This article represents the development protocol for the Chinese Practice Guideline for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (2026 Revision). Since the publication of the 2021 Chinese guideline, new evidence has emerged regarding disease burden, early identification and active screening, lung function and imaging assessment, pharmacological and non-pharmacological management of stable disease, management of acute exacerbations, and comorbidity identification and management. Given the large patient population in China, persistent underdiagnosis, and the incorporation of COPD management into China's national basic public health services, an updated guideline is needed that integrates evidence-based findings from both domestic and international research over the past five years-particularly studies in Chinese populations-to produce a scientific, practical, and forward-looking guideline. The guideline is jointly initiated by the Chronic Obstructive Pulmonary Disease Group of the Chinese Thoracic Society and the Chronic Obstructive Pulmonary Disease Group of the Chinese Association of Chest Physicians, with methodological support from Peking University Third Hospital. The guideline has been registered at the International Practice Guidelines Registry Platform (registration No.: PREPARE-2026CN522). The guideline working group consists of a steering committee, advisory experts, clinical writing experts, an evidence appraisal group, a secretariat, and external reviewers. The work focuses on key domains including diagnosis, assessment, stable-phase management, acute exacerbation management, and comorbidity management of COPD, with 22clinical questions formulated and structurally deconstructed using the PICO framework. Evidence is symstematically retrieved from Chinese and English databases, appraised using the GRADE approach, and translated into recommendations through a modified Delphi consensus process and expert meetings. The full guideline will be drafted in accordance with the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement and is planned for publication in 2026, with the aim of improving the standardization of COPD diagnosis and treatment in China and reducing the disease burden.

Sample size and consensus methods used in Delphi studies are heterogeneous: meta-research study.

International expert consensus on definitions and management of weight recurrence and suboptimal response after metabolic and bariatric surgery: a Delphi study.

To establish a UK consensus vision of a standardised genomic testing pathway in unresectable/metastatic urothelial cancer (mUC) with clear roles and responsibilities for multidisciplinary team (MDT) members and molecular pathology laboratory teams, and to agree how the pathway must evolve to accommodate emerging innovations. A modified Delphi method was used. Six healthcare professionals (HCPs) with expertise in UC formed the Steering Committee (SC), which met in May 2025. Seven key consensus topics were developed covering the steps of the pre-testing and genomic testing pathways, the current and future state of precision medicine, and approaches to overcome barriers and ensure readiness for the future. Within these topics, statements were developed and distributed to clinical scientists and HCPs via an on-line 4-point Likert scale survey. Respondents could opt out of responding to statements outside their area of expertise. Consensus was pre-defined as ≥75% agreement. Overall, 50 responses were received; consensus was reached on 41/42 statements. The statement that did not achieve consensus was part of a paired set. A proposed pathway for pre-testing and genomic testing in unresectable or mUC was developed based on survey results and discussions at SC meetings. Key priorities for the pathway include: timely fibroblast growth factor receptor 3 testing, ideally at the commencement of first-line systemic therapies; selection of specimens based on volume of tissue and recency; immediate access to the genomic testing report for all MDT members; and secure data environments with federated access to genomic results. Since the stopping criteria were met, no further survey rounds were required. Adopting the genomic testing pathway derived from this Delphi consensus will provide greater clarity around MDT and molecular laboratory responsibilities, reduce regional inequities in access, and optimise patient outcomes through timely delivery of genomic testing and subsequent treatment.

Developing an implementation guide for quality assurance of midwifery education - A Delphi study.

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

Development and psychometric validation of the Adolescent Self-Harm Risk Assessment (ASRA) Scale: A multi-dimensional approach.

Nursing students need to be equipped with effective clinical skills to prevent ventilator-associated pneumonia (VAP) in high-risk patients in intensive care units. The study aimed to determine the effectiveness of scenario-based simulation training in developing knowledge and skills for the prevention of VAP in undergraduate nursing students. A single-group, pretest-posttest quasi-experimental study was conducted with undergraduate nursing students enrolled in an intensive care course. Scenario-based simulations and a VAP Prevention Performance Checklist were prepared for the study. The students' skill performance was assessed simultaneously by two independent observers before and after the simulation training. Pretest and posttest scores were compared with Wilcoxon, McNemar and McNemar-Bowker tests, and interrater agreement was assessed using intraclass correlation coefficients (ICC). In total, 36 students participated in the study. The content validity of the VAP Prevention Performance Checklist was assessed using the Delphi method, which resulted in expert consensus for all items in the second round (the scale-level content validity index was 1.00). There was excellent interrater agreement in the skill performance assessment (ICC = 0.982; p < 0.001). The students' VAP prevention performance scores were significantly higher in the posttest than in the pretest (38.38 ± 7.81 vs. 18.38 ± 5.06, p = 0.002, Cohen's d = 1.25). Scenario-based simulation training was shown to be effective in increasing nursing students' awareness and implementation of skills that contribute to the prevention of VAP. Scenario-based simulations can be used as an effective method to improve VAP prevention knowledge and skills during undergraduate nursing education and in-service training. Scenario-based simulations can be used as an effective method to improve VAP prevention knowledge and skills during undergraduate nursing education and in-service training.

