Consensus Procedure Research Articles

Position statement on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies, part 3: precautions in situations of surgery, fever, and opportunistic infections

The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient’s previous situation as well as the current infectious disease, in addition to experience.What is Known:• Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases.• Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults.What is New:• In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.

National Palliative Care Strategy in a Conflict Affected Country: A Jordanian Demonstration Project

ContextPalliative care (PC) integration is vital, as endorsed by the World Health Organization. Yet, Jordan, a Middle Eastern country with limited resources, faces ongoing challenges despite efforts to improve palliative and home care. Establishing a national PC strategic framework, with government and stakeholder consensus, is essential for ensuring universal access to high-quality palliative care. However, processes for achieving this, particularly in the Middle East, are underreported. ObjectivesThis study delineates the process of developing Jordan's National Palliative and Home Care Strategic Framework, reflecting on its five-year impact. Additionally, it identifies barriers to PC progress in Jordan and offers recommendations to stakeholders. MethodsWe conducted a rapid review and analyzed reports, minutes, meetings, and publications. The sequential framework development involved content and situational analysis, expert review, transparent expert consultation, multistage consensus procedures, and high-level advocacy meetings. ResultsThe National Palliative and Home Care Strategic Framework encompasses six domains: 1) policy, 2) finance, 3) service delivery, 4) opioid access, 5) capacity building, and 6) information, research, monitoring, and evaluation. Government endorsement in April 2018 ignited national engagement, driving policy, service delivery, workforce development, education, training, and research progress. Nonetheless, workforce shortages, limited opioid access, and inadequate funding persist as barriers. ConclusionJordan's collaborative development of the inaugural National Palliative and Home Care Strategic Framework, endorsed by the government and stakeholders, provides a comprehensive roadmap for PC advancement. While it promises improved services, effective solutions to workforce and opioid access issues are crucial for successful implementation.

64 The Biomarker-Based Etiological Diagnosis of Neurocognitive Disorders: the European Inter-Societal Delphi Consensus

Objective:In the field of neurocognitive disorders, the perspective offered by new disease-modifying therapy increases the importance of etiological diagnosis. The prescription of cerebrospinal fluid analysis (CSF) and imaging biomarkers is a common practice in the clinic but is often driven more by personal expertise and local availability of diagnostic tools than by evidence of efficacy and cost-effectiveness analysis. This leads to a widely heterogeneous dementia care across Europe. Therefore, a European initiative is currently being conducted to establish a consensus for biomarker-based diagnosis of patients with mild cognitive impairment (MCI) and mild dementia.Participants and Methods:Since November 2020, a European multidisciplinary task force of 22 experts from 11 scientific societies have been defining a diagnostic workflow for the efficient use of biomarkers. The Delphi consensus procedure was used to bridge the gaps of incomplete scientific evidence on biomarker prioritization. The project has been in two phases. During Phase 1, we conducted a literature review on the accuracy of imaging, CSF, neurophysiological and blood biomarkers in predicting the clinical progression or in defining the underpinning aetiology of main neurocognitive disorders. Evidence was provided to support the panelists’ decisions. In phase 2, a modified Delphi procedure was implemented, and consensus was reached at a threshold of 70% agreement, or 50%+1 when a question required rediscussion.Results:In phase 1, 167 out of 2,200 screened papers provided validated measures of biomarker diagnostic accuracy compared with a gold standard or in predicting progression or conversion of MCI to the dementia stage (i.e., MRI, CSF, FDG-PET, DaT-imaging, amyloid-PET, tau-PET, and myocardial MIBG-scintigraphy and EEG). During phase 2, panelists agreed on the clinical workspace of the workflow, the stage of application, and the patient age window. The workflow is patient-centered and features three levels of assessment (W): W1 defines eleven clinical profiles based on integrated results of neuropsychology, MRI atrophy patterns, and blood tests; W2 describes the first-line biomarkers according to W1 versus clinical suspicion; and W3 suggests the second-line biomarkers when the results of first-line biomarkers are inconsistent with the diagnostic hypothesis, uninformative or inconclusive. CSF biomarkers are first-line in the suspect of Alzheimer’s disease (AD) and when inconsistent neuropsychological and MRI findings hinder a clear diagnostic hypothesis; dopamine SPECT/PET for those leading to suspect Lewy body spectrum. FDG-PET is first-line for the clinical profiles leading to suspect frontotemporal lobar degeneration and motor tauopathies and is followed by CSF biomarkers in the case of atypical metabolic patterns, when an underlying AD etiology is conceivable.Conclusions:The workflow will promote consistency in diagnosing neurocognitive disorders across countries and rational use of resources. The initiative has some limitations, mainly linked to the Delphi procedure (e.g., kickoff questions were driven by the moderators, answers are driven by the Delphi panel composition, a subtle phrasing of the questions may drive answers, and 70% threshold for convergence is conventional). However, the diagnostic workflow will be able to help clinicians achieve an early and sustainable etiological diagnosis and enable the use of disease-modifying drugs as soon as they become available.

How ready is the Italian healthcare system in the use of genomics? The B1MG Maturity Level Model

Abstract Background The integration of genomics into healthcare systems allows to fulfilling the potential of Personalised Medicine for patients and citizens. This demands countries to make extensive adjustments in key areas, such as technical infrastructure, health professional competencies, or ethical and legal frameworks. Effective identification of current challenges and barriers to integrating genomics in the healthcare system is crucial to define a path toward sustainable implementation. Methods We applied the B1MG Maturity Level Model framework to assess the maturity of the Italian national health system (NHS) in key aspects of genomics implementation. From March to June 2022, 18 experts from academic and non-academic institutions that participate in the B1MG activities rated on a 5-point scale (from ad hoc to fully implemented) the level of maturity of 49 indicators grouped into eight domains: governance (I), economic aspects (II), ethics and legislation (III), public awareness (IV), workforce skills (V), clinical organization (VI), clinical genomics guidelines (VII), and data infrastructure (VIII). From July to September 2022, consensus procedures were carried out within each domain. Results Italy stands at a local level of genomics implementation in most indicators, but several regional and/or national initiatives are ongoing. Genomic medicine is considered a priority but still lacks updated strategies, governance, and investment plans. The highest maturity is reached for ethical and legal aspects, followed by domain VII. There is a strong need to invest in workforce training for some health professionals, citizen engagement, and literacy. Infrastructures to improve data security and fairification are still under development. Conclusions We defined the status of genomics implementation in the Italian NHS, drawing a comprehensive picture of all key domains and identifying areas for investment. Regional and national initiatives currently ongoing need to be monitored. Key messages • Italy stands at a local level of genomics implementation in most indicators, but several regional and/or national initiatives are ongoing. • Genomic medicine is considered a priority but lacks updated strategies, governance, and investment plans.

Therapeutic Exercise Parameters, Considerations and Recommendations for the Treatment of Non-Specific Low Back Pain: International DELPHI Study.

Therapeutic exercise (TE) recommendations for non-specific low back pain (LBP) are meant to support therapy choices for people who suffer from this condition. The aim of this study was to reach an agreement on the definition and use of TE in the care of people with LBP. A Delphi study was carried out with a formal consensus procedure and sufficient scientific evidence, using an established methodology. Four rounds of anonymous questionnaires were administered to create useful suggestions and instructions in terms of the therapeutic activity for patients with LBP, and a group consensus conference. A consensus was reached on most of the questions after 35 physiotherapists completed the questionnaires. Participants agreed that proper TE requires correct posture, body awareness, breathing, movement control, and instruction. Patients with LBP were advised to participate in supervised sessions twice a week for 30 to 60 min for a period of 3 to 6 months. Participants added that tailored evaluation and exercise prescription, monitoring, and functional integration of exercise, as well as using specific equipment, would benefit patients with LBP. TE recommendations for patients with LBP should be dosed and customized based on their personal psychological needs, level of fitness, and kinesiophobia.

From Decentralization to Oligopoly: A Data-Driven Analysis of Decentralization Evolution and Voting Behaviors on EOSIO

As one of the most popular blockchain systems, EOSIO has been widely used in decentralized applications (DApps). Compared with traditional proof-of-work (PoW)-based blockchain systems like Bitcoin, EOSIO achieves a high transaction throughput and an alleged decentralization with the Delegated Proof-of-Stake (DPoS) consensus protocol. However, recent reports claimed the existence of voting collusion and manipulation during the DPoS consensus procedure of EOSIO, which may greatly decline the decentralization degree, fault tolerance, and reliability of the whole system. In this article, we obtain data from up to 135 000 000 blocks of EOSIO and conduct a data-driven decentralization analysis. Specifically, we characterize the decentralization evolution of the two phases in DPoS, namely block producer election and block production. Moreover, we study the voters with similar voting behaviors and propose methods to discover abnormal mutual voting behaviors in EOSIO. The analysis results show how EOSIO gradually evolves from decentralization to oligopoly and our methods can effectively capture abnormal voting phenomena in the EOSIO, which can also provide important insights for the design and maintenance of other DPoS-based blockchains.

Expert consensus on clinical application of mechanical airway clearance techniques

Mechanical airway clearance techniques refer to the therapeutic method of using mechanical means to clear airway secretions and maintain airway patency. Currently, mechanical airway clearance techniques are widely used in clinical practice and have significant effects in clearing respiratory secretions, improving symptoms of respiratory distress, and preventing and reducing respiratory tract infections. However, up to now, there is no consensus, guidance, or standardized procedures for the clinical application of mechanical airway clearance techniques. Therefore, the Respiratory Care Group of Chinese Thoracic Society organized relevant experts to write the consensus on the clinical application of mechanical airway clearance techniques, and systematically describe the definition, historical development, working principles and mechanisms, and clinical applications of mechanical airway clearance techniques. The aim is to increase awareness of mechanical airway clearance techniques, to provide clinical practitioners with standardized procedures for the application of mechanical airway clearance techniques, and to guide the standardized clinical practice.

The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel

ObjectiveTo develop and present consensus findings of the National Sleep Foundation sleep timing and variability panel regarding the impact of sleep timing variability on health and performance. MethodsThe National Sleep Foundation assembled a panel of sleep and circadian experts to evaluate the scientific evidence and conduct a formal consensus and voting procedure. A systematic literature review was conducted using the NIH National Library of Medicine PubMed database, and panelists voted on the appropriateness of 3 questions using a modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting. ResultsThe literature search and panel review identified 63 full text publications to inform consensus voting. Panelists achieved consensus on each question: (1) is daily regularity in sleep timing important for (a) health or (b) performance? and (2) when sleep is of insufficient duration during the week (or work days), is catch-up sleep on weekends (or non-work days) important for health? Based on the evidence currently available, panelists agreed to an affirmative response to all 3 questions. ConclusionsConsistency of sleep onset and offset timing is important for health, safety, and performance. Nonetheless, when insufficient sleep is obtained during the week/work days, weekend/non-work day catch-up sleep may be beneficial.

Developing diagnostic criteria for tooth wear, a preliminary beta version based on expert opinion, and a narrative literature review.

Tooth wear is a multifactorial condition, leading to the irreversible loss of dental hard tissues. The availability of an unambiguous, universally applicable assessment protocol remains lacking. The goal of the authors is to develop a set of diagnostic criteria for the assessment of tooth wear (DC-TW). A two-step approach will be used to achieve this objective: (1) to develop a preliminary beta version of the DC-TW, based on the authors' clinical experience and their shared expertise and supported by a narrative review of the existing literature, and (2) to develop the final DC-TW, with input from a larger group of experts using an international Delphi process. This paper relates to the first step. The authors outlined the components that should be incorporated into the DC-TW. The literature search was performed to investigate if their concept was in line with the available literature. The search was conducted to identify eligible publications from inception to July 11, 2022. Two authors independently screened all publications, and differences in judgements were resolved through a consensus procedure. The search yielded 5362 publications, resulting in the final inclusion of 383. These publications were divided into four main topics: (1) nomenclature/taxonomies; (2) self-report tools; (3) clinical assessment tools; and (4) clinical decision-making. The information from the publications was used and fused with the clinical experience and shared expertise of the authors to contribute to the development of a preliminary beta version of the DC-TW.

