Rounds Of Delphi Survey Research Articles

Conceptual framework of value management adoption in the Nigerian construction industry

PurposeThe Nigerian construction industry is bedeviled with poor project performance and outcomes which value management (VM) could address if applied. The application of VM on Nigerian construction projects is very minimal due to certain obstacles, namely, lack of VM experts, paucity of knowledge on the techniques, etc., which inhibits the adoption into the construction industry. Therefore, this study aims to develop a conceptual framework of the adoption of VM on construction projects in a typical developing economy.Design/methodology/approachThis study engaged 15 selected VM experts in two rounds of Delphi survey to develop a conceptual framework of VM adoption. The method of data analysis includes mean score, standard deviation, Kendall’s coefficient of concordance, chi-square (χ2) test, interrater agreement analysis and significant level analysis. The developed conceptual framework was sent to a team of local and international VM experts for validation.FindingsThis study reveals that the adoption of VM requires the collective effort of relevant stakeholders in the construction industry. The framework developed presents individual and collective activities to be undertaken by the stakeholders. The activities include training, legislation, government-funded research, etc. Thus, the adoption of innovative management methodology like VM requires the collaboration of academics, construction professional bodies and government parastatals. This will assist in the judicious use of limited construction resources and boost the relevance of the Nigerian construction industry among developing nations and in the global construction market.Originality/valueThis study used the opinions of few construction professionals that can be regarded as VM experts in Nigeria, as against engaging a pool of construction professionals who may not be knowledgeable in VM process. Engaging the few VM experts in the Nigerian construction industry is important to have a valid basis for drawing conclusion, as large questionnaire survey could be possibly filled by inexperienced or unqualified respondents if stringent criteria are not considered at the outset of this study.

Consensus-driven conceptual development of a standardized whole body-MRI scoring system for assessment of disease activity in juvenile idiopathic arthritis: MRI in JIA OMERACT working group

ObjectivesWhole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. MethodsAn iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. ResultsTwenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2–4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. ConclusionA novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.

Developing the surgical technique reporting checklist and standards: a study protocol.

Standardized and transparent reporting of surgical technique is the cornerstone of effective dissemination, implementation and improvement. However, current reporting of surgical techniques is inadequate. The existing guidelines potentially applied to guide surgical technique reporting are with a minimal highlight of the surgical technique, lack requirements explaining what extent and dimensions need to be described in detail, or are unlikely to extrapolate to a wide range of surgical techniques. This study aims to formulate a rigorous protocol to develop a surgical technique reporting checklist and standards (SUPER) that defines what a clear, comprehensive and detailed surgical technique report should be contained. This protocol is designed following the classic guidance for developing reporting guidelines recommended by the EQUATOR network. The development team will consist of surgeons (~80%), methodologists, and journal editors. The draft checklist sources will include a scoping review of existing reporting guidelines related to surgical technique, surgical technique articles from 15 top journals published in the last year, and brainstorming by the multidisciplinary development team. The final SUPER checklist will be formed after three rounds of Delphi surveys, one round of face-to-face meeting, and a month-long pilot test. The SUPER checklist will be published as open-access and be used in combination with existing reporting guidelines related to surgical techniques (e.g., IDEAL). This protocol will steer the SUPER checklist's development, allowing us to further elaborate surgical technique reporting for all surgical specialties, and enabling a more favorable experience for surgeons, nurses, medical students, residents, editors, and reviewers. This trial is registered at the EQUATOR network on December 18th, 2020. Available at: https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-other-study-designs/.

