Level Of Consensus Research Articles

Assessment of the relevance of a prescribing competency framework in Kuwait – An e-Delphi study

Abstract Introduction Prescribing is the most common intervention used to manage patients. Globally, prescribing competency frameworks have been developed to standardize prescribing practice across all healthcare disciplines1. Research on prescribing practice in different chronic diseases in Kuwait has shown some inconsistencies in the quality of care delivered to patients. Aim This study assesses the relevance of the National Pharmaceutical Society (NPS) MedicineWise Prescribing Competency Framework statements amongst physicians, dentists, and pharmacists in Kuwait as a first step in developing a National Prescribing Competency Framework for Kuwait. Methods Ethical approval was granted by Kuwait’s Ministry of Health (MOH) for this project. A 4-phase adopt and adapt approach was planned to develop the Prescribing Competency Framework for Kuwait. This study covers phases 1 and 2 of this approach. Phase one involved translating the Framework into Arabic using parallel translation. Phase two utilised the e-Delphi method to reach consensus on the relevance of 48 statements (divided into 7 Competency Areas) for prescribing in Kuwait. For this phase, a survey, with a 4-point Likert scale, was developed using Google Forms and distributed to experts participating in the e-Delphi process. Purposive and snowballing method was used to recruit the experts, targeting all doctors, dentists, and pharmacists working in MOH. Participants were asked to rate their agreement with the relevance of the statements to Kuwait and allowed to leave comments. Statements achieving a consensus level ≥90%, with no answer as strongly disagree, were deemed relevant. Statements not reaching consensus will be reevaluated in Round 2 of the e-Delphi process (planned for July-September 2024). Results The translation phase yielded a bilingual framework that could be utilised by prescribers in Kuwait. Round 1 of the e-Delphi included 36 experts (22 doctors, 8 dentists, and 6 pharmacists). Out of the seven Competency Areas in the NPS framework, four Competency Areas reached 100% consensus (Areas 1, 4, 5, and 6). 90% of the statements in Competency Area 2 reached consensus, while only 40% of the statements in Competency Area 3, and 85.7% of the statements in Competency Area 7 reached consensus. Competency statements that did not reach consensus will be re-assessed in Round 2 of the e-Delphi process. Conclusion To our knowledge, this is the first study conducted to initiate the process of adopting and adapting a Prescribing Competency Framework in Kuwait. Competency statements involving patient engagement in their management plan seemed to gain the least consensus in Round 1 of our study, which will be explored further in Round 2 of our e-Delphi process. This is consistent with current published literature in the Middle Eastern and North African regions which shows that there is no clear understanding by healthcare professionals of how to apply patient-centred care2,3. Limited comments on disagreed statements in Round 1 require further clarification. There is a need to standardize the prescribing process due to the complexity of choosing the right medication, the imperative to optimize medication use, a change in the patient's care models, and the possibility of other healthcare professionals taking on prescribing roles.

A Delphi consensus project to capture experts' opinion on hyperkalaemia management across the cardiorenal spectrum.

The main purpose of this project was to capture experts' opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece. A steering committee of nephrologists and cardiologists developed 37 statements. An online questionnaire completed by 32 experts in cardiorenal management in Greece. Median score used to determine the level of agreement and disagreement index (DI) used to determine the level of consensus for each statement. Statements divided in four sectors: hyperkalaemia risk management, preventative measures, treatment and collaboration between specialties. The rate of the first round of the consensus was 94.6%. Median score was >7 for 36 of 37 statements and DI≤1 for 35 of 37. Among other statements, consensus reached for recognizing levels K+>5.0mEq/L as associated with elevated mortality risk; retaining renin-angiotensin-aldosterone system inhibitors (RAASi) on maximum recommended dose for cardiorenal patients; and using novel K+ binders to help enabling guideline-recommended doses of RAASi therapy. Cardiologists compared to nephrologists showed higher reluctance to discontinue down-titrate RAASi and MRA in patients with K+ levels above 5mEq/L. Additionally, 88.9% of nephrologists and 71.4% of cardiologists agreed that cross-specialty alignment on a serum K+ concentration level (K>5.5mEq/L) is needed to initiate hyperkalaemia treatment. Both cardiologists and nephrologists showed disagreement with the statement on keeping titration in cardiorenal patients with K+>5.5mEq/L or preserving fruit and vegetable consumption when moderate or severe hyperkalaemia exhibits. This Delphi project pointed out nephrologists' and cardiologists' agreement on hyperkalaemia management in cardiorenal patients; thus, it can help a cross-specialty optimal management of cardiorenal patients, with hyperkalaemia not being an obstacle for disease-optimizing therapy. Novel potassium binding agents can enable guideline-recommended doses of potassium-sparing medication.

The management of isolated meniscal tears in skeletally immature children. An international expert consensus.

The prevalence and appreciation of meniscal tears in children have increased in both number and complexity. There is currently a paucity of high-quality evidence that can guide surgeons in treating skeletally immature patients with meniscal injuries. The aim of this study was to develop comprehensive recommendations for the management of isolated meniscal tears in skeletally immature children. An international, two-round, modified Delphi consensus was completed. Included 'experts' were identified as having an established adult knee practice, including children and either: (1) Faculty at an international paediatric knee conference, (2) Active members of complex national paediatric multi-disciplinary groups or (3) Members of faculty on recognised national/international instructional courses aimed at teaching the management of meniscal lesions to knee surgeons. The currently available literature was reviewed, and areas of poor quality, inconclusive or absent evidence were examined and formed the focus of the study. A threshold of 70% was used to define consensus for our study based on other similar Delphi consensus studies in the literature. A total of 43 experts (Round 1) and 41 experts (Round 2) took part in the Delphi study, including surgeons from Europe, the United States of America and South America. 34 statements were identified exploring three main domains-clinical assessment, management and complex tears (bucket handle, discoid and radial). Following Round 1, consensus was reached on 17 (50%) statements; subsequently, after completion of Round 2, consensus was reached on 28 (82%) statements, leaving six (18%) with no consensus. The areas of no consensus included investigation of painless clicking, the most sensitive clinical test for meniscal pathology, treatment of small radial tears (less than 1/3 width), ability to reduce chronic bucket handle tears and timing of surgery. This is the first modified Delphi consensus that provides evidence for surgeons treating skeletally immature children with isolated meniscal tears. A valuable level of consensus was reached on the assessment and management of simple and specialist meniscal tears. These consensus statements can both inform clinical practice and be used in the development of further high-quality research studies. Level V.

Research Priorities in Neuroeducation: Exploring the Views of Early Career Neuroscientists and Educators

The field of neuroeducation, which integrates neuroscience findings into educational practice, has gained significant attention in recent years. Establishing research priorities in neuroeducation is crucial for guiding future studies and ensuring that the field benefits both neuroscience and education. This study aimed to address the need for collaboration between neuroscientists and educators by conducting a priority-setting exercise with early career professionals from both fields. Using the nominal group technique (NGT) with interquartile range (IQR) analysis, we identified seven key priorities in neuroeducation and assessed the level of consensus on these priorities. The top-ranked priorities were “Emotional and Mental Well-being”, “Neurodiversity and Special Education Needs”, and “Active and Inclusive Teaching Methods”, though IQR analysis revealed varying levels of consensus. Lower-ranked priorities, such as “Role of Technology on Learning and the Brain”, showed a higher consensus. This discrepancy between ranking and consensus highlights the complex nature of neuroeducation, reflecting differing perspectives between neuroscientists and educators. These findings suggest the need for interdisciplinary collaboration to bridge these gaps and foster evidence-based practices. We recommend that future research focuses on the specific neural mechanisms underlying emotional well-being, strategies for supporting neurodivergent learners, and practical approaches to integrating inclusive teaching methods in diverse educational contexts.

