Consensus Terminology Research Articles

International Skin Imaging Collaboration-Designated Diagnoses (ISIC-DX): Consensus terminology for lesion diagnostic labeling.

A common terminology for diagnosis is critically important for clinical communication, education, research and artificial intelligence. Prevailing lexicons are limited in fully representing skin neoplasms. To achieve expert consensus on diagnostic terms for skin neoplasms and their hierarchical mapping. Diagnostic terms were extracted from textbooks, publications and extant diagnostic codes. Terms were hierarchically mapped to super-categories (e.g. 'benign') and cellular/tissue-differentiation categories (e.g. 'melanocytic'), and appended with pertinent-modifiers and synonyms. These terms were evaluated using a modified-Delphi consensus approach. Experts from the International-Skin-Imaging-Collaboration (ISIC) were surveyed on agreement with terms and their hierarchical mapping; they could suggest modifying, deleting or adding terms. Consensus threshold was >75% for the initial rounds and >50% for the final round. Eighteen experts completed all Delphi rounds. Of 379 terms, 356 (94%) reached consensus in round one. Eleven of 226 (5%) benign-category terms, 6/140 (4%) malignant-category terms and 6/13 (46%) indeterminate-category terms did not reach initial agreement. Following three rounds, final consensus consisted of 362 terms mapped to 3 super-categories and 41 cellular/tissue-differentiation categories. We have created, agreed upon, and made public a taxonomy for skin neoplasms and their hierarchical mapping. Further study will be needed to evaluate the utility and completeness of the lexicon.

CURRENT STATUS OF METATRANSCRIPTOMIC AND RELATED STUDIES IN HEMATOPHAGOUS DISEASE-TRANSMITTING VECTORS

The incidence of numerous vector-borne diseases (VBDs) has recently increased alarmingly due to various widespread factors, including unplanned urbanization, greater human mobility, environmental changes, vector resistance to insecticides, and evolving pathogens. In this context, the World Health Organization (WHO) has repositioned effective and sustainable vector control as a key approach to prevent and eliminate VBDs. It has been shown that the microbiome influences development, nutrition, and pathogen defense in disease-transmitting vectors such as mosquitoes, sandflies, tsetse flies, triatomine bugs, and ticks. Consequently, understanding the endogenous regulation of vector biology can aid in developing effective approaches for vector control. In this respect, a metatranscriptomic approach analyzes all the expressed RNAs in an environmental sample (meta-RNAs) and can thus reveal how the metabolic activities of the microbiome influence vector biology. This review includes an extensive analysis of available literature on microbial and viral studies for some of the major hematophagous disease-transmitting arthropods, with a focus on studies that used next generation sequencing (NGS) approaches. Since a consensus terminology for these “meta-sequencing analyses” has not yet been established, a definition of these terms is presented here to provide the framework for systematically sorting the available information for each of the VBDs analyzed here to single out metatranscriptomic analyses. Finally, key gaps in knowledge were identified for some of these hematophagous disease-transmitting arthropods which will prove very useful for driving future studies.

Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions

BackgroundCurrently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. ObjectiveTo present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. Methods10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. ResultsThe terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. Study limitationsThe limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). ConclusionThis Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation.

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice. The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice. Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis. CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line. Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area. What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.

Improving Communication of Peer-Review Conference Outcomes: A Practical Experience

The aim of this work was to describe the design and implementation of a more robust workflow for communicating outcomes from a peer-review chart rounds conference. We also provide information regarding cycle times, plan revisions, and other key metrics that we have observed since initial implementation. A multidisciplinary team of stakeholders including physicians, physicists, and dosimetrists developed a revised peer-review workflow that addressed key needs to improve the prior process. Consensus terminology was developed to reduce ambiguity regarding the priority of peer-review outcomes and to clarify expectations of the treating physician in response to peer-review outcomes. A custom workflow software tool was developed to facilitate both upstream and downstream processes from the chart rounds conference. The peer-review outcomes of the chart rounds conference and resulting plan changes for the first 18 months of implementation were summarized. In the first 18 months after implementation of the revised processes, 2294 plans were reviewed, and feedback priority levels assigned. Across all cases with feedback, the median time for the treating attending physician to acknowledge conference comments was 1 day and was within 7 calendar days for 89.1% of cases. Conference feedback was acknowledged within 1 day for 74 of 115 (64.3%) cases with level 2 comments and for 18 of 21 (85.7%) cases with level 3 comments (P=.054). Contours were modified in 13 of 116 (11%) cases receiving level 2 feedback and 10 of 21 (48%) cases receiving level 3 feedback (P < .001). The treatment plan was revised in 18 of 116 (16%) cases receiving level 2 feedback and 13 of 21 (61%) cases receiving level 3 feedback (P < .001). We successfully implemented a workflow to improve upstream and downstream processes for a chart rounds conference. Standardizing how peer-review outcomes were communicated and recording physician responses allow for improved ability to monitor conference activities.

Type I interferon pathway assays in studies of rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider

ObjectivesTo systematically review the literature for assay methods that aim to evaluate type I interferon (IFN-I) pathway activation and to harmonise-related terminology.MethodsThree databases were searched for reports of IFN-I and...

Defining effective communication for critically ill patients with an artificial airway: An international multi-professional consensus

ObjectivesTo define effective communication and identify its key elements specific to critically ill patients with an artificial airway. DesignA modified Consensus Development Panel methodology. SettingInternational video-conferences. Main outcome measuresDefinition of effective communication and it’s key elements. ResultsEight experts across four international regions and three professions agreed to form the Consensus Development Panel together with a Chair and one person with lived experience who reviewed the outputs prior to finalisation. “Communication for critically ill adult patients with an artificial airway (endotracheal or tracheostomy tube) is defined as the degree in which a patient can initiate, impart, receive, and understand information, and can range from an ineffective to effective exchange of basic to complex information between the patient and the communication partner(s). Effective communication encompasses seven key elements including: comprehension, quantity, rate, effort, duration, independence, and satisfaction. In critically ill adults, communication is impacted by factors including medical, physical and cognitive status, delirium, fatigue, emotional status, the communication partner and the nature of the ICU environment (e.g., staff wearing personal protective equipment, noisy equipment, bright lights).” The panel agreed that communication occurs on a continuum from ineffective to effective for basic and complex communication. ConclusionWe developed a definition and list of key elements which constitute effective communication for critically ill patients with an artificial airway. These can be used as the basis of standard terminology to support future research on the development of communication-related outcome measurement tools in this population. Implications for clinical practiceThis study provides international multi-professional consensus terminology and a definition of effective communication which can be used in clinical practice. This standard definition and key elements of effective communication can be included in our clinical impressions of patient communication, and be used in discussion with the patient themselves, their families and the multi-professional team, to guide care, goal development and intervention.

Comprehensively identifying Long Covid articles with human-in-the-loop machine learning

A significant percentage of COVID-19 survivors experience ongoing multisystemic symptoms that often affect daily living, a condition known as Long Covid or post-acute-sequelae of SARS-CoV-2 infection. However, identifying scientific articles relevant to Long Covid is challenging since there is no standardized or consensus terminology. We developed an iterative human-in-the-loop machine learning framework combining data programming with active learning into a robust ensemble model, demonstrating higher specificity and considerably higher sensitivity than other methods. Analysis of the Long Covid collection shows that (1) most Long Covid articles do not refer to Long Covid by any name (2) when the condition is named, the name used most frequently in the literature is Long Covid, and (3) Long Covid is associated with disorders in a wide variety of body systems. The Long Covid collection is updated weekly and is searchable online at the LitCovid portal: https://www.ncbi.nlm.nih.gov/research/coronavirus/docsum?filters=e_condition.LongCovid.

806 Histopathology features of cutaneous acute graft-versus-host disease can be reliably detected by noninvasive reflectance confocal microscopy

BACKGROUND: The reliability to noninvasively identify features of inflammatory dermatoses by reflectance confocal microscopy (RCM) remains unknown. Specific consensus terminology with representative images is necessary to ensure consistent feature-level interpretation among RCM readers. METHODS: Through an iterative process of refinement and discussion among five international RCM experts, we developed a glossary with representative images of RCM features of aGVHD. In 17 lesions from 12 patients with cutaneous aGVHD, four dermatopathologists and four RCM readers independently evaluated the presence of aGVHD features in scanned histopathology slides and 1.5x1.5 mm RCM submosaics at 4 depths, respectively.

Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation.

Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings. We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking. Small groups (n = 121) and survey ranking (n = 54) were used with distance, remote, and telesimulation as leading terms. Each was favored by a third of the participants without consensus. This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of distance, remote and telesimulation is preferred.

