Expert Agreement Research Articles

Investigation and Evaluation of the Most Important Factors Affecting Non-Native Medical Tourists' Reception of the Historical City of Yazd Using Delphi Technique

Background: Medical tourism in Yazd city has been greatly developed as one of the treatment poles of the country and can be said that this industry has become one of the development axes of Yazd city. The purpose of this research is to identify the most important factors influencing the attraction of non-native medical tourists to the historical city of Yazd.
 Methods: The current research was of a qualitative type conducted in the fall of 1401. Desk research and Delphi method were used to collect data. The statistical sample of this study included 41 experts in the fields of treatment, tourism, and urban planning, and these experts were selected based on their related specialties using a snowball method. After studying the theoretical foundations of the research, 41 effective factors in attracting medical tourists were specified from related research texts, and during studying, categorization and editing, 23 indicators were provided to the experts in the form of a questionnaire on a 5-point Likert scale, and at the end of the questionnaire, an open question was provided. After analyzing the answers, the results were recorded and a new questionnaire was created for the next stage, which was repeated 3 times. According to the results of the Kolmogorov-Smirnov test at a significance level of 0.05, the correlation between the factors was analyzed using the W. Kendall non-parametric correlation test and the SPSS 18 software, and the Delphi technique was used to achieve the research objectives.
 Results: In the course of data analysis, indicators with an average difference of less than 0.1 were confirmed, indicators with an average of less than 4 were removed, and other indicators were moved to the next stage. After completing 3 stages of the test, 12 factors were identified as the most important factors affecting medical tourism in Yazd city, and these factors were placed in 5 categories: characteristics of the treatment staff, characteristics of the hospital, economic factors, giving information and communication, and other related factors. According to W. Kendall's correlation coefficients obtained during the 3 Delphi steps, the convergence and agreement of experts' opinions were confirmed.
 Conclusion: Considering that infrastructure indicators, personnel skills and economic factors are among the most important indicators of attracting medical tourists to the historical city of Yazd, it is suggested that to develop medical tourism in Yazd city, these items should be taken into consideration in managing the current situation of medical centers; Furthermore, investment should focus on the development of medical infrastructure.

Co-Curricular Activity Risk Management (CoARM) Development and Validation: A Fuzzy-Delphi Method

Co-curricular activities encompassing uniform units, clubs, and associations are compulsory courses in all educational institutions in Malaysia. The implementation of co-curricular activities requires neat preparation in order to reduce exposure to the risk of loss, injury, and accidents during the activities. Therefore, this study aimed to produce an instrument for effective co-curricular activity risk management (also known as (CoARM) to guide administrators, lecturers, and students, in conducting safe co-curricular activities, especially at Malaysian teacher education institute (TEIM). This study used the Fuzzy-Delphi method involving 30 experts in the field of co-curriculum from public universities and TEIM. The questionnaire was constructed based on the analysis of field expert interviews and a literature review. It was then sent for expert agreement on the elements, sub-elements, and content of CoARM at TEIM. The findings distinguish three (3) elements and fifteen (15) sub-elements of CoARM when planning and implementing co-curricular activities. The first element was the human element involving trainers, participants, support staff, service providers, and external agencies. The second element, the equipment element, involved anchorage, accommodation, facilities for special activity equipment, and safety equipment. The third element was the environment element with the sub-elements of weather, location, activity routes, security threats, and rescue routes. The CoARM instrument is expected to provide new knowledge as well as to serve as a guide in the field to increase the public’s confidence in organising co-curricular activities at Malaysian educational institutions and as a reference source in the future construction of CoARM modules.

Expert Agreement towards the Orang Asli Community Learning Center Model Based On the Local Environment: Analysis of the Fuzzy Delphi Method

The purpose of this study is to obtain the agreement and opinion of experts towards the framework of the Orang Asli Community Learning Center model based on the local environment. This study has used Fuzzy Delphi method as well as using a 7 Likert-scale to collect feedback from 11 experts in various fields of education at public universities in Malaysia. A total of 5 main elements and sub-item elements of the questionnaire were given to experts for evaluation. Data was analyzed using triangular fuzzy number and position (ranking) with each element of the model is determined using defuzzification process. The results of the analysis of expert agreement and consensus have been shows that the agreement value is at a good level. This shows the elements of The Community Learning Center model has received good expert approval. The elements are arranged according to the priority (ranking) that has been agreed by experts.

Expert Agreement on the Presence and Spatial Localization of Melanocytic Features in Dermoscopy

Dermoscopy aids in melanoma detection; however, agreement on dermoscopic features, including those of high clinical relevance, remains poor. In this study, we attempted to evaluate agreement among experts on exemplar images not only for the presence of melanocytic-specific features but also for spatial localization. This was a cross-sectional, multicenter, observational study. Dermoscopy images exhibiting at least 1 of 31 melanocytic-specific features were submitted by 25 world experts as exemplars. Using a web-based platform that allows for image markup of specific contrast-defined regions (superpixels), 20 expert readers annotated 248 dermoscopic images in collections of 62 images. Each collection was reviewed by five independent readers. A total of 4,507 feature observations were performed. Good-to-excellent agreement was found for 14 of 31 features (45.2%), with eight achieving excellent agreement (Gwet's AC >0.75) and seven of them being melanoma-specific features. These features were peppering/granularity (0.91), shiny white streaks (0.89), typical pigment network (0.83), blotch irregular (0.82), negative network (0.81), irregular globules (0.78), dotted vessels (0.77), and blue-whitish veil (0.76). By utilizing an exemplar dataset, a good-to-excellent agreement was found for 14 features that have previously been shown useful in discriminating nevi from melanoma. All images are public (www.isic-archive.com) and can be used for education, scientific communication, and machine learning experiments.

Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures.

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic-ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options.

Myanmar Articulation, Resonation, Nasal Emission, and Nasal Turbulence Test: A Preliminary Study.

Background This article describes the development of the Myanmar Articulation, Resonation, Nasal Emission, and Nasal Turbulence test for children with cleft lip and palate (CLP), and evaluation of its validity and reliability. Methods It was created by three Thai researchers and a Burmese research assistant based on Burmese phonology. The content validity was evaluated by six Burmese language experts. All test items were divided into three groups: high-pressure oral consonants, low-pressure oral consonants, and nasal consonants. Results All items (58-word and 32-phrase/sentence) gave an excellent level of the expert agreement (item-level content validity indexes = 1.00). The target items were illustrated as color pictures. Each picture was clearly drawn and easy to identify. As a pilot study of face validity, all pictures were administered to 10 typical-developing children. The actual testing was assessed by 10 CLP children, and the developed test was analyzed through consultation of the Burmese teachers and interpreters from a speech camp. Testing scores for a total including three groups of target items were shown acceptable for internal consistency reliability (ranged from 0.4 to 0.88). Conclusion The constructed test is valid in terms of its content.

Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method.

Fifteen million babies are born preterm globally each year, with 81% occurring in low- and middle-income countries (LMICs). Preterm birth complications are the leading cause of newborn deaths and significantly impact health, quality of life, and costs of health services. Improving outcomes for newborns and their families requires prioritising research for developing practical, scalable solutions, especially in low-resource settings such as Bangladesh. We aimed to identify research priorities related to preventing and managing preterm birth in LMICs for 2021-2030, with a special focus on Bangladesh. We adopted the Child Health and Nutrition Research Initiative (CHNRI) method to set research priorities for preventing and managing preterm birth. Seventy-six experts submitted 490 research questions online, which we collated into 95 unique questions and sent for scoring to all experts. A hundred and nine experts scored the questions using five pre-selected criteria: answerability, effectiveness, deliverability, maximum potential for burden reduction, and effect on equity. We calculated weighted and unweighted research priority scores and average expert agreement to generate a list of top-ranked research questions for LMICs and Bangladesh. Health systems and policy research dominated the top 20 identified priorities for LMICs, such as understanding and improving uptake of the facility and community-based Kangaroo Mother Care (KMC), promoting breastfeeding, improving referral and transport networks, evaluating the impact of the use of skilled attendants, quality improvement activities, and exploring barriers to antenatal steroid use. Several of the top 20 questions also focused on screening high-risk women or the general population of women, understanding the causes of preterm birth, or managing preterm babies with illnesses (jaundice, sepsis and retinopathy of prematurity). There was a high overlap between research priorities in LMICs and Bangladesh. This exercise, aimed at identifying priorities for preterm birth prevention and management research in LMICs, especially in Bangladesh, found research on improving the care of preterm babies to be more important in reducing the burden of preterm birth and accelerating the attainment of Sustainable Development Goal 3 target of newborn deaths, by 2030.

Patient Safety Culture Analysis in Dental Hospital Using Dental Office Survey on Patient Safety Culture Questionnaire: A Cross-cultural Adaptation and Validation Study.

The culture of safety and patient safety management in dental practice lags compared with medical practice. Hospitals strive to pursue quality and safety of healthcare services, with evidence of patient safety incidents in medical practice demonstrating the importance of promoting a safety culture. Measuring patient safety culture is a necessary first step to improving safety culture in clinical settings. As a hospital, dental hospital should improve the quality and culture of patient safety. Thus, our objective was to conduct a cross-cultural adaptation of a US measure of dental office patient safety culture for use in Indonesian dental hospitals. A cross-sectional study was conducted on 200 respondents at a dental hospital in Java, Indonesia. The first stage includes cultural adaptation and translation, followed by developing a questionnaire that was tested through expert agreement and analysis of validity and reliability using Spearman, Cronbach correlation coefficients, and correlation coefficients between classes. The Dental Office Survey on Patient Safety Culture consists of 58 items and 10 dimensions (overall perceptions of patient safety and quality, organizational learning, teamwork, staff training, work pressure and pace, management support for patient safety, office processes and standardization, communication about errors, communication openness, and patient care tracking/follow-up). A total of 200 respondents with a response rate of 61.5% and 77 invalid responses due to incomplete filling, so 123 respondents were analyzed. The validity test results on 38 question items from 10 dimensions, with a sign of 0.05%, 35 items are declared valid. The Indonesian version of the Dental Office Survey on Patient Safety Culture shows good validity and good reliability and has the potential to be used to evaluate patient safety culture in dental hospitals in Indonesia.

Criticizