest: Another Tale of Two County Hospitals

Extracorporeal cardiopulmonary resuscitation (ECPR) is a form of intensive life support that has seen increasing use globally to improve outcomes for patients who experience out-of-hospital cardiac arrest (OHCA). Hospitals with advanced critical care capabilities may be interested in launching an ECPR program to offer this support to the patients they serve; however, to do so, they must first consider the significant investment of resources necessary to start and sustain the program. The existing literature describes many single-center ECPR programs and often focuses on inpatient care and patient outcomes in hospitals with cardiac surgery capabilities. However, building a successful ECPR program and using this technology to support an individual patient experiencing refractory cardiac arrest secondary to a shockable rhythm depends on efficient out-of-hospital and emergency department (ED) management. This article describes the process of implementing 2 intensivist-led ECPR programs with limited cardiac surgery capability. We focus on emergency medical services and ED clinician roles in identifying patients, mobilizing resources, initiation and management of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the ED, and ongoing efforts to improve ECPR program quality. Each center experienced a significant learning curve to reach goals of arrest-to-flow times of cannulation for ECPR. Building consensus from multidisciplinary stakeholders, including out-of-hospital stakeholders; establishing shared expectations of ECPR outcomes; and ensuring adequate resource support for ECPR activation were all key lessons in improving our ECPR programs.

How do cicadas emerge together? Thermophysical aspects of their collective decision-making.

Periodical cicadas exhibit life cycles with durations of 13 or 17 years, and it is now accepted that large prime cycles arose to avoid synchrony with predators. Less well explored is how, in the face of intrinsic biological and environmental noise, insects within a brood emerge together in large successive swarms from underground during springtime warming. Here, we consider the decision-making process of underground cicadas experiencing random, spatially correlated thermal microclimates such as those in nature. Introducing short-range communication between insects leads to an Ising model of consensus building with a quenched, spatially correlated random magnetic field and annealed site dilution, which displays the kinds of collective swarms seen in nature. These results highlight the need for fieldwork to quantify the spatial fluctuations in thermal microclimates and their relationship to the spatiotemporal dynamics of swarm emergence.

Abstract WP52: Evaluation of Post Stroke Telehealth Services in Texas (Vast-1)

Background: Shortly after AHA/ASA released an updated policy on stroke care systems, COVID-19 disrupted these systems. Lockdowns and social distancing were considered critical to mitigate COVID-19 transmission but altered public perceptions about stroke medical care. As a result, telehealth expanded rapidly across Texas. However, little is known how to optimally integrate telehealth services into the continuum of stroke care. Methods: To identify barriers and facilitators of post-acute stroke telehealth services among stroke survivors’ facilities of the Lone Star Stroke Consortium (LSSC) Research Consortium, we conducted semi-structured interviews with stroke providers and focus groups with patients. Audiotapes were transcribed, and files prepared for analysis. Using a grounded theory approach, we performed data analysis to allow theory to emerge from data. Two independent reviewers read transcripts, developed coding using an iterative consensus building, verified codes, developed concepts, and created categories. Constant comparison process found emerging themes within each category. Results: We enrolled 23 providers and 34 patients. Access, telemedicine encounter and technology were revealed as major categories of post-acute stroke telehealth among providers and patients. Facilitators of access included increased accessibility and elimination of barriers. Reliable internet connection and technological skills were barriers for both groups. Patients and providers identified virtual visits as good. However, full medical exam, including cognitive evaluation, was a barrier for patients and providers. Technology increased ability to communicate with patients and providers. Barriers included constrains of internet services, lack of documentation for virtual visits, and lack of telemedicine platform. Conclusion: Our study will contribute to future telehealth services integration into continuum of stroke care.