The beneficial effect of short-term multimodal physiological therapy on female provoked vulvodynia: A pilot study

ABSTRACT Introduction Vulvodynia is a subset of the genito-pelvic/penetration disorder and is currently defined by chronic pain in the vulva area of at least 3-6 months duration. It affects 8-10% of women of all ages. According to 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of vulvodynia, it can be divided into provoked (e.g., insertional, contact), spontaneous or mixed type. Although the etiology remains an enigma, peripheral neurologic mechanism has recently been identified as a factor. Objective The aim of this trial was to evaluate the effectiveness of short-term physical therapy in women with vulvodynia. Methods Women with intolerable vulvodynia were included in the study from Jan to May 2021. Medical screen including cotton-tipped testing and pelvic examination were performed by one gynecologist. After informed consent obtained, women lied down with cross-legged receiving once treatment per 1-2 weeks until completely pain relief achieved. Treatment consisted of a multimodal approach including lidocaine gel 20mins, capsaicin gel 20mins and TENS (Transcutaneous electrical nerve stimulator) 30 mins. TENS was administered through skin probes via a dual channel NeuroTrac device. A set of double electrode patches were placed on the dermatome of unilateral side of pain: channel A constant 80Hz, and channel B burst of 9 pulses 150Hz, 175 µS pulse duration and the intensity at the maximal level that patient could tolerate. At the completion, all women were followed for 3-6 months to assess efficacy, satisfying sexual events (SSE) in 4weeks, adverse events and recurrence. Results Ten women were diagnosed with provoked (n=8) or spontaneous vulvodynia (n=2) (primary 60% and secondary 40%). The average age was 34.1 years (range= 25-50) with an average duration of vulvodynia of 50.0 months (range= 4-276). 50% of women reported tolerating intercourse sometimes, 40% never did, and one was virgin. 37.5% (n=3) underwent one treatment session, and 62.5% (n=5) two sessions to achieve completely pain relief. At the completion of one week, 100% of provoked type women reported moderate or high improvement on vulvodynia region. Those reported improvement in the frequency of SSE within 4 weeks after treatment completion (62.5% sometimes, 25% often and one didn't restart intercourse). However, both of spontaneous type women failed to treatment and were suggested a referral for nerve blocking. After 4.4-24.3 weeks follow-up, 25% of provoked group reported no recurrence, 62.5% mild recurrence, and 12.5% (n=1) moderate recurrence. Only minor adverse events occurred. 90% reported mild to moderate vulva irritation immediately after treatment, which were completely resolved after bath. Only one spontaneous type reported vulva swelling and moderate irritation for one week. 100% of participants were willing to receive treatment in the next time. Conclusions A short-term multimodal physiological therapy including lidocaine, capsaicin and TENS enabled women with provoked vulvodynia to achieve rapid pain relief, moderate or high improvement in sexual encounters and the efficacy is seemed to last long. The tolerability and safety were high. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Youren clinic).

Consensus Terminology for Point of Care Ultrasound Studies with Incomplete Documentation and Workflow Elements.

Point of Care Ultrasound (POCUS) use by emergency physicians has grown in both breadth and depth of clinical use [1-3]. POCUS workflow is different from a traditional imaging-based specialist workflow because a single clinician orders, obtains images, interprets, and reports the exam results. Traditionally, multiple individuals participate in the workflow: the clinician places the order; an ultrasound technologist reconciles order and identifiers and acquires images; lastly an imaging specialist interprets the exam and creates a report. hese contrasting approaches has led to unique challenges in streamlining POCUS workflows and identifying disruptions, errors and potential corrections given the differences from radiology focused workflow and resources.

Proceedings of the 2021 GRAPPA-Collaborative Research Network (CRN) Meeting.

At the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Collaborative Research Network (CRN) annual meeting, the GRAPPA-CRN group presented a number of project updates, including a pilot investigator-initiated study to evaluate liquid and tissue biomarkers associated with axial involvement in psoriatic arthritis (PsA). The GRAPPA-CRN session updated progress made with 3 parallel international research initiatives based on 3 previously defined unmet needs in PsA. The Health Initiatives in Psoriasis and PsOriatic arthritis ConsoRTium European States (HIPPOCRATES) is a European research consortium formed to address unmet clinical needs in PsA. The Preventing Arthritis in a multicenter Psoriasis At-Risk Population (PAMPA) is a US-based organization that has defined consensus terminology for preclinical phases of PsA and is interested in the transition process from psoriasis to PsA. An overview of the Accelerating Medicines Partnership Autoimmune and Immune-Mediated Diseases (AMP AIM) program 2.0, a consortium including GRAPPA-CRN members that addressed these 3 unmet needs in PsA, was also presented.

