Delphi Methodology Research Articles

Infective Native Aortic Aneurysm: a Delphi Consensus Document on Treatment, Follow Up, and Definition of Cure

Abstract Background Evidence is lacking to guide the management of infective native aortic aneurysm (INAA). Aims The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured. Methods Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, 3 weeks each, using an online questionnaire with initially 28 statements. The panelists rated the statements on a 5-point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach’s α > 0.80. Results All 49 panelists fulfilled all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: n = 3 on need for consensus, n = 20 on treatment, n = 5 on follow up, and n = 1 on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach’s α increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements. Conclusion INAA is rare, and high-level evidence is lacking to guide optimal management. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.

Infective Native Aortic Aneurysms: A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards

Abstract Background There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. Aims The aim of this study was to establish this by performing a consensus study. Methods The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two-week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five-point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting “strongly agree” or “agree” on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient > .80. Results All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 = .84, round 2 = .87, round 3 = .90, and round 4 = .92). Thus, consensus was reached for all statements and reporting items. Conclusion This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge.

Research priorities in tranexamic acid after trauma: Secondary analysis of the National Trauma Research Action Plan.

Tranexamic acid (TXA) is an antifibrinolytic drug that is used in traumatic hemorrhage and traumatic brain injury. Although TXA is considered relatively safe and inexpensive and is widely available, data regarding its mechanisms, optimal dosing, and timing, as well as relative risks and benefits for different patient populations, are inconsistent. In this study, we aim to identify and summarize consensus research questions related to TXA across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to identify priorities for future research on TXA in trauma. A secondary analysis was performed using consensus-based research priorities collected by 11 NTRAP topic panels using a Delphi methodology. The database of questions was queried for the keywords "tranexamic" and "TXA." The identified questions were sorted by subject matter and summarized. Seven panels included a total of 73 TXA-related questions. Forty-six questions reached consensus. The most addressed topic was outcomes (discussed in 64% of questions) followed by indications (49%) and specific patient populations (38%). Because of overlap across panels, questions were summarized and sorted by topic resulting in 21 priority research questions. Seventy-three total questions and 46 questions reaching consensus were identified by NTRAP panelists. The key topics identified in these questions should be prioritized in future funded research on TXA in trauma. Prognostic and Epidemiological; Level V.

Unpacking the advantages and challenges of flipped classrooms in initial mathematics teacher education in Vietnam

The flipped classroom is an innovative pedagogical approach in which students are introduced to instructional content outside of class and engage in active problem-solving and discussions during in-class sessions. This pedagogical shift empowers students to take greater responsibility for their learning pace, transforming teachers into facilitators. Despite increased interest in flipped classrooms, their implications for mathematics teacher education still need to be clarified. This study employs a Delphi methodology to investigate the advantages and challenges associated with implementing the flipped classroom approach in Vietnam’s initial mathematics teacher education. The findings reveal a high consensus among experts regarding the importance of the identified indicators related to the advantages and challenges of flipped classroom in initial mathematics teacher education. Our study also uncovers contextual and institutional constraints, providing insights into unique challenges within the Vietnamese context. This research offers guidance for improving initial mathematics teacher education through flipped classroom model.

Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology

IntroductionPreoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The “Patient Blood Management” (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. ObjectiveTo make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. Material and MethodsA coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety.Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants).In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14).The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations.Statistical treatment: tabulation of mean, median and interquartiles 25–75 of the value of each survey question (Tables 1, 2 and 3). ResultsExcept for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into:1.- “It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients”.2.- “The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition”.3.- “There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8−10g/dL who are candidates for potentially bleeding surgery that cannot be delayed.”4.- “It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients.”5.- “Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term”. ConclusionsThere was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.

PICO questions and DELPHI methodology for improving the management of patients with acute hepatic porphyria

BackgroundAcute hepatic porphyrias (AHPs) are a group of rare diseases that encompasses acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and 5-aminolaevulinic acid dehydratase deficiency porphyria. Symptoms of AHP are nonspecific which, together with its low prevalence, difficult the diagnosis and follow-up of these patients. Material and methodsThis project used DELPHI methodology to answer PICO questions related to management of patients with AHPs. The objective was to reach a consensus among multidisciplinary porhyria experts providing answers to those PICO questions for improving diagnosis and follow-up of patients with AHP. ResultsTen PICO questions were defined and grouped in four domains: 1. Biochemical diagnosis of patients with AHP. 2. Molecular tests for patients with AHP. 3. Follow-up of patients with AHP. 4. Screening for long-term complications of patients with AHP. ConclusionsPICO questions and DELPHI methodology have provided a consensus on relevant and controversial issues for improving the management of patients with AHP.