Prediction of the Future Trends of Housing Project Development with Modified Delphi Technique

This research was initiated to study the trend of the housing projects in the next ten years (2022-2031), with the applied Modified Delphi Technique. The research was conducted by interviewing five experts with more than ten years of knowledge and experience in design, construction, technology, location, and marketing. The gathered trends were applied to create questionnaires in order to conduct two rounds of surveys to assess the consensus level of ten experts with at least ten years of experience in the real estate industry, according to the consensus analysis method from the Modified Delphi Technique. Thirteen trends were found from the study. There are four design trends: more beautiful façade, soundproof wall, universal design furniture, and universal design house building. In addition, eco-friendly materials and modular construction systems were found to be construction trends while smart home device installation and active air flow technology were found to be technology trends. Regarding the trend of the project location, the projects tend to be located in areas expanding into the suburbs. Finally, four marketing trends were also reported: Virtual Reality utilization in sales presentation, advertising to reach more customers, inviting social media influencers to play a role in reviewing projects, providing credit consulting services and refunding of reservation money if a customer’s loan is not approved. The results of the study provide information to all parties involved in planning strategies and operating a business in developing housing estates in the future.

Sex Differences in Hierarchical and Modular Organization of Functional Brain Networks: Insights from Hierarchical Entropy and Modularity Analysis.

Existing studies have demonstrated significant sex differences in the neural mechanisms of daily life and neuropsychiatric disorders. The hierarchical organization of the functional brain network is a critical feature for assessing these neural mechanisms. But the sex differences in hierarchical organization have not been fully investigated. Here, we explore whether the hierarchical structure of the brain network differs between females and males using resting-state fMRI data. We measure the hierarchical entropy and the maximum modularity of each individual, and identify a significant negative correlation between the complexity of hierarchy and modularity in brain networks. At the mean level, females show higher modularity, whereas males exhibit a more complex hierarchy. At the consensus level, we use a co-classification matrix to perform a detailed investigation of the differences in the hierarchical organization between sexes and observe that the female group and the male group exhibit different interaction patterns of brain regions in the dorsal attention network (DAN) and visual network (VIN). Our findings suggest that the brains of females and males employ different network topologies to carry out brain functions. In addition, the negative correlation between hierarchy and modularity implies a need to balance the complexity in the hierarchical organization of the brain network, which sheds light on future studies of brain functions.

Working towards consensus on the assessment of mood after severe acquired brain injury: Focus groups with UK-based professionals.

The assessment of mood after brain injury is more challenging when people have ongoing severe cognitive and receptive communication impairments. There is no gold standard on how these assessments should be undertaken. This study aimed to reach a consensus on this among specialists working with this population. Focus groups were completed using a structured nominal group technique. Groups were compared for overlapping themes and agreed processes. Five focus groups with a total of 14 participants who work with the population of interest were completed. Participants included 12 clinical psychologists, one psychiatrist and one consultant in rehabilitation medicine. Each of the five groups reached a consensus on a process for assessing mood in this population. Results overlapped and were combined into a proposed circular and iterative model of assessment that includes: (pre) information gathering, (peri) assessment processes, and (post) treatment; with formulation being seen as a vital part of the process. Standardised measures were not recommended for use with this population. Beyond the consensus processes, three implicit themes were identified: (1) depression is different after severe brain injury, (2) overlapping tasks and roles, and (3) looking at the bigger picture. A good level of consensus was achieved across the five groups on processes to follow when assessing mood when people have ongoing cognitive and receptive communication impairments after severe brain injury. We recommend that this formulation-based model be followed when assessing people in this clinical population.

Multi-Institutional Evaluation of Interrater Agreement of Biomarker-Drug Pair Rankings Based on the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) and Sources of Discordance.

The widespread use of next-generation sequencing in clinical practice has contributed to the accumulation of a large number of genomic findings associated with targeted therapy; therefore, the problem of ranking the detected findings has become acute. The European Society for Medical Oncology Scale of Clinical Actionability of molecular Targets (ESCAT) system was designed by the European Society for Medical Oncology to rank biomarkers into levels of evidence that reflect their potency and clinical significance based on published clinical data. However, the ESCAT system remains imperfect, as it is based on a subjective assessment of the levels of evidence. The objective of this study was to determine whether the ranking of LOE for biomarker-drug pairs based on the ESCAT system is dependent on the human factor, and to uncover potential issues associated with the use of the framework. To evaluate the inter-rater agreement, we created a dataset of a total of 154 biomarker-drug pairs for 18 unique tumor types. We aimed to include biomarker-drug pairs that could be considered standard of care as well as less common and under investigated pairs. Fourteen precision oncology experts were invited to assign an ESCAT level of evidence for biomarker-drug pairs. Statistical analysis was carried out using Cohen's kappa and the Kolmogorov-Smirnov test. The inter-rater agreement was low with some exceptions, and significant deviations from the consensus level of evidence were observed. For biomarker-drug associations, the deviations from the consensus were observed for more than 50% of the contributors' rankings. The most agreement between the contributors was observed for lung adenocarcinoma (p < 0.005), while the most disagreement was observed for esophageal cancer (p < 0.01) biomarker-drug pairs in our dataset. This study demonstrates noteworthy discordances between the precision oncology experts and may provide the directions for future developments in modifying the ESCAT framework and the overall applicability of the results of genomic profiling into clinical practice.