Interactive Craft Activities – Elevating Special Needs Education Learning Tools with “Craft Interactive Teaching Approach”

Abstract: The aim of this study is to determine the Expert Panels agreement and consensus on the suitable items for the development of the Craft Interactive Teaching Approach (CiTA). A purposive sampling consisting of 12 Expert Teachers with more than ten years of experience in the field of Special Education were used in this research to measure their consensus on the design and development of the CiTA video module. The CiTA video module was developed using the ADDIE Model that is supported by the Delphi Technique. This study utilised the Design Development Research (DDR) approach that consisted of three phases. However, for the purpose of this article, the researchers will only discuss Phase 2: Design and Development in developing the Interactive Teaching Approach Video module. The responding twelve VAE teachers provided positive feedback towards learning and teaching using the tutorial module. With the interquartile range of 0 to 1.00 for all items included in the activities, all Expert Teachers in the field of Special Education approved with the content of the CiTA video module from the two rounds of Delphi surveys performed. The CiTA video module was developed with the inclusion of all items that were highly approved by the participating Expert Teachers in the Special Needs Education. Since the two rounds of item evaluation demonstrated a significant relationship between Round One and Round Two, the development of the video module could improve inclusive learning in the Malaysian classroom.
 
 Keywords: Interactive Visual Arts Education, Special education needs, Special needs children.

Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine

Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine (TCM) and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review. The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets (COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps: (i) development of a comprehensive list of outcomes (including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records; (ii) merging and grouping of outcomes within domains; (iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome- set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.

Important Topics for Fostering Research Integrity by Research Performing and Research Funding Organizations: A Delphi Consensus Study

To foster research integrity (RI), it is necessary to address the institutional and system-of-science factors that influence researchers’ behavior. Consequently, research performing and research funding organizations (RPOs and RFOs) could develop comprehensive RI policies outlining the concrete steps they will take to foster RI. So far, there is no consensus on which topics are important to address in RI policies. Therefore, we conducted a three round Delphi survey study to explore which RI topics to address in institutional RI policies by seeking consensus from research policy experts and institutional leaders. A total of 68 RPO and 52 RFO experts, representing different disciplines, countries and genders, completed one, two or all rounds of the study. There was consensus among the experts on the importance of 12 RI topics for RPOs and 11 for RFOs. The topics that ranked highest for RPOs concerned education and training, supervision and mentoring, dealing with RI breaches, and supporting a responsible research process (e.g. through quality assurance). The highest ranked RFO topics concerned dealing with breaches of RI, conflicts of interest, and setting expectations on RPOs (e.g. about educating researchers about RI). Together with the research policy experts and institutional leaders, we developed a comprehensive overview of topics important for inclusion in the RI policies of RPOs and RFOs. The topics reflect preference for a preventative approach to RI, coupled with procedures for dealing with RI breaches. RPOs and RFOs should address each of these topics in order to support researchers in conducting responsible research.

Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study

ObjectiveTo develop and validate a midwifery-led task list in the task-shifting context.DesignAn extensive literature review followed by a two-iterative Delphi survey.SettingTwenty university hospitals, three non-university hospitals and four university colleges...

Quality Indicators for Older Persons' Transitions in Care: A Systematic Review and Delphi Process.

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons' transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

Development of a questionnaire assessing nursing staff’s knowledge, attitude, and practice on the prevention of the nosocomial infection in elderly patients: testing reliability and validity†

Abstract Objective To develop a questionnaire assessing nursing staff’s knowledge, attitude, and practice on the prevention of the nosocomial infection in elderly patients and test its reliability and validity. Methods After the drafted questionnaire was developed, two rounds of Delphi survey were conducted by consulting experts to improve the questionnaire. Subsequently, 700 copies of the questionnaire were distributed to nursing staff to assess its reliability and validity. Results Exploratory factor analysis (EFA) identifies 3 aspects, namely knowledge, attitude, and practice, with a total of 38 items. The Cronbach’s α coefficients of the questionnaire and each of the aspects are 0.85, 0.80, 0.886, and 0.77 (>0.7), respectively. Confirmatory factor analysis (CFA) of each of the aspects are c2/df = 3.99, 2.26, and 3.32; Goodness-of-fit index (GFI) = 0.91, 0.97, and 0.92; Root mean square error of approximation (RMSEA) = 0.06, 0.04, and 0.05; Comparative fit index (CFI) = 0.91, 0.96, and 0.90. Conclusions Through this study, it can be ascertained whether the developed questionnaire enjoys sound reliability and validity in assessing nursing staff’s knowledge, attitude, and practice on preventing the nosocomial infection in elderly patients and thus has certain application value.

A relational framework for smart information delivery manual (IDM) specifications

This study proposes a relational framework for standardized machine-applicable, readable, and transferable (smart) information delivery manual (IDM) specifications. As the demand for projects using building information modeling (BIM) increases, there is a more acute awareness and need for clearly defined information requirements to support the BIM projects. The ISO 29481-1 IDM standard defines how to specify exchange requirements (ERs) and their use cases (UCs) using a process map (PM). However, IDM specifications are currently not easily sharable or reusable due to the lack of a commonly accepted standard data schema. This study overcomes this problem by identifying definitions and relationships of IDM components to develop the relational framework for an IDM data schema. An extensive review of existing IDM-related documents and standards, and iterative international meetings, were conducted by 46 international IDM experts from 16 countries. A consensus on the relational framework was then reached through three Delphi survey rounds. The formalized relational IDM framework lays a foundation for further developing an IDM data schema as an international standard.

Postinflammatory hyperpigmentation: protocol for development of a core outcome set for clinical trials.

Postinflammatory hyperpigmentation (PIH) is a disorder of pigmentation that is a common presenting complaint, especially in individuals with skin of color. It is associated with a significant psychological burden and decrement of quality of life. Management options include photoprotection, topical lightening agents, and lasers and energy devices. Clinical trials of melasma report a diversity of outcomes, which often impedes synthesis of results across trials, or comparison of results associated with different treatment modalities. This protocol describes the design of a consensus process that would culminate in the development of a core set of outcomes to be assessed in all clinical trials for PIH. A long list of candidate outcomes will be developed through a systematic review, combined with semi-structured interviews with various stakeholders, including patients, scientists, regulators, and health care professionals. This long list of outcomes will be reviewed and refined by a steering committee. Then two rounds of Delphi surveys of patient and physician groups, respectively, will be used to cull the list, with provisional inclusion of those items deemed "important" by 70% of the respondents. A consensus meeting will be held virtually or in person to vote on these items, and also to consider any changes necessary before acceptance of a final core outcome set. Development of a core outcome set for PIH is expected to improve and standardize outcomes reporting in current and future clinical trials. This, in turn, may facilitate aggregation of research results and permit comparison of outcomes across multiple studies.

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Processes for evidence summarization for patient decision aids: A Delphi consensus study.

BackgroundPatient decision aids (PDAs) should provide evidence‐based information so patients can make informed decisions. Yet, PDA developers do not have an agreed‐upon process to select, synthesize and present evidence in PDAs.ObjectiveTo reach the consensus on an evidence summarization process for PDAs.DesignA two‐round modified Delphi survey.Setting and participantsA group of international experts in PDA development invited developers, scientific networks, patient groups and listservs to complete Delphi surveys.Data collectionWe emailed participants the study description and a link to the online survey. Participants were asked to rate each potential criterion (omit, possible, desirable, essential) and provide qualitative feedback.AnalysisCriteria in each round were retained if rated by >80% of participants as desirable or essential. If two or more participants suggested rewording, reordering or merging, the steering group considered the suggestion.ResultsFollowing two Delphi survey rounds, the evidence summarization process included defining the decision, reporting the processes and policies of the evidence summarization process, assembling the editorial team and managing (collect, manage, report) their conflicts of interest, conducting a systematic search, selecting and appraising the evidence, presenting the harms and benefits in plain language, and describing the method of seeking external review and the plan for updating the evidence (search, selection and appraisal of new evidence).ConclusionA multidisciplinary stakeholder group reached consensus on an evidence summarization process to guide the creation of high‐quality PDAs.Patient contributionA patient partner was part of the steering group and involved in the development of the Delphi survey.

Development and Validation of a Food Literacy Assessment Tool for Community-Dwelling Elderly People.