Laxative use in adults with intellectual disabilities: development of prescribing guidelines.

Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population. To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities. A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into 'negative consensus' and 'positive consensus'. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting. A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication. Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.

Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology.

Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency. We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (n = 25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada's National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with < 50% agreement, revised those with 50-79% agreement based upon feedback provided, and maintained unrevised those items with ≥ 80% agreement. We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies. Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.

Overview for developing Delphi-based interdisciplinary consensus statements on imaging: pros and cons

This review paper offers a concise guide on how to execute Delphi-based interdisciplinary consensus statements on imaging. Fundamental to the Delphi methodology are several core principles. First, an initial key element is the selection of experts, known as panelists. Second is the principle of anonymity among participants, ensuring that no single individual or group applies excessive influence over others. Third, the methodology involves iterative rounds where statements are presented repeatedly, allowing for controlled feedback. Lastly, after each round, participants are given insight into the collective panel’s previous responses. This knowledge enables them to potentially reconsider and adjust their positions in subsequent rounds, driving towards the group consensus. These principles emphasize the critical role of statistical group responses and the structured interaction inherent in the Delphi approach. Looking at the broader process, the development of Delphi-based interdisciplinary consensus statements on imaging unfolds through several stages. It begins with identifying the research field or the consensus statements in question. This is followed by undertaking comprehensive literature research. Subsequently, pertinent questions and their corresponding statements are crafted. The process then moves on to administering anonymous, iterative questionnaire rounds. Feedback, both on an individual and collective level, is provided between the rounds. The process culminates in the summarization and reporting of the finalized Delphi-based interdisciplinary consensus statements on imaging.

Choosing Wisely in oncology in Latin America: what SLACOM does not recommend in the care of cancer patients in Latin America: Ten essential recommendations to avoid harmful onclogy procedures in Latin America.

Choosing Wisely is an initiative by the American Board of Internal Medicine (ABIM) and ABIM Foundation to deter unnecessary medical treatments and procedures. Faced with the burden of modern technologies and treatments, it is crucial to identify practices lacking value in daily care. The Latin American and Caribbean Society (SLACOM), comprising cancer control experts, deems it vital to tailor this initiative for enhancing cancer care in the region. Through a modified DELPHI methodology involving two rounds of electronic questionnaires and a hybrid meeting to discuss key points of contention, ten essential recommendations were identified and prioritised to avoid harmful oncology procedures in our region. These consensus-based recommendations, contextualised for Latin America, have been compiled and shared to benefit patients. The Scientific Committee, consisting of prominent oncologists and health experts, collaborates remotely to drive this project forward.

Delphi technique in plastic surgery research priority setting: a systematic review

"Background: Delphi research priority setting exercises in plastic and reconstructive surgery aim to encourage future research in areas that align with clinical needs. This can guide the allocation of research funding and further the knowledge base of the speciality. This systematic review evaluates the content and quality of existing Delphi research priority setting studies in plastic and reconstructive surgery, to inform future studies. Method: A predefined protocol and PRISMA guidelines were followed. The search was performed by a research librarian. Screening and data extraction was performed in duplicate with a third reviewer arbitrating. Primary outcomes included the number of studies and subject areas. Secondary outcomes were the methods and results (including types of stakeholders, uncertainties, numbers of stakeholders, journal impact factor, implementation plans and dissemination plans). The risk of bias was assessed using four domains of quality. Data underwent synthesis with descriptive statistics. Results: Seven articles were included in the review, covering breast reconstruction, craniomaxillofacial, burns, aesthetics, skin and soft tissue, and general plastics. Studies had national or international scope, used either Delphi or modified Delphi methodology, and had a variable number of rounds. Four included studies had funding, and implementation plans were absent in four included studies. Discussion and conclusion: Included studies had a variable methodology, making a direct comparison between studies difficult. Six of the seven included studies had a high or moderate risk of bias, and implementation plans for studies were variable or absent. The review highlights the need for future Delphi research priority setting exercises to have a more standardised method and adhere to quality criteria."

Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent

Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.

Moving forwards with the Standard THC Unit: what are the next steps?