Development, implementation, and evaluation of entrustable professional activities (EPAs) for medical radiation technologists in Taiwan: a nationwide experience

BackgroundCompetency-based medical education (CBME) is an outcomes-oriented approach focused on developing competencies that translate into clinical practice. Entrustable professional activities (EPAs) bridge competency assessment and clinical performance by delineating essential day-to-day activities that can be entrusted to trainees. EPAs have been widely adopted internationally, but not yet implemented for medical radiation professionals in Taiwan.Materials and methodsA nationwide consensus process engaged 97 experts in radiation technology education representing diagnostic radiography, radiation therapy, and nuclear medicine. Preliminary EPAs were developed through the focus group discussion and the modified Delphi method. The validity of these EPAs was evaluated using the QUEPA and EQual tools.ResultsThrough iterative consensus building, six core EPAs with 18 component observable practice activities (OPAs) in total were developed, encompassing routines specific to each radiation technology specialty. QUEPA and EQual questionnaire data verified these EPAs were valid, and of high quality for clinical teaching and evaluation.ConclusionThe consensus development of tailored EPAs enables rigorous competency assessment during medical radiation technology education in Taiwan. Further expansion of EPAs and training of clinical staff could potentially enhance care quality by producing competent professionals.

High-fidelity (repeat) consensus sequences from short reads using combined read clustering and assembly

BackgroundDespite the many cheap and fast ways to generate genomic data, good and exact genome assembly is still a problem, with especially the repeats being vastly underrepresented and often misassembled. As short reads in low coverage are already sufficient to represent the repeat landscape of any given genome, many read cluster algorithms were brought forward that provide repeat identification and classification. But how can trustworthy, reliable and representative repeat consensuses be derived from unassembled genomes?ResultsHere, we combine methods from repeat identification and genome assembly to derive these robust consensuses. We test several use cases, such as (1) consensus building from clustered short reads of non-model genomes, (2) from genome-wide amplification setups, and (3) specific repeat-centred questions, such as the linked vs. unlinked arrangement of ribosomal genes. In all our use cases, the derived consensuses are robust and representative. To evaluate overall performance, we compare our high-fidelity repeat consensuses to RepeatExplorer2-derived contigs and check, if they represent real transposable elements as found in long reads. Our results demonstrate that it is possible to generate useful, reliable and trustworthy consensuses from short reads by a combination from read cluster and genome assembly methods in an automatable way.ConclusionWe anticipate that our workflow opens the way towards more efficient and less manual repeat characterization and annotation, benefitting all genome studies, but especially those of non-model organisms.

Evaluating the current state of evolution acceptance instruments: a research coordination network meeting report

AbstractHundreds of studies have explored student evolution acceptance because evolution is a core concept of biology that many undergraduate biology students struggle to accept. However, this construct of “evolution acceptance” has been defined and measured in various ways, which has led to inconsistencies across studies and difficulties in comparing results from different studies. Many studies and essays have offered evaluations and perspectives of evolution acceptance instruments, but publications with a focus on consensus building across research teams is still needed. Further, little attention has been paid to how evolution acceptance instruments may be interpreted differently by students with varied religious backgrounds. Funded by a Research Coordination Network in Undergraduate Biology Education grant from the National Science Foundation, we gathered 16 experts from different disciplinary and religious backgrounds to review current evolution acceptance instruments and create a guide to the strengths and weaknesses of these instruments, including appropriate contexts for using these instruments and their potential weaknesses with different religious populations. Finally, in an attempt to move the field forward, we articulated a consensus definition of evolution acceptance that can be used to guide future instrument development.

Survival strategies at the edge of the capital city of Mongolia, Ulaanbaatar: Revealing ger residents’ capacity to aspire

ABSTRACT Inspired by the conceptual frame of the capacity to aspire, this study explores how public administrative officers can make formal resources available and accessible for ger residents while recognizing the “capacity to aspire” among migrant ger residents in the Tahilt area of Ulaanbaatar, Mongolia. We argue that building people’s capacity to aspire, consisting of (1) internal efforts to (2) consensus building, resulting in (3) practices of voice being heard, and (4) bottom up collaborations between public administrative officers and residents, represents a strategy toward alleviating difficulties encountered in the new urban space collectively. The ethnographic findings of this study illustrate inaccessibility of formal resources, spatiality and aspirations in an effort to incorporate residents’ voices for more collaboration. The paper calls for public administrative officers, such as public administrative officials, planners and social workers, to negotiate between policy objectives and ger residents’ agency, so that the capacity to aspire is nurtured for a collaborative culture.

Participatory development of a target policy profile to support soil-transmitted helminth elimination.

Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale. We aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components. The scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented. This information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale.

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design.

Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.

Corporate engagement with start-ups (CEWS): a systematic review of literature and future research agenda

PurposeThe purpose of this paper is to provide a systematic review of literature on corporate engagement with start-ups (CEWS) by identifying the modes, contexts, antecedents, barriers and outcomes. As an emerging field, CEWS presently has no such review available which will help in building consensus within the field and shape future research directions.Design/methodology/approachThe study followed a two-phased systematic review of literature. Three research databases (i.e. Web of Science, ScienceDirect and SCOPUS) were accessed to gather and conduct the review. Of the total 379 papers retrieved, 63 total relevant papers were studied and analysed. The exhaustive review of literature helped to uncover the contexts, perspectives, antecedents, outcomes and barriers reported across the different modes of CEWS.FindingsThe study highlighted the five prominent modes of CEWS favoured by large corporations and start-ups. It found that the large corporations and start-ups associate with one another on the basis of complementarities of activities, resources and motives to pursue their strategic orientations. The engagements also face barriers on the ground, such as incompatibility of goals, power imbalances, cultural differences and weak engagement plans. Most important contexts seen were the high-technology industries in the developed economies like the USA and Europe. It also found that ecosystem creation, accessing innovation and corporate strategy have been preferred as the most productive modes of CEWS in the literature.Practical implicationsThis review provides practitioners with a detailed list of the modes and drivers of CEWS. Subsequently, the barriers that need to be managed to successfully execute a specific mode of engagement. This shall enable the practitioners in developing and adopting the best practices while engaging with the start-ups to better facilitate the outcomes of CEWS.Originality/valueTo the best of the authors’ knowledge, there is no systematic literature review available in the domain of CEWS – thus, this study makes an important methodological contribution to the field. By consolidating the fragmented yet growing knowledge on CEWS, the study presents a detailed understanding of what drives and obstructs the engagement between large corporations and start-ups.

Framework Development: Standardizing Definition of Advanced Practice Radiation Therapy Activities for Clinical Workload Quantification

PurposeAdvanced practice (AP) in radiation therapy (RT) is being implemented around the globe. In an effort to advance the understanding of the similarities and differences in APRT roles in Ontario, Canada, a community of practice (CoP) sought ways to provide quantitative data on the nature of APRT clinical activities and the frequency with which these activities were being executed. MethodsIn 2017, a consensus building project involving 20 APRTs and 14 radiation therapy (RT) department managers in Ontario was completed to establish a mechanism to quantify APRTs’ clinical impact. In Round 1 & 2, expert feedback was gathered to generate an Advanced Practice (AP) Activity List. In Round 3: 20 APRTs completed an online survey to assess the importance and applicability of each AP Activity to their role using Likert scale (0–5). A final AP Activity List & Definitions was generated. Results & discussionRound 1: Forty-seven AP activities were identified. Round 2: 3/14 RT managers provided 145 feedback statements on Round 1 AP Activity List. The working group used RT managers’ feedback to clarify AP activities and definitions, specifically merging 33 unique AP activities to create 11 inclusive AP activities and eliminating 8 activities identified from Round 1. The most inclusive AP activity created was #1 New Patient Consultation, this AP Activity is merged from 7 unique AP activities. Incorporating RT managers’ feedback with the internal AP clinical workload lists from 2 Ontario cancer centres resulted in a revised AP Activity List with 20 AP inclusive activities. Round 3: 14/20 APRTs provided Likert scores on this revised list. The most applicable AP activities (mean score) were #16 Technical Consultation (4.0), #15 Contouring Target Volume (3.8) and #2 Planning Consultation (3.8); the least applicable was #18 MR Applicator Assessment (0.9). ConclusionsThis is the first systematic attempt to build consensus on AP clinical activities. Non-clinical APRT activities related to research, education, innovation, and program development were not in the scope of this project.The Final AP Activity List & Definitions serves as a framework that allows standardized and continuous monitoring of AP clinical activities and impact.