Coalition Formation Game for Cost-Efficient Multiparty Payment Channel in Payment Channel Networks.

Blockchain has introduced a new era for online payment services and its economy with tamper-proof cryptocurrencies. However, blockchain, which is based on global peer-to-peer networks, has its limitations due to payment delays from global consensus and transaction costs for maintenance. Thus, payment channel networks (PCN) have been proposed as one of the most promising off-chain solutions, allowing users to pay directly through payment channels (PC), with minimal blockchain involvement. However, payment delays and cost problems still exist, especially given the large size of the PCN. This study proposes a multiparty payment channel (MPC) that enables multiple users to join the same PC and exchange payment transactions, compared to the legacy PC. To avoid a consensus procedure among users in the PC, we introduce sequential and parallel updates for the PC status. Since increasing the MPC size limits the advantages in terms of the delay and cost, we propose a distributed coalition formation algorithm to form the MPC group, in which each user has the choice to join or leave the group. Simulations show that the proposed algorithm establishes MPCs successfully, considering the trade-off between the payoff gain and the MPC delay cost.

The EURO-FORTA (Fit fOR The Aged) List Version 2: Consensus Validation of a Clinical Tool for Improved Pharmacotherapy in Older Adults.

The aging of our societies leads to a higher prevalence of multimorbidity and therefore polypharmacy, which often results in inappropriate drug treatment. To address this issue, numerous listing approaches, such as the Fit fOR The Aged (FORTA) list have been developed. FORTA's positive impact on the quality of medications and relevant clinical outcomes has been shown. Based on new emerging evidence and experiences with the existing FORTA lists, we aimed to update the FORTA lists in several European countries/regions. Two-step Delphi consensus procedures were conducted in Poland, UK/Ireland, Italy, Spain, the Nordic countries, The Netherlands and France. The existing European FORTA lists served as survey proposals. Thirty-two experts agreed to take part in this study (return rate: 96.9%). The country/region-specific overall consensus for all items and participants after the first round was >90%. FORTA lists from six participating countries, plus the FORTA list for the German-speaking countries, were collated into the new EURO-FORTA List, which now contains 267 items aligned to 27 indications. Three items were added to the EURO-FORTA List, and no drugs were deleted. Eight FORTA items were relabeled, and 96.9% of the labels remained unchanged. In this study, seven new country/region specific FORTA lists, as well as a new overarching EURO-FORTA List, were developed. An overall increase in the mean consensus coefficient and increases for all disease-specific mean consensus coefficients show a wider consensus among participants. The new lists have the potential to improve drug therapy in older people internationally.

Which sectors should be involved in public health emergency preparedness, response and recovery?: a RAND modified consensus procedure among European union national experts

Which sectors should be involved in public health emergency preparedness, response and recovery?: a RAND modified consensus procedure among European union national experts

InTraocular EMulsion of Silicone oil (ITEMS) grading system: an evidence-based expert-led consensus.

To propose the InTraocular EMulsion of Silicone oil (ITEMS) grading system for the assessment of silicone oil (SiO) emulsion, applicable in a routine clinical setting and validated through an expert-led consensus procedure. Seven experts on intraocular liquid tamponades, led by a facilitator, performed a literature review on the detection of SiO emulsion. Based on the proposed ideas, a questionnaire was developed and submitted to the experts on the methods to detect SiO emulsion and the items to grade. After two rounds of individual ranking using a nine-point scale and related discussion, the final grading system was developed including items that reached consensus (score ≥7 from ≥75% of members). The agreed ITEMS grading system includes the identification of SiO microbubbles and large SiO bubbles through slit lamp biomicroscopy, gonioscopy, fundus examination under mydriasis or ultra-widefield fundus photography. Moreover, macular and disc OCT are used to detect SiO-associated hyperreflective dots. An evidence-based expert-led consensus was conducted to develop grading system of SiO emulsion, allowing, for the first time, homogenous collection of data on SiO emulsion. This has the potential to improve our understanding of the role and clinical relevance of SiO emulsion allowing comparisons between different studies.