AbstractCurrent metrics of cannabis use are inconsistent. This issue prevents the integration of the literature to date and to robustly measure the health risks and benefits associated with specific levels of cannabis consumption. This talk will overview a number of international initiatives to improve the current metrics of cannabis use.The Standard THC Unit was created to objectively measure cannabis potency across all products, mode of administration, jurisdictions, contexts and over time.To build upon the notion of the Standard THC Unit, addional multidisciplinary, international consensus based frameworks have been created.One such ongoing initiatives, seeks to reach expert consensus on how cannabis potency should be reported in cannabis products in order to clearly and effectively inform consumers. The talk will overview preliminary results of the Delphi.A similar Delphi methodology was used to establish internationally agreed-upon minimum standards to measure cannabis consumption in research (iCannToolkit), the results of which will be outlined.Overall, it is imperative for cannabis researchers to join forces with multidisciplinary experts in order to improve metrics of use to inform consumers, general practitioners, researchers and public health experts on the harms and benefits associated with cannabis use.Disclosure of InterestNone Declared

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study.

Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

Using the Delphi methodology to develop technology criteria to assess e-learning readiness in Higher education Institutions

Many higher education institutions in Viet Nam are adopting e-learning to explore new education opportunities. However, the successful implementation of e-learning depends on various aspects of the organization's readiness, particularly technology readiness. This research aims to identify and develop a scale that measures the requiredtechnology factors for evaluating the readiness of higher education institutions in Viet Nam to deploy e-learning. To achieve this, the authors presented the concept and scales of eight technology factors: hardware, software, connectivity, security, flexibility, skills and support, and data centers. These factors were identified through two roundsof Delphi interviews with 17 experts. This research provides a framework for higher education institutions to assess their readiness to implement e-learning projects based on technological criteria® 2024 Journal of Science and Technology - NTTU

Access to Oncology Medicines in Canada: Consensus Forum for Recommendations for Improvement.

Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients' access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival.

Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

ObjectivesThe main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and...

Development and Validation of the Bilingual Catalan/Spanish Cross-Cultural Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice.

This study aimed to develop a valid and reliable bilingual version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for the auditory-perceptual evaluation of voice in Catalan and Spanish speakers. The development of this CAPE-V adaptation included Delphi methodology with 20 voice and speech experts reaching consensus on the optimal adapted terminology of the perceptual vocal attributes, considering also input from the original instrument authors. The adaptation and validation of vocal tasks followed a sequential validation procedure, with input from phoneticians and speech-language pathologists. Following pilot testing with a large sample of speech-language pathology students, a refined adapted version was empirically tested for validity and reliability. Concurrent validity was assessed by comparing the adapted CAPE-V with the reference Grade, Roughness, Breathiness, Asthenia, Strain scale. Construct validity was assessed through convergent and discriminant validity analysis. Intrarater and interrater reliability were assessed via intraclass correlation coefficient calculations. User experience was evaluated through a questionnaire. Scale properties were validated using a confusion matrix, and cutoff values were calculated to achieve the optimal balance between sensitivity and specificity. Through a formalized consensus process, optimal Catalan/Spanish terminology was determined for the perceptual attributes of voice present in the CAPE-V. An adapted protocol of tasks was obtained that preserves the objectives of the original instrument and the relevance of the phonetic criteria in the target languages. The results demonstrated concurrent validity, construct validity, and intrarater reliability. Interrater reliability was found to depend on the extent to which evaluators shared their internal standards. The raters identified CAPE-V as an effective and preferred instrument. An adapted, validated version of the CAPE-V is made available to clinical professionals for the evaluation of voice in Catalan and Spanish speakers.

Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine.

Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care. In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.

Perioperative management of blood pressure in neurocritical patients: Consensus reached through the Delphi method

Elaboration of a consensus document to address perioperative blood pressure (BP) in neurocritical patients, made with anesthesia and resuscitation, and intensive medicine specialists in Spain, by means of a modified Delphi methodology in two rounds with a questionnaire answered by 65 panelists. Consensus was reached in 126 (74.6 %) of 169 statements, with 113 agreements (66.9 %). Consensus was obtained for the use of clevidipine, urapidil, and beta-blockers for acute hypertension in head trauma patients and for brain tumor surgery, among others. The experts considered that the existing clinical studies evaluating the optimal perioperative therapy in neurocritical patients with altered BP are insufficient and that most recommendations are based on clinical experience. Therefore, treatment must be individualized regardless of absolute BP target value and based on occurrence/absence of acute organ damage and the coexistence of other diseases.