Influenza A virus within-host evolution and positive selection in a densely sampled household cohort over three seasons.

While influenza A virus (IAV) antigenic drift has been documented globally, in experimental animal infections, and in immunocompromised hosts, positive selection has generally not been detected in acute infections. This is likely due to challenges in distinguishing selected rare mutations from sequencing error, a reliance on cross-sectional sampling, and/or the lack of formal tests of selection for individual sites. Here, we sequenced IAV populations from 346 serial, daily nasal swabs from 143 individuals collected over three influenza seasons in a household cohort. Viruses were sequenced in duplicate, and intrahost single nucleotide variants (iSNVs) were identified at a 0.5% frequency threshold. Within-host populations exhibited low diversity, with >75% mutations present at <2% frequency. Children (0-5 years) had marginally higher within-host evolutionary rates than adolescents (6-18 years) and adults (>18 years, 4.4 × 10-6 vs. 9.42 × 10-7 and 3.45 × 10-6, P < .001). Forty-five iSNVs had evidence of parallel evolution but were not over-represented in HA and NA. Several increased from minority to consensus level, with strong linkage among iSNVs across segments. A Wright-Fisher approximate Bayesian computational model identified positive selection at 23/256 loci (9%) in A(H3N2) specimens and 19/176 loci (11%) in A(H1N1)pdm09 specimens, and these were infrequently found in circulation. Overall, we found that within-host IAV populations were subject to genetic drift and purifying selection, with only subtle differences across seasons, subtypes, and age strata. Positive selection was rare and inconsistently detected.

Classification-based consensus model considering quantum interference in linguistic distribution environment

Multi-attribute group classification (MAGC) is widely used in dealing with a variety of practical problems. However, cognitive biases, resulting from factors such as irrational behaviors, epistemic uncertainty, and interference phenomena, may critically affect the consensus reaching process (CRP) of MAGC. To eliminate such influences, this study proposes an ordinal classification consensus model in a linguistic environment based on quantum probability theory (QPT), with the aim of classifying the alternatives into several predefined ordinal classifications accepted by a majority of experts. First, the linguistic distribution assessments (LDAs), which can depict the quantitative distribution and qualitative vagueness, are used to express the uncertain preference of experts. Second, the LDAs best-worst method (BWM) and LDAs maximizing deviation model (MDM) are developed to identify the subjective and objective weight of attributes, and then these two types of attributes weight are integrated by quantum-like Bayesian networks (QLBN). Third, a maximum consensus model (MCM), maximizing the consensus level of ordinal classification results of experts, is provided to determine the parameters of QLBN. When the consensus level is lower than the predetermined threshold, a minimum adjustment distance model (MADM) is designed to guide the preference-modification of experts to derive the consensus classification of alternatives. Finally, a risk assessment case study is conducted to verify the feasibility and effectiveness of the proposed method. Sensitivity analysis and comparison analysis are performed to verify the feasibility and effectiveness of the proposed method

Transition from paediatric to adult neurological care: What do we know?

