Delphi Survey Research Articles

Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment tool.

Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making. We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool's purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users. The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups. This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.

Management of type III acromioclavicular joint dislocation: A Delphi consensus survey by Shoulder & Elbow Society, India (SESI)

PurposeThe study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations. MethodsThis study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale. ResultsOur Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. ConclusionThe survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.

Development of a core outcome set for cardiac rehabilitation in patients with myocardial infarction: a study protocol

IntroductionHeterogeneous outcome reporting is common in clinical trials focused on cardiac rehabilitation for myocardial infarction (MI); this practice often results in the exclusion of data from clinical trials in systematic...

Optimizing hematology/oncology (H/O) curricula for internal medicine (IM) residents: A two-institution Delphi survey.

9033 Background: Although H/O topics are essential for primary care physicians, internists and subspecialists, the H/O curriculum is not standardized across IM residency programs. We aimed to identify the most important H/O topics for IM residents to learn, according to IM generalists and H/O specialists. Methods: We used a modified Delphi approach to conduct a 2-round cross-sectional survey of IM generalists and H/O specialists at the University of California, San Francisco and Stanford University. Participants rated the importance of H/O curricular topics gathered from national H/O and IM organizations on a 1-5 scale (very unimportant to very important). Participants then viewed their own ratings compared to the group mean and standard deviation (SD) for each topic from round 1 and could change their ratings in round 2 if they wished. We used a content validity index (CVI, the percentage of respondents who rated the topic ≥4) of >75% to identify the most important topics. We compared the effect sizes of the differences between mean generalist and specialist ratings for each topic using Cohen’s d. Results: The survey included 239 topics (75 classical hematology, 52 malignant hematology, 112 solid oncology). The round 1 survey was sent to 132 clinicians (68 generalists, 64 H/O specialists), with 92 round 1 responses (response rate [RR] 69.7%) and 77 round 2 responses (RR 83.7%). The average variance decreased from round 1 to round 2 (1.00 to 0.86), indicating increasing agreement. Ninety-two topics met the CVI threshold: 41 from classical hematology, 15 from malignant hematology, and 36 from solid oncology. The Table shows the highest rated topics as examples. Most effect sizes were small (58.6%), indicating agreement between generalists and specialists across most topics. Conclusions: With input from both generalists and H/O specialists, we identified the most important H/O topics for IM residents, which can guide curriculum development for IM residency programs. [Table: see text]

Establishing a course to train ICU nurses on prone position mechanical ventilation: A Delphi study.

To develop a comprehensive training course for training ICU nurses in prone positioning. A mixed study combining semi-structured interviews and two rounds of Delphi surveys. We constructed a questionnaire after collecting data through a literature review and semi-structured interviews. We used the Delphi expert correspondence method to conduct two rounds of research among 17 experts in the field of critical illness. Data collection took place between May and August 2022. The effective questionnaire recovery rate was 88.2%. The expert authority coefficient was 0.876; the Kendall coordination coefficient was 0.402; the average importance score for each index ranged from 4.00 to 4.93; and the coefficient of variation for each index ranged from 0.05 to 0.19. We established 13 second-level indicators and 41 third-level indicators on prone position ventilation training according to three aspects: training contents, training methods and training assessment. The training system of prone mechanical ventilation for ICU nurses established in this study will provide an effective framework for training and evaluating the practical ability of prone mechanical ventilation for ICU nurses.

Using Routinely Collected Electronic Healthcare Record Data to Investigate Fibrotic Multimorbidity in England.

Electronic healthcare records (EHRs) are used to document diagnoses, symptoms, tests, and prescriptions. Though not primarily collected for research purposes, owing to the size of the data as well as the depth of information collected, they have been used extensively to conduct epidemiological research. The Clinical Practice Research Datalink (CPRD) is an EHR database containing representative data of the UK population with regard to age, sex, race, and social deprivation measures. Fibrotic conditions are characterised by excessive scarring, contributing towards organ dysfunction and eventual organ failure. Fibrosis is associated with ageing as well as many other factors, it is hypothesised that fibrotic conditions are caused by the same underlying pathological mechanism. We calculated the prevalence of fibrotic conditions (as defined in a previous Delphi survey of clinicians) as well as the prevalence of fibrotic multimorbidity (the proportion of people with multiple fibrotic conditions). We included a random sample of 993,370 UK adults, alive, and enrolled at a UK general practice, providing data to the CPRD Aurum database as of 1st of January 2015. Individuals had to be eligible for linkage to hospital episode statistics (HES) and ONS death registration. We calculated the point prevalence of fibrotic conditions and multi-morbid fibrosis on the 1st of January 2015. Using death records of those who died in 2015, we investigated the prevalence of fibrosis associated death. We explored the most commonly co-occurring fibrotic conditions and determined the settings in which diagnoses were commonly made (primary care, secondary care or after death). The point prevalence of any fibrotic condition was 21.46%. In total, 6.00% of people had fibrotic multimorbidity. Of the people who died in 2015, 34.82% had a recording of a fibrotic condition listed on their death certificate. The key finding was that fibrotic multimorbidity affects approximately 1 in 16 people.

Establishing consensus on nutrition competencies for medicine: a Delphi study

BackgroundSignificant research, regulatory bodies and even governmental resolutions have identified meaningful nutrition education for medical and other healthcare professionals as a priority. Doctors are well placed to provide nutrition care,...

Development of Items for Social Cognitive Assessment of the Elderly: Delphi Survey

Development of Items for Social Cognitive Assessment of the Elderly: Delphi Survey

What is the best set of indices/indicators for evaluating “health promotion governance” in health systems? A proposed methodology for health promotion decision-making

ABSTRACT We aimed to identify the indices/indicators needed for assessing health promotion governance in health systems. Data were obtained from a literature review, a modified Delphi process, and an Analytic Hierarchy Process (AHP). The study was conducted from May 2021 to January 2022 using a multi-method design comprised of four sequential stages: (1) a comprehensive literature review for identifying the health promotion indices/indicators originating from the Ottawa Charter’s action areas; (2) a 3-round Delphi survey to identify, by consensus, which of those indices/indicators would be relevant to the health promotion governance in the health system;(3) Analytic Hierarchy Process technique (AHP) to prioritize the selected indices/indicators; (4) presenting the results of AHP to a group of the health promotion specialists of the selected experts to selecting other indices/indicators if necessary. Health literacy was considered the most important index to assess health promotion governance from experts’ perspectives. The per capita public health expenditure was supposed to be the second most important indicator. The indices ranked third and fourth in priority were the health equality and urban health indexes, respectively. The health promotion specialists selected three other indices: the number of policies changed due to advocacy, social capital, and positive health. Based on the results, a series of essential indices/indicators have been proposed depending on the study’s purpose, which can help health system policymakers and managers to assess the health promotion governance in the health system.

The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study.

Sesamoiditis is a common, and often painful, musculoskeletal pathology frequently encountered by podiatrists. However, there are currently no recommendations to guide podiatrists in the assessment and management of people with sesamoiditis. The aim of this study was to develop consensus-driven clinical recommendations on the assessment and management of people with sesamoiditis. A four-round online Delphi survey was conducted with a panel of New Zealand and Australian podiatrists. In the first round, panellists answered open-ended questions that were used to create statements. In round two, the panellists scored the statements from 1 to 9 (1=not at all important, 9=absolutely essential). Consensus was defined using the RAND/University of California Los Angles Disagreement Index. Panellists were asked to reconsider statements that did not achieve consensus in round three. In the final round, content validity and acceptability of the statements for inclusion in clinical recommendations were determined using content validity ratios and the Content Validity Index (CVI). Eighteen panellists completed round one with 16 (89%) completing all four rounds. A total of 118 statements were generated following round one. Following rounds two and three, 78 statements were accepted by panellists as being important, with 62 statements achieving sufficient content validity for inclusion in clinical recommendations. The CVI for these 62 statements was 0.58. These recommendations provide guidance on subjective assessment (pain characteristics/symptomology, activity/sports/training history and medical history) objective assessment (establishing a diagnosis, identifying contributing biomechanical factors, footwear/orthoses, ruling out differential diagnoses) and management (temporary padding/strapping, education, footwear, foot orthoses and when to consider referral). This consensus exercise has provided a set of consensus-based recommendations for the assessment and management of people with sesamoiditis. In the current absence of research-based evidence in this area, these recommendations are intended to support clinicians. The recommendations may also serve as a basis for future clinical trials evaluating the efficacy of conservative interventions for people with sesamoiditis.