Patients and general practitioners agree that wearing masks during consultations complicates physician--patient relationships: An exploratory, qualitative study

Background The physician--patient relationship plays a critical role in the quality of primary care management. The generalised wearing of surgical masks in enclosed spaces – common during the COVID-19 pandemic -- could change the communication between patients and healthcare professionals. Objectives To assess how general practitioners (GPs) and patients feel about wearing masks during a consultation and its influences on physician--patient relationship. To evaluate methods healthcare professionals could use to compensate for mask wearing during a consultation. Methods A qualitative study using semi-structured interviews based on a literature-based interview guide with GPs and patients in Brittany, France. Recruitment took place from January to October 2021 until data saturation. Two independent investigators performed an open and thematic coding and then discussed their results with a consensus procedure. Results Thirteen GPs and 11 patients were included. It appears that wearing masks complicates consultations by creating distance, impairing communication, mainly non-verbal and altering relationship quality. However, GPs and patients believed relationships were preserved, especially those with a solid foundation prior to the pandemic. GPs described having to adapt to maintain relationship. Patients worried about misunderstandings or diagnostic errors but saw the mask as a protective factor. GPs and patients described similar populations requiring vigilance, including geriatric and paediatric populations, and people with hearing impairments or learning difficulties. According to GPs, possible adaptations include speaking clearly, exaggerating non-verbal communication, temporarily removing mask while maintaining safe distance and identifying patients who need increased vigilance. Conclusion Wearing masks makes the doctor--patient relationship more complex. GPs adjusted their practice to compensate.

Prospective Cohort Study Comparing Ligament Reconstruction with Tendon Interposition and Suture-Only Suspension Arthroplasty.

Basal joint arthritis is a common form of osteoarthritis. There is no consensus procedure for maintenance of trapezial height following trapeziectomy. Suture-only suspension arthroplasty (SSA) is a simple method for stabilizing the thumb metacarpal following trapeziectomy. This single-institution, prospective, cohort study compares trapeziectomy followed by either ligament reconstruction with tendon interposition (LRTI) or SSA for the treatment of basal joint arthritis. Patients underwent LRTI or SSA from May of 2018 to December of 2019. Visual analogue scale pain scores; Disabilities of the Arm, Shoulder and Hand questionnaire functional scores; clinical thumb range of motion, pinch, and grip strength data; and patient-reported outcomes were recorded and analyzed preoperatively and at 6 weeks and 6 months postoperatively. Total number of study participants was 45 (LRTI, n = 26; SSA, n = 19). Mean ± SE age was 62.4 ± 1.5 years; 71% were female patients; and 51% underwent surgery on the dominant side. Visual analogue scale scores improved for LRTI and SSA ( P < 0.0001) over 6 months, with no differences between groups at any time point ( P > 0.3). Disabilities of the Arm, Shoulder and Hand questionnaire scores improved for LRTI and SSA over 6 months ( P < 0.0001), with no differences between groups at any time point ( P > 0.3). Following SSA, opposition improved ( P = 0.02), but not as well for LRTI ( P = 0.16). Grip and pinch strength decreased following LRTI and SSA at 6 weeks but recovered similarly for both groups over 6 months. Patient-reported outcomes were generally no different between groups at all time points. LRTI and SSA are similar procedures following trapeziectomy relative to pain, function, and strength recovery. Therapeutic, II.

ESPEN guideline on Clinical Nutrition in inflammatory bowel disease

The present guideline is an update and extension of the ESPEN scientific guideline on Clinical Nutrition in Inflammatory Bowel Disease published first in 2017. The guideline has been rearranged according to the ESPEN practical guideline on Clinical Nutrition in Inflammatory Bowel Disease published in 2020. All recommendations have been checked and, if needed, revised based on new literature, before they underwent the ESPEN consensus procedure. Moreover, a new chapter on microbiota modulation as a new option in IBD treatment has been added. The number of recommendations has been increased to 71 recommendations in the guideline update. The guideline is aimed at professionals working in clinical practice, either in hospitals or in outpatient medicine, and treating patients with IBD. General aspects of care in patients with IBD, and specific aspects during active disease and in remission are addressed. All recommendations are equipped with evidence grades, consensus rates, short commentaries and links to cited literature.