In Vivo reflectance confocal microscopy of cutaneous acute graft-versus-host disease: concordance with histopathology and interobserver reproducibility of a glossary with representative images.

The reliability to non-invasively identify features of inflammatory dermatoses by reflectance confocal microscopy (RCM) remains unknown. Lack of formal training among RCM readers can result in inconsistent assessments, limiting clinical utility. Specific consensus terminology with representative images is necessary to ensure consistent feature-level interpretation among RCM readers. (1) Develop a glossary with representative images of RCM features of cutaneous acute graft-versus-host disease (aGVHD) for consistent interpretation among observers, (2) assess the interobserver reproducibility among RCM readers using the glossary, and (3) determine the concordance between RCM and histopathology for aGVHD features. Through an iterative process of refinement and discussion among five international RCM experts, we developed a glossary with representative images of RCM features of aGVHD. From April to November 2018, patients suspected of aGVHD were imaged with RCM and subsequently biopsied. 17 lesions from 12 patients had clinically and pathologically confirmed cutaneous aGVHD. For each of these lesions, four dermatopathologists and four RCM readers independently evaluated the presence of aGVHD features in scanned histopathology slides and 1.5 × 1.5 mm RCM submosaics at 4 depths (blockstacks) respectively. RCM cases were adjudicated by a fifth RCM expert. Interobserver reproducibility was calculated by mean pairwise difference (U statistic). Concordance between modalities was determined by fraction of assignments with agreement. We present a glossary with representative images of 18 aGVHD features by RCM. The average interobserver reproducibility among RCM readers (75%, confidence interval, CI: 71-79%) did not differ significantly from dermatopathologists (80%, 76-85%). The concordance between RCM and histopathology was 59%. By using the glossary, the interobserver reproducibility among RCM readers was similar to the interobserver reproducibility among dermatopathologists. There was reasonable concordance between RCM and histopathology to visualize aGVHD features. The implementation of RCM can now be advanced in a variety of inflammatory conditions with a validated glossary and representative image set.

ESPEN micronutrient guideline

Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction.

The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

In-hospital complications associated with COVID-19

As the COVID-19 pandemic persists globally,1 an emerging challenge is the shift from acute infection to the burden of long-term consequences resulting from the disease. Although a consensus terminology has not yet been reached, the post-acute stage of COVID-19 is mostly defined as 3 or 4 weeks after symptom onset, and long or chronic COVID-19 is defined as symptoms and abnormalities persisting or presenting beyond 12 weeks.2,3 Most studies have focused on acute and subacute COVID-19, although evidence-based guidance for the management of long COVID-19 is limited.

Clubfoot pathoanatomy-biomechanics of deformity correction: a narrative review.

Clubfoot is a common and complex, multi-segmental, 3-dimensional, congenital foot deformity. The segmental deformities have been recognized for millennia. They are cavus of the forefoot/midfoot, adductus of the midfoot, varus of the hindfoot, and equinus of the ankle, often referred to by the acronym CAVE. However, description of the deformities and their correction have varied over time with changes in consensus terminology for foot deformities and the understanding of foot biomechanics. In this narrative review, the most current terminology for foot deformities and understanding of foot biomechanics are applied to the clubfoot. The concept of the calcaneopedal unit (CPU) is applied to the in-depth discussion and understanding of clubfoot for perhaps the first time in the English language literature. Of the 4 basic clubfoot deformities, cavus and adductus are static structural deformities within the CPU, i.e., all bones of the foot except the talus. Varus is a restricted dynamic deformity between the CPU and the talus. Equinus is a restricted dynamic deformity in the ankle joint between the talus and the tibia. Understanding the CPU concept improves ones understanding of clubfoot deformities and the rationale for treatment techniques. Consensual agreement on the terms used to define interosseous relationships and motions in the foot improves communication. Finally, this narrative review highlights the histologic and biologic changes that occur in collagen and cartilage during clubfoot deformity correction to provide further understanding and rationale for treatment.

How to Perform a High-Quality Endoscopic Submucosal Dissection

How to Perform a High-Quality Endoscopic Submucosal Dissection