IntroductionHealthcare advances have allowed an increase in the survival of paediatric patients with neurological diseases. As a result, it is increasingly common to find these patients in adult neurology consultations. The aim of this study is to evaluate the current level of consensus on the transition of neuropaediatric patients among neurology and paediatric professionals in the Balearic Islands. Material and methodsWe conducted an observational, analytical, cross-sectional study through an anonymous questionnaire consisting of 27 questions, which was distributed to neurologists, paediatric neurologists, hospital paediatricians, and primary care paediatricians in the healthcare network of the Balearic Islands. It was developed using Google Forms and distributed by the competent professional societies. Consensus was considered to exist for answers with 70% or more agreement. ResultsResponses were received from 58 professionals; 46.6% were hospital paediatricians, 29.9% were neurologists, 13.8% were paediatric neurologists, and 13.8% were primary care paediatricians. Among other issues, consensus was observed on the need for a transition programme for patients with neurological diseases. No consensus was observed regarding the duration of the transition (P=.029) and how long simultaneous follow-up must last after the transfer (P=.09). ConclusionsDue to increased survival rates, there is a need to create transition programmes for paediatric patients with neurological diseases. In our study, more than 70% of professionals believed that it would be beneficial to create such programmes.

A Relative Projection-Based Multiattribute Group Decision-Making Model With Noncooperative Behavior Management and Application to NEV Supplier Selection.

This article reports a novel consensus model where a group of internal and external experts evaluate alternatives under multiple attributes and provide mutual evaluations. First, different from previous studies, the cognitive and interest conflicts of internal and external experts are considered simultaneously. But interest conflict is emphasized for internal experts, and cognitive conflict is mainly considered for external experts. Second, we explore the categorization and management methods of noncooperative behaviors (NCBs) of experts. The relative projection-based indexes are proposed for the first time to measure the degrees of cognitive and interest conflicts by using multiattribute preference matrices (MAPMs) and the weight vectors of attributes. A group of experts are divided into three categories and the corresponding management strategies are developed. Third, we investigate the consensus mechanism among experts with cognitive and interest conflicts. For reaching an acceptable consensus level, an adjustment process is proposed to revise some local entries in MAPMs and mutual evaluation matrix (MEM). A penalty mechanism is further established to dynamically update the weights of experts. An algorithm is designed to capture the consensus reaching process in multiattribute group decision making, where internal and external experts are distinguished by proposing a parameter. Finally, the high-performance battery supplier selection of new energy vehicle is studied to illustrate the proposed model. The results reveal that the efficiency of reaching consensus can be enhanced by using the developed model with effective management of NCBs.

Optimal planning and management strategies for minimally invasive lung segmentectomies: an international Delphi consensus report.

CALGB140503/JCOG0802 RCTs comparing lobectomy with sublobar resection in stage IA NSCLC have confirmed the non-inferiority of segmentectomy. Additional insight is needed to improve preoperative work-up and intraoperative strategies to increase safety and promote the dissemination of minimally invasive segmentectomy (MIS). A Delphi panel study assessed the level of consensus among surgeons for the planning and management of MIS. Twenty-one expert lung surgeons represented academic institutions, major teaching hospitals, and community hospitals from Europe, North America, and Asia. A 3-round Delphi methodology was used to analyse the answers of each panellist. Recognizing that questions with fewer response options have a higher consensus probability due to limited variability, weighted consensus thresholds were modified based on the number of response options. The 21 panellists responded to all 3 rounds of questions. Based on the most robust consensus (94.4%), 3D chest CT reconstructions are recommended only when planning complex segmentectomies. Surgeons should perform 3D reconstructions chest CT scans (consensus = 83.3%). The most effective and safest technique is image-guided VATS in a hybrid operating room (consensus = 83.3%). Dyes with intravenous administration are the safest technique for identifying the intersegmental plane during MIS (consensus = 72.2%). Augmented/mixed reality will probably not immediately help reduce perioperative complications (consensus = 72.2%). This Delphi consensus supports 3D reconstructions and preoperative pulmonary nodule localization before complex MIS. These recommendations should be considered when allocating resources to improve MIS's safety and oncologic efficacy for patients with small, early-stage lung cancers.

Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech and language therapists.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 3 Palatal Surgery, Outcomes and Follow-Up, Complications, and Post-Operative Management.