Food literacy refers to the knowledge, skills, and attitudes required for individuals to choose foods that promote health. As the rate of diet-related diseases increases, food literacy is becoming more important. However, there are no tools available to evaluate food literacy among the Korean elderly. We derived 547 questions from a literature review and, after three rounds of Delphi surveys, selected 33 preliminary questions. We calculated the content validity ratio of the questions and applied a face validity procedure. We then selected 32 questions, assessed their validity, and distributed them as a questionnaire to 205 elderly people. We then conducted exploratory factor analysis (EFA) to determine the validity of the questionnaire and used an internal consistency index (Cronbach’s α coefficient) to determine reliability. Based on the factor analysis, 13 questions were selected, distributed among three factors, and evaluated using the Kaiser–Meyer–Olkin (KMO) and Bartlett sphericity tests. The factor analysis showed that KMO was 0.872, which is a highly acceptable score, and the Bartlett sphericity test was χ2 = 1,374.69 at p = 0.00. The food literacy questionnaire developed in this study will likely be helpful for improving the healthcare of elderly people.

Development of a Core Outcome Set for the Benefits and Adverse Events of Acute Heart Failure in Clinical Trials of Traditional Chinese Medicine and Western Medicine: A Study Protocol.

Aims: To identify a minimum set of efficacy and adverse events for patients with acute heart failure (AHF) among different stakeholders in clinical trials of traditional Chinese medicine and Western medicine.Methods and Analysis: First, we will develop a preliminary long list of outcomes that includes efficacy and adverse events/reactions via three steps: (i) systematic reviews of efficacy and safety outcomes for clinical trials of AHF; (ii) drugs included in the National Medical Insurance Catalog, the National Essential Medicines Catalog, and the WHO Essential Medicines List will be collected and safety outcomes extracted from the package inserts; and (iii) patients' or caregivers' semi-structured interviews will be carried out to add new viewpoints to the list. Second, after merging outcomes and grouping them under different outcome domains, questionnaires for health professionals and patients will be separately developed. Further, two rounds of Delphi survey for health professionals and a survey for patients and the public will be carried out. Third, different stakeholders will discuss and determine the final core outcome set (COS) for AHF in a consensus meeting.Ethics and Dissemination: The entire project has been approved by the Ethics Committee of the main institution. After the final COS is developed, it will be published and discussed widely in conferences.Clinical Trial Registration: This study is registered with the Core Outcome Measures in Effectiveness Trials database as study 1566 (available at: https://www.cometinitiative.org/Studies/Details/1566).

Standardizing the Diagnostic Evaluation of Nonarthritic Hip Pain Through the Delphi Method.

Background:Femoroacetabular impingement and acetabular dysplasia have gained increased attention as nonarthritic sources of pain and dysfunction in young, active patients. To date, no standardized approach to the diagnostic evaluation of nonarthritic hip pain has been identified, as previous work has focused on the diagnostic evaluation and management of patients with femoroacetabular impingement undergoing hip arthroscopy.Purpose:To explore the standard diagnostic evaluation practice of experts in the field of hip preservation surgery and combine their expertise through the Delphi method to form a standardized approach to the diagnostic evaluation of patients with nonarthritic hip pain.Study Design:Consensus statement.Methods:An expert panel made up of 18 orthopaedic surgeons with extensive experience in the treatment of nonarthritic hip disorders participated in this Delphi study. The Delphi panelists were presented with 4 clinical vignettes representing a spectrum of patients with nonarthritic hip pain. Three iterative survey rounds were presented to the panelists based on these clinical vignettes, and a 3-step classic Delphi method was used to establish consensus techniques in the diagnostic evaluation of nonarthritic hip pain.Results:Total (100%) participation was gained, with all 18 experts completing all 3 Delphi survey rounds. Consensus (≥75% support) was achieved for some, if not all, vignettes for each of the following diagnostic domains: historical features, physical examination, radiographic sequences, radiographic interpretation, cross-sectional imaging, and ancillary diagnostics.Conclusion:In this Delphi study, we identified standardized diagnostic treatment approaches as derived from expert opinion for patients with nonarthritic hip pathomorphologies.

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

BackgroundHypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care.MethodsMaternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically.ResultsA total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants.ConclusionsMost evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

Development of a core outcome set for idiopathic clubfoot management.