Paediatric patient experience during hospitalisation stays: Developing paediatric PREMS questionnaires through a collaborative Delphi study.

Consensus recommendations on surveillance and survivorship for patients with unresectable/stage IV non-small cell lung cancer after completing Immunotherapy: a Delphi study by Canadian experts.

Alcohol screening in primary healthcare services, including Aboriginal Community Controlled Health Organisations, may encounter barriers. These include time constraints, competing health priorities and sensitivities about the topic. Digital tools like the Grog App, validated in population settings, offer potential opportunities to overcome these barriers. We conducted a three-round Delphi study to gain consensus on items to include in a digital alcohol screening tool for Aboriginal and Torres Strait Islander people accessing primary healthcare services ('Grog Check'). Twelve Australian health experts, of whom a majority were Aboriginal or Torres Strait Islanders (67%, n = 8/12), evaluated the clinical importance of potential items (consensus level: 80%). Panellists had expertise in drug and alcohol, primary care, addiction medicine and Indigenous health. Half of the 42 questions, relating to 24 items, reached consensus. Panellists agreed that the screening tool should be brief and culturally relevant. Of the 24 items, there was consensus on 17 including pregnancy, episodic drinking, harms and dependence. Panellists agreed on asking individuals about worries from their own drinking but were divided on asking about worries from others' drinking. There was consensus to ask about dependence, but no agreement if everyone should be asked or only high-risk individuals. Panellists endorsed including a 'cheat-sheet' to guide clinicians on interpretating results and next steps. We identified questions for a digital alcohol screening tool (Grog Check). This app has the potential to support clinicians and enable safer ways for Aboriginal and Torres Strait Islander people to describe their drinking in primary healthcare settings.

Best practices for critically ill patients boarding in the emergency department: A Delphi study.

The Plan A blocks framework was proposed in 2019 with the aim of promoting a small number of versatile, high-value regional anaesthetic techniques to build core competencies among all anaesthetists. Clinical practice, educational curricula and academic understanding have evolved since then. We aimed to provide a pragmatic and clinically focused narrative review on the current understanding of Plan A blocks and to explore their implementation and signpost future directions. We conducted a focused literature search for articles of relevance to Plan A blocks. We also searched online resources, including websites of societies and institutions, for evidence relevant to our primary area of interest. Plan A blocks have influenced the Royal College of Anaesthetists' curriculum and inspired several international consensus projects defining core blocks for adult and paediatric practice. Delphi studies have supported the inclusion of interscalene brachial plexus, axillary brachial plexus, femoral and sciatic nerve blocks as key techniques. Despite wide dissemination, challenges hindering clinical practice change persist, including resource limitations; lack of confidence; and variable access to structured training. Emerging educational technologies such as simulation, artificial intelligence-assisted ultrasound interpretation and augmented reality offer promise, but remain limited by cost and fidelity. The Plan A blocks framework has become an established concept and is accepted widely as a pragmatic, scalable strategy. Although barriers remain to clinical practice change, ensuring widespread competence in Plan A blocks and implementation into clinical pathways should improve patient access to regional anaesthesia globally.

Psychological contracts and retention strategies in Malaysia: A Delphi study on contract and permanent employment.

A qualitative analysis of the experiences of pioneering females in pediatric otolaryngology.

This study aimed to investigate the effect of fetal growth restriction (FGR) on cortical maturation and fissure development using detailed neurosonography. We compared cortical grades and fissure measurements between FGR and healthy fetuses to determine if growth restriction is linked to delayed cortical maturation in specific regions. This observational case-control study included singleton pregnancies at 31-35 weeks of gestation between January 2025 and September 2025. FGR was diagnosed according to the Delphi consensus criteria. All participants underwent obstetric ultrasonography, fetoplacental Doppler, and fetal neurosonography. The depths of the Sylvian, parieto-occipital, calcarine, and cingulate fissures, as well as the insula, were measured and normalized to biparietal diameter (BPD). Cortical maturation was assessed using the Pistorius grading system. A total of 148 fetuses were analyzed (74 FGR, 74 controls). The FGR group showed higher uterine artery pulsatility index (PI) (P = .015) and lower middle cerebral artery (MCA) PI (P < .001). Neurosonography revealed significantly shallower parieto-occipital (P < .001), calcarine (P < .001), and cingulate (P < .001) fissures in the FGR group, while Sylvian fissure depth showed a nonsignificant trend (P = .057). After normalization to BPD, parieto-occipital/BPD and calcarine/BPD ratios remained significantly lower. In addition to quantitative fissure measurements, cortical maturation was evaluated. Only the Sylvian fissure showed a significantly lower maturation grade (P = .003). Cerebellar, vermian, and corpus callosum measurements were comparable. FGR is associated with region-specific cortical developmental delay, predominantly involving the parieto-occipital, calcarine, and cingulate fissures, while infratentorial and commissural structures remain preserved. Neurosonography provides a practical, accessible, and reliable tool for detecting these subtle cortical alterations in high-risk pregnancies.