노인 운동중심의 신체적 frailty 측정 도구 개발

Health-related aging affects physical, psychological, and social life. In old age, when aging progresses considerably, aging-related variables are involved in the progression of frailty in the human body. Therefore, developing an elderly exercise-centered tool to measure the appropriate frailty to prevent frailty and prevent disorders caused by aging are required. This study aimed to develop a physical 'frailty measurement scale' applying based on the kinematic exercisecentered frailty criterion to discriminate physical frailty. The subject of this study is a group of experts who have verified the measurement scale. As a purposive sampling for the application of the Delphi survey, 11 experts were composed. In the first step of the research process, the primary screen and preliminary questions were completed using physical loss, walking speed delay, Fried's frailty determination method, daily life performance ability, functional daily life performance ability, elderly physical fitness test, and TUG. In the second step, opinions were first collected to confirm the degree of convergence, agreement, and stability with the consensus of experts, and content validity was secondarily verified. The reliability was chronbach α=.954, and in a total of 17 questions, convergence was .5 or less, agreement was .75 or more, and stability was .5 or less. Content validity was satisfied except for question 2 (unintended loss of 5kg of two-year-old weight within 6 months). Finally, the measurement tool was completed by determining that question 2 was suitable by reflecting the degree of convergence, agreement, stability and content validity.

노인 운동중심의 신체적 frailty 측정 도구 개발

Health-related aging affects physical, psychological, and social life. In old age, when aging progresses considerably, aging-related variables are involved in the progression of frailty in the human body. Therefore, developing an elderly exercise-centered tool to measure the appropriate frailty to prevent frailty and prevent disorders caused by aging are required. This study aimed to develop a physical 'frailty measurement scale' applying based on the kinematic exercisecentered frailty criterion to discriminate physical frailty. The subject of this study is a group of experts who have verified the measurement scale. As a purposive sampling for the application of the Delphi survey, 11 experts were composed. In the first step of the research process, the primary screen and preliminary questions were completed using physical loss, walking speed delay, Fried's frailty determination method, daily life performance ability, functional daily life performance ability, elderly physical fitness test, and TUG. In the second step, opinions were first collected to confirm the degree of convergence, agreement, and stability with the consensus of experts, and content validity was secondarily verified. The reliability was chronbach α=.954, and in a total of 17 questions, convergence was .5 or less, agreement was .75 or more, and stability was .5 or less. Content validity was satisfied except for question 2 (unintended loss of 5kg of two-year-old weight within 6 months). Finally, the measurement tool was completed by determining that question 2 was suitable by reflecting the degree of convergence, agreement, stability and content validity.

Integrating Fuzzy Cognitive Maps and the Delphi Method in the Conservation of Transhumance Heritage: The Case of Andorra

Transhumance and its associated heritage are extremely complex and dynamic systems, and their conservation requires the analysis of interdisciplinary factors. To this end, fuzzy cognitive maps (FCMs) and Delphi surveys were applied for the first time in the field of heritage conservation. The model was applied to the tangible and intangible transhumance heritage of Andorra to determine its current state of conservation and to evaluate strategies for its preservation. Two panels of experts worked on the development of the model. Five experts with profiles related to conservation and transhumance heritage formed the first panel, which designed the preliminary FCMs, while seven experts in Andorran cultural heritage (panel 2) adapted the preliminary FCM model to Andorran transhumance heritage using Delphi surveys. The FCM model allowed us to analyze the influence of different variables on the conservation of transhumance heritage and to assess policy decisions. Further studies will focus on the implementation of this model in other countries to establish common recommendations for the conservation of the cultural heritage of transhumance.

Reconnecting systemic family therapy: How family therapy training can attend to the ecosystem and climate emergency, recommendations from a Delphi survey

AbstractWe are facing devastating effects of the climate emergency and systemic environmental breakdown. These impact on mental health and wellbeing. Family therapy has only marginally engaged with these crises and the relationship between people and ecosystem. This Delphi survey identifies key elements to include in family therapy training to attend to the ecosystem and the climate and ecological emergencies. Participants generated ninety‐six statements that were clustered into six overarching ‘topic areas’ (theories, orientations, schools, integrations/transformations, methods, and techniques). There were sixty‐six statements agreed at a high level of consensus and seventeen with a moderate level of consensus, while there was no consensus over the remaining thirteen items. All participants opted to suggest references, which form a reading list to accompany these ideas.