Ordinal-cardinal consensus analysis for large-scale group decision making with uncertain self-confidence

Consensus analysis is necessary for large-scale group decision making (LSGDM) for ensuring reasonable decision results. This paper offers a new method for LSGDM with uncertain self-confidence that follows ordinal-cardinal consensus analysis. For this purpose, a new interval ranking method is first proposed to compare alternatives. Then, an improved ordinal clustering method on criteria is introduced using the deviation between individual ranking positions. In view of opinion deviation, uncertain self-confidence deviation, and ranking deviation, the weights of decision makers (DMs) are defined. Similarly, the weights of clusters are determined by further combining cluster cardinality. Further, an ordinal-cardinal consensus procedure is offered, which contains two algorithms: the first algorithm is about the ordinal consensus improvement in view of three aspects: ranking adjustment, opinion adjustment, and uncertain self-confidence; the second algorithm studies the cardinal consensus improvement under the ordinal consensus requirement, which also mainly contains three aspects: opinion adjustment, the number of adjusted judgments, and uncertain self-confidence. Moreover, a new algorithm for LSGDM is presented. Finally, an example is provided to check the feasibility and efficiency of the new method, and a comparison analysis is also made.

Wenn der Sterbeprozess nicht zum Tod führt

For some patients death no longer occurs as an event but comes at the end of a prolonged dying process. Particularly in patients with primary or secondary brain injury, physiological body functions can be maintained for weeks and months thanks to modern medical technology but these patients will never have a chance to regain consciousness. How long this dying process lasts depends on the intensity and duration of the medical and technical measures. It is known that the attitude of the population in Germany is divided with respect to the question of intensive medical measures to preserve life. According to a survey carried out by the Social Scientific Institute of The Evangelical Church in Germany (EKD), 57% of the participants feared being kept alive only by “machines”, whereas 30% were worried that the medical measures will not be exhausted and death prematurely occurs [1]. As far as an advance directive (living will) is present or a clearly expressed will can be identified, the legal and medical situations are unambiguous. The physician must respect and follow the self-determined will of the patient, the patient’s will is binding; however, there is a much more difficult problem if this will is not known or not clearly expressed. This problem area results in highly complex ethical, legal and social crossroads issues: is the limitation of medical and technical measures permitted under certain circumstances? Which criteria should be used as a basis for such a decision? Who has the authority to make the decision? Do we need a consensus procedure that leads to the decision? This article addresses these questions and aims to intensify the discussion on a problem that will become significantly more important in the future due to the rapid progress in medicine.

Developing Core Elements and Checklist Items for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals: A Modified Delphi Survey.

Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use by minimizing the spread of antimicrobial resistance. The core elements for implementing ASPs in healthcare facilities have been developed by the World Health Organization, international research group and government agencies of various countries. However, to date, there is no documented core elements for implementation of ASP in Korea. This survey aimed to establish a national consensus on a set of core elements and their related checklist items for the implementation of ASPs in Korean general hospitals. The survey was conducted from July 2022 to August 2022 by the Korean Society for Antimicrobial Therapy with support from the Korea Disease Control and Prevention Agency. A literature review was conducted by searching Medline and relevant websites to retrieve a list of core elements and checklist items. These core elements and checklist items were evaluated by a multidisciplinary panel of experts using a structured modified Delphi consensus procedure, using two-step survey included online in-depth questionnaires and in-person meeting. The literature review identified 6 core elements (Leadership commitment, Operating system, Action, Tracking, Reporting, and Education) and 37 related checklist items. Fifteen experts participated in the consensus procedures. Ultimately, all 6 core elements were retained, and 28 checklist items were proposed, all with ≥80% agreement; in addition 9 items were merged into 2 items, 2 items were deleted, and 15 items were rephrased. This Delphi survey provides useful indicators for the implementation of ASP in Korea and suggests national policy improvement about the barriers (e.g., shortage of staffing and financial support) existing in Korea for optimal implementation of ASPs.

Fractures in professional footballers: 7-years data from 106 team seasons in the Middle East.

Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.