Governance Framework for Safe and Ethical Implementation of Artificial Intelligence in Surgery: A Modified Delphi Consensus.

Hidradenitis suppurativa (HS) is a chronic, systemic, immune-mediated disease requiring multimodal care, which is crucial for raising awareness and advancing treatment. This project aimed to establish consensus among HS experts to define HS Competence Centers (HSCC) criteria using the Delphi consensus method. Overall, 22 global HS experts (3 patient representatives and 19 healthcare professionals [HCPs]) from 16 countries across 5 continents were invited to participate. Subsequently, a three-step Delphi polling was conducted among the HS experts from 20 May 2024 to 8 July 2024. A 50% agreement was required to reach consensus. Consensus levels included strong consensus (≥ 95%), consensus (≥ 75%), majority agreement (≥ 50%) and no majority agreement (< 50%). In the prepolling step, 22 participants proposed 26 criteria. In step 1, 23 criteria were selected, of which 6 (23.1%) reached strong consensus, 11 (42.3%) reached consensus, and 6 (23.1%) majority agreement. The remaining 3 (11.5%) criteria proposed were rejected. In step 2, 13 of the 23 criteria (56.5%) were proposed for wording modifications. Of these, four (30.8%) retained initial wording and nine (69.2%) were modified. In step 3, 21 of the 23 criteria were identified as very important (91.3%), while 2 (8.7%) were considered less important. Among the 21 very important criteria, 2 (9.5%) reached strong consensus, i.e., essential, 12 (57.1%) reached consensus, and 7 (33.4%) had majority agreement. Overall, a set of 23 criteria (2 essential, 12 required-1st grade, 7 required-2nd grade, and 2 potential) was recommended to establish HSCC. This article reveals a consensus among an international group of HCPs and patients on a series of evidence-based criteria for HSCC. Standardized care, a hub and spoke model, multidisciplinary teams, specialized treatments, well-defined protocols, patient education, medical training, and robust referral systems were identified as essential/very important criteria for HSCC.

Advancements in bronchoscopic technologies have improved the diagnosis of peripheral pulmonary nodules, yet inconsistent methodology and outcome definitions in observational studies hinder interpretation and comparison. The American Thoracic Society (ATS) and American College of Chest Physicians (ACCP) have published a Delphi consensus definition of diagnostic yield and reporting standards for diagnostic testing in respiratory medicine. Recognition that bronchoscopy is a multi-disease test has highlighted limitations of traditional dichotomous accuracy metrics. This review summarizes these methodologic advances and provides a practical framework for clinicians to critically appraise diagnostic bronchoscopy studies, compare technologies, and apply results to individual patients with suspected lung cancer. Emphasis is placed on appropriate reference standards, recognition of bronchoscopy as a multi-disease test, and the superiority of disease specific sensitivity over diagnostic yield for cross-study comparisons.

Moderate psoriasis, despite its clinical relevance, remains inconsistently defined in current guidelines, leading to heterogeneous treatment decisions and variable access to systemic therapy. A unified, clinically meaningful definition is currently lacking. To establish a consensus-based, operational definition of moderate psoriasis, we conducted a two-round modified Delphi process involving expert dermatologists. Fifteen Italian dermatologists with recognized expertise in psoriasis participated in a Delphi survey composed of 18 statements addressing clinical severity, quality of life, symptoms, involvement of special areas, and treatment response. Consensus was defined as a median score ≥ 7 with interquartile range (IQR) ≤ 2, or ≥ 75% of ratings ≥ 7, on a scale going from 1 (completely disagree) to 10 (completely agree). Statements not reaching consensus in Round 1 were revised according to participants' comments and re-evaluated in Round 2. In Round 1, 12 of 18 statements reached consensus. Six statements required revision owing to ambiguity or insufficient operational clarity. After refinement, including clearer definitions of early and frequent relapses, specification of Dermatology Life Quality Index (DLQI) thresholds, and explicit mention of difficult-to-treat or highly visible areas, all six statements achieved consensus in Round 2. Ultimately, consensus was obtained for all 18 statements. This Delphi process produced a comprehensive and clinically actionable definition of moderate psoriasis, emphasizing a multidimensional view of severity that extends beyond Psoriasis Area and Severity Index (PASI) or Body Surface Area (BSA). These consensus-based criteria may support earlier access to systemic therapies, including biologics and small molecules, and improve harmonization in both clinical practice and research.