Background/Objectives: Exploring and establishing a consensus on palatal surgery, the outcomes and follow-up after the palatal surgery, the complications of palatal surgery, and the post-operative management after palatal surgery for snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the surgical management of patients with such conditions. Methods: Using the Delphi method, a set of statements was developed based on the literature and circulated among a panel of eight European experts. Responses included agreeing and disagreeing with each statement, and the comments were used to assess the level of consensus and to develop a revised version. The new version with the level of consensus and anonymized comments was sent to each panel member as the second round. This was repeated over a total of five rounds. Results: The final set included a total of 111 statements, 27 of which were stand-alone questions and 21 of which contained 84 sub-statements. Of the 34 statements regarding palatal surgery, consensus was achieved among all eight, seven, and six panelists for 50%, 35.3%, and 5.9% of the questions, respectively. Of the 43 statements regarding the outcomes and follow-up after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 53.5%, 23.3%, and 4.7% of the questions, respectively. Of the 24 statements regarding complications after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 91.7%, 0%, and 4.2% of the questions, respectively. Of the 10 statements regarding post-operative management after palatal surgery, consensus was achieved among all eight, seven, and six panelists for 10%, 30%, and 30% of the papers, respectively. Conclusions: This consensus provides an overview of the work of European sleep surgeons to develop a set of statements on palatal surgery for the treatment of snoring and OSA, the outcomes and follow-up, the complications, and the post-operative management of palatal surgery. We believe that this will be helpful in everyday practice. It also indicates key areas for further studies in sleep surgery.

Class of international functioning disability and health core sets for autism spectrum disorder: Occupational therapists’ perspective

Purpose: This study was conducted to examine the ICF Core Sets prepared for autism from the perspective of occupational therapists within the scope of the International Classification of Functioning, Disability, and Health. Materials and Methods: Data were collected from 70 occupational therapists working with children diagnosed with autism spectrum disorder. Opinions of the participants were collected using the three-stage Delphi technique. Results: In the first Delphi round in which 70 occupational therapists from our country participated, a total of 2952 concepts related to autism spectrum disorder were named. The collected responses were associated with 142 ICF categories, excluding personal factors, and then the number of categories was reduced to 132 because 10 of them were mentioned by less than 5% of the respondents. While consensus was achieved in 82% of the 111 categories in the comprehensive ICF Core Sets for autism spectrum disorder . Discussion and Conclusion: According to the results of this study, ICF-CSs prepared for autism spectrum disorder overlap with the perspective of occupational therapists to define the physiological, occupational, environmental, and personal factors affecting individuals with autism spectrum disorder . The high level of consensus among occupational therapists underscores the practical applicability and acceptance of ICF Core Sets in the field.

Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism.

Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.

Omicron and periodontal health; a clinical exploration of gingivitis and periodontitis

Introduction: The COVID-19 pandemic has profoundly affected global health, with variants such as Omicron posing new challenges due to their increased transmissibility and potential to evade immunity. Periodontal diseases, which are highly prevalent worldwide, have been linked to various systemic conditions, including respiratory infections. Objectives: To determine how periodontal problems affect Omicron infection susceptibility, symptom severity, and outcome in individuals infected with this variety and discover oral microbiota biomarkers that indicate severe Omicron patients. Materials and Methods: To gather data, a quantitative descriptive study was instituted, utilizing a well-structured questionnaire comprising multiple-choice and Likert scale questions. The sample population, dentists in Erbil, was reached through email, followed by statistical analyses involving mean scores, standard deviations, and practices degree to interpret the data. Results: Results displayed a varied range of perceptions, with significant discrepancies highlighted through high standard deviations in specific responses, pointing to the necessity for homogenized guidelines or educational outreach. The overall mean score categorized the sentiment as ‘Medium,’ indicating a moderate level of consensus on the relationship between the Omicron variant and periodontal issues. Conclusion: This exploration unveils not only a nuanced understanding among the dentist community but also showcases domains where unanimity is deficient, calling for intensified research and educational efforts to harmonize perspectives in this pressing matter, especially amid the prevalence of the Omicron variant. The findings signify an imperative to foster aligned understandings through enhanced educational interventions in the dental community in Erbil, Kurdistan, Iraq, potentially steering towards a more cohesive approach in handling cases with pre-existing periodontal conditions amid the Omicron surge.

Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study.

For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message-based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions.

Prehospital guidelines on in-water traumatic spinal injuries for lifeguards and prehospital emergency medical services: an international Delphi consensus study

BackgroundTrauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed.MethodsAn international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75–85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2.ResultsTwenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90–95%). The integral flowchart received strong consensus (93%).ConclusionsThis study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.