Critical outcomes to be included in the Core Outcome Set for nutritional intervention studies in older adults with malnutrition or at risk of malnutrition: a modified Delphi Study

IntroductionAs part of the development of an agreed minimum set of outcomes or Core Outcome Set (COS) for future nutritional intervention trials in older adults with malnutrition or at risk of malnutrition, this work reports on the Delphi surveys and final consensus.MethodsOutcomes from a scoping review were incorporated into a two-round Delphi survey. Researchers and healthcare professionals experienced in malnutrition in older adults were invited to take part in an online survey to rate 38 selected outcomes on a nine-point Likert scale ranging from ‘not important’ to ‘critical’ for their setting (community, hospital, or long-term care). Consensus for inclusion was reached when ≥75% (or ≥60% if a patient-reported outcome) of the participants scored the outcome as ‘critical’ and <15% as ‘not important’. Resulting outcomes were voted for inclusion or exclusion in the COS in a final online consensus meeting.ResultsNinety-three and 72 participants from diverse professional backgrounds and countries participated in the 1st and 2nd Delphi round, respectively. After both rounds eleven outcomes met the inclusion criteria, largely irrespective of setting. Fifteen participants, representing academia, health care, health policy, industry, and PPI, voted in a final online consensus meeting resulting in ten outcomes: malnutrition status, dietary intake, appetite, body weight or BMI, muscle strength, muscle mass, functional performance, functional limitations, quality of life, and acceptability of the intervention.ConclusionsTen outcomes will form the COS which is intended to be used by the scientific community in all future nutritional intervention studies for older adults with malnutrition or at risk of malnutrition. The subsequent phase will establish the appropriate methods to measure these outcomes.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Priorities for enhancing nurses' and social workers’ competence and confidence in helping families support dependent children through parental death. A classic-Delphi survey

BackgroundAnnually, approximately five per cent of dependent children — aged under eighteen years — in the United Kingdom (UK), experience parental death. Nurses and social workers caring for parents with life-limiting illnesses, including cancer, help families support their children. However, these professionals have been found to lack confidence and competence in fulfilling this role.MethodsWe conducted three rounds of a classic-Delphi survey to identify and measure a panel of topic experts’ consensus on the priorities and issues for nurses and social workers when supporting families and children through parental death. The Delphi survey was conducted with a panel of UK topic experts (n=43) including lead health and social care professionals (n=30), parents bereaved of a partner whilst parenting dependent children (n=6), academics (n=4) and bereaved young adults (n=3).ResultsNinety per cent (n=18/20) of the issues for nurses and social workers and all (7/7) of the priorities rated and ordered in the survey achieved consensus. Key priorities were 1) training in opening conversations with families about dependent children, 2) training and support for nurses and social workers to manage their own and others’ emotions arising from conversations with parents about children’s needs regarding parental death, and 3) increasing nurses’ and social workers’ knowledge of sources of information to support families before the death of a parent.ConclusionWe identified priorities for UK nurses and social workers. Further research is needed to identify which of these nurses and social workers would benefit most from support, and how any resultant interventions could enhance confidence and competence in helping families to support children through parental death.

ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats.

Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

유아기 자녀를 둔 부모공감능력의 의미와 구성요인에 관한 델파이 연구

Objectives This study aims to clarify the meaning of parental empathy ability using the Delphi technique and to derive constituent and sub-factors. Methods To this end, the concept of parental empathy ability was defined through preceding research and liter-ature review, and the structuring factors of the ability were derived. An expert Delphi survey was conducted using the derived data to confirm the exploratory study of deriving the components of parental empathy ability. The data analysis method of the first Delphi survey questionnaire was conducted in order to define the concept of parental empathy and derive the structuring factors. A structured questionnaire, free-choice and open-ended questions were conducted with 13 experts in order to confirm the content validity. Using SPSS 25.0, the average value, standard deviation, skewness, agreement, convergence, and CVR ranges of each variable were calculated, and questions that did not meet each criterion were modified and deleted. Since the number of panels participating in the Delphi survey in this study is 13, if the CVR value is .554 or higher, it can be judged that the content validity is valid. The contents, were revised and supplemented with the experts, used to construct the second Delphi survey. It was used to construct the second questionnaire by reflecting the opinions of experts and revising and supplementing the contents. The second survey tool were gathered from the responses of the first survey. In or-der to clarify the opinions of each panel, structured questions with a 5-point rating scale were presented. Results First, the area of the scale consisted of three areas: ‘emotional empathy ability’, ‘cognitive empathy abil-ity’, and ‘behavioral empathy ability’, ‘emotional empathy ability’ consisted of perspective acceptance, cognitive empathy, and perspective acceptance, ‘cognitive empathy ability’ consisted of emotional response, emotional al-location, and emotional perception, and ‘behavioral empathy ability’ consisted of pseudo-movement, expression consistency, listening, and relationship formation. Conclusions The study is significant in that it derives categories and sub-factors of parental empathy ability that have recently come into focus. Furthermore, the study is significant in that it can be used as basic data for deriving the question composition through focus group interviews in the future.

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process.

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.