AimsThis study aims to define a set of core outcomes (COS) to allow consistent reporting in order to compare results and assist in treatment decisions for idiopathic clubfoot.MethodsA list of outcomes will be obtained in a three-stage process from the literature and from key stakeholders (patients, parents, surgeons, and healthcare professionals). Important outcomes for patients and parents will be collected from a group of children with idiopathic clubfoot and their parents through questionnaires and interviews. The outcomes identified during this process will be combined with the list of outcomes previously obtained from a systematic review, with each outcome assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). This stage will be followed by a two round Delphi survey aimed at key stakeholders in the management of idiopathic clubfoot. The final outcomes list obtained will then be discussed in a consensus meeting of representative key stakeholders.ConclusionThe inconsistency in outcomes reporting in studies investigating idiopathic clubfoot has made it difficult to define the success rate of treatments and to compare findings between studies. The development of a COS seeks to define a minimum standard set of outcomes to collect in all future clinical trials for this condition, to facilitate comparisons between studies and to aid decisions in treatment.Cite this article: Bone Jt Open 2021;2(4):255–260.

Core Competencies in Cancer Genomics for Healthcare Professionals: Results From a Systematic Literature Review and a Delphi Process.

The continuous development and use of genomic sequencing requires healthcare professionals to constantly integrate these advancements into their clinical practice. There is a documented lack of cancer genomics contents in the teaching and learning programs. We aimed to identify the core competencies in cancer genomics for non-genetic healthcare professionals. We performed a literature review in PubMed, SCOPUS, and Web of Science databases to retrieve articles published from 2000 to 2018, in English or Italian language. We included articles that reported the competencies for non-genetic healthcare professionals in cancer genomics. A web-based modified Delphi survey was conducted, aiming to define, through consensus, a set of core competencies that should be covered in the curricula. The international expert panel included specialists in genetics, genomics, oncology, and medical specialists. In the literature review, we retrieved nine articles, from which we identified core competencies for general physicians and nurses. The competencies were organized in three main domains: knowledge, attitudes, and practical abilities. In the second round of Delphi survey, consensus of 83.3% was reached for the definition of the core competencies. Thirty-seven items were defined as the competencies required for physicians and forty-two items for nurses. Through a consensus-based approach, a set of core competencies in cancer genomics for non-genetic healthcare professionals has been identified. Our findings could benchmark standards for curriculum development and future educational strategies.

A team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation set in clinical evaluation.

ObjectiveTo develop a team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in clinical evaluation.DesignA Delphi study.SubjectsExperts from rehabilitation institutions in China including physicians, nurses, physiotherapists and occupational therapists.MethodsA 2-round Delphi survey and expert panel discussion were used to generate the team approach. Firstly, the candidate types of professionals for team rating were chosen through expert panel discussion. A carefully selected group of participants was then asked to score the suitability of physicians, nurses, or other candidate therapists for each category’s rating, applying the International Classification of Functioning, Disability and Health Rehabilitation Set in clinical evaluation. After initial assignment of category to types of professionals, a second round Delphi survey was conducted to quantify the professionals’ agreement with the category assignments and generate a final team evaluation approach.ResultsThirty of the category assignments achieved consensus. The final team evaluation approach assigned 6 categories to physicians to evaluate, 7 categories to nurses, 9 categories to physiotherapists, and 8 to occupational therapists.ConclusionSuch a team evaluation approach could facilitate implementation of the ICF-RS in clinical settings and provide a more convenient assessment tool for professionals.LAY ABSTRACTAs the Chinese International Classification of Functioning, Disability and Health Rehabilitation Set became widely used in rehabilitation institutions in China, it was found to be timeconsuming and inefficient for a single rater to complete the entire evaluation in a single setting. Team evaluation provides an alternative team approach for busy professionals, especially when used to evaluate patients with complex problems or poor communication ability. The whole set of 30 evaluation categories was divided among a hypothetical team consisting of a physician, a nurse, a physiotherapist and an occupational therapist, with 6 categories assigned to the physician, 7 to the nurse, 9 to the physiotherapist, and 8 to the occupational therapist. Each professional in the team rated categories closely related to their daily work. The team evaluation approach promises to better share the evaluation workload, perhaps improving the accuracy of evaluations and strengthening interdisciplinary collaboration in the clinic.