Defining and Risk-Stratifying Immunosuppression (the DESTINIES Study): Protocol for an Electronic Delphi Study.

Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts-which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients. We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for "adult immunosuppression." Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses. This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024. This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record-compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed. PRR1-10.2196/56271.

Privileged information access, analyst consensus building, and stock return volatility: Evidence from the JOBS Act

This study examines whether allowing select analysts private access to management before an IPO affects analyst consensus building and subsequently post-IPO stock return volatility. The 2012 Jumpstart Our Business Startups (JOBS) Act creates many exemptions to reduce the cost of going public for smaller issuers that qualify as an Emerging Growth Company (EGC). One set of provisions allows analysts affiliated with an EGC's underwriters to communicate privately with management and potential investors before the IPO. Using a sample of IPOs during 2001–2022, we find that the dispersion in affiliated analysts' initiation forecasts is significantly higher for EGCs than similar IPOs in the pre-JOBS period. A path analysis reveals that the JOBS Act indirectly contributes to the heightened post-IPO stock return volatility through the mediating role of forecast dispersion among affiliated analysts. Our exploratory analyses suggest that more significant variations in affiliated analysts' social connections and their workload tend to be associated with higher forecast dispersion. Overall, our findings indicate that having privileged access to management could reduce consensus among analysts, which can increase post-IPO stock return volatility in EGCs.

Patient-Reported Outcome Measures (PROMs) in Neurology for Web 3.0 and mHealth: A Conceptual Framework

According to 2019 WHO data, neurological conditions contribute to 1503.39 disability-adjusted life years (DALYs) per 100,000 population. Approximately 57% of office-based physicians use EHR systems and the natural place to incorporate standardized ePRO is into EHR. However, implementing patient-reported outcomes (PROs) for neurological conditions is challenging because many patients are elderly, have comorbidities, and experience cognitive impairment. As healthcare digitization increases, we propose a framework for easily customizable electronic PROs (ePROMs) in neurology. The framework requires implementation of technological standards, including governance plans, integration, and reporting workflows. It consists of four steps: developing an ePRO questionnaire, making ePRO mobile-compatible and user-friendly, building consensus around ePRO, and validating ePRO. It is important to involve all stakeholders in the ePRO development process and continuously monitor and evaluate progress in real-time to sustain ePRO tools over time.

Development of a novel primate welfare assessment tool for research macaques.

Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.

Konsens oder Agreeing to Disagree?: Die Bedeutung wissenschaftlicher Synthese in der Wirtschaftspolitik

Abstract Discussions in the field of economics can take different forms to reach consensus or dissent among those involved. According to which rules and procedures is it possible to reach a consensus in economic policy advice? And in which cases is an all-round consensus undesirable? Based on a panel discussion at the annual conference of the Verein für Socialpolitik in Regensburg in September 2023, the following two articles reflect on consensus building and “agreeing to disagree” in the context of the work of two statutory policy advisory bodies in Germany, the German Council of Economic Experts and the Joint Economic Forecast Project Group.

The COVID-19 pandemic's effects on mental and psychosocial health in the Philippines: A scoping review.

Low- and middle-income countries (LMICs) remained at elevated risk for the effects of the COVID-19 pandemic because of persistent stressors to their health systems. Simultaneously facing high infection rates, strict containment measures and natural disasters, the Philippines provides important grounds for health research in LMICs. This review examined how the COVID-19 pandemic affected mental and psychosocial health in the Philippines. This scoping review included literature in English from 2020 to mid-2022 from PubMed, PsycInfo and SCOPUS, and used the PRISMA-ScR and PCC-question model. Two independent reviewers conducted blind article screening and data extraction using COVIDENCE software, followed by consensus building, data charting and analyses. This work identified 405 publications across PubMed (N=56), PsycInfo (N=106) and SCOPUS (N=243), of which 76 articles addressed the Philippines. Article types included 54 research articles, 10 opinion pieces, 4 literature reviews, 6 letters to journals, 1 study protocol and 1 other report. These findings focused primarily on health professionals (N=23) and educators/learners (N=22) and reported mostly on moderate-to-severe clinical outcomes such as fear, depression, anxiety or stress. Coping behaviors, like resiliency and other ways of adapting to the pandemic, including religious, spiritual and community-oriented approaches highlighted experiences with stringent infection prevention and control measures to contain COVID-19 in the Philippines. The COVID-19 pandemic brought severe challenges to mental and psychosocial health in the Philippines. The literature focused mostly on healthcare workers and educators/learners, and moderate-to-severe mental health outcomes in these groups. There is a need to expand studies to other sociodemographic groups and communities across the Philippines. Future work stands to benefit from more in-depth qualitative, mixed methods, longitudinal and representative quantitative research in LMICs following this pandemic. Literature reviews remain important to synthesize post-pandemic experiences by providing context for future studies and health practice in the Philippines and other LMICs.

Developing lifestyle intervention program for pre-hypertensive patients; consensus building using a modified Delphi approach.

Prehypertension is a preclinical state of hypertension which leads to an increased likelihood of coronary heart disease, myocardial infarction, cerebrovascular disease as well as target organ damage. Addressing pre-hypertension through early lifestyle interventions is crucial to mitigating these detrimental effects and improving long-term health outcomes. So, the main objective of this study is to develop a lifestyle intervention program (LSIP) for the management of prehypertension using consensus building approach. It was a three round online modified Delphi study with 70 members panellists. All panellists had an experience of prehypertension either as patients (n = 30) or professionals (n = 40). Round 1 included initial recommendations developed from a previous systematic review and metanalysis, which were rated by panellists for their importance on a 5-point Likert scale. Panellists could also suggest additional items in the Round 1. Round 2 and 3 included all items from the Round 1 with new items suggested by the panellists. Data was analysed descriptively using SPSS version 29. All items receiving at least 70% of all respondents combined rating of 'Important' and 'Very Important' in Round 3 were included in the final set of recommendations. Fifty-one panellists (80.9%) (patients = 25, professionals = 26) completed Round 3. Twenty-six recommendation items were included in the Round 1. Twenty new items were added in Round 2 with 46 total items in Round 2 and 3. Thirty-five of these items reached consensus in Round 3. The final set of recommendation comprised of 15 educational. 10 dietary, and 10 exercise recommendations. This modified Delphi study developed a comprehensive LSIP for the prevention of prehypertension, incorporating a holistic approach with educational, dietary, and exercise components aimed at the general population. Previously established standards of care (SOC) for managing prehypertension varied significantly and often provided fragmented guidance particularly on physical activity and education. This preventive model offers a novel and scalable approach for early intervention in prehypertension, potentially reducing reliance on medications and improving long-term health outcomes.

From Chaos to Rationality: A Contingent Meta-Model for Evidence-Informed Health Policymaking in Diverse Contexts.

Evidence-informed policymaking is a complex process that requires adapting to diverse contexts characterized by varying degrees of certainty and agreement. Existing models and frameworks often lack clear guidance for dealing with such contexts. This study aimed to develop a novel contingency model to guide the context-specific use of evidence in health policymaking. The study conducted a meta-ethnographic synthesis of 15 existing models and frameworks on evidence-informed policymaking, integrating key factors and concepts influencing the use of evidence in policy decisions. The study also adapted the Stacey Matrix, a tool for understanding the complexity of decision-making, into a quantitative scoring system to assess the levels of certainty and agreement in a given policy context. The study proposed a contingency model that delineates seven modes of decision-making based on the dimensions of certainty and agreement, ranging from rational to molasses-slow collective. For each mode, the model suggests configuring four aspects: team composition, policy idea generation, problem analysis, and consensus building. The model also highlights the multifaceted influences of evidence, interests, values, and beliefs on policy decisions. The contingency model offers researchers and policymakers a flexible framework for aligning policymaking processes with available evidence. The model also underscores the importance of context-specific approaches to evidence-informed policymaking. The model could enhance evidence-informed policymaking capacity, improving health outcomes and system performance. Further research should validate and extend the model empirically across diverse contexts.

Building consensus on the application of organoid-based drug sensitivity testing in cancer precision medicine and drug development

Building consensus on the application of organoid-based drug sensitivity testing in cancer precision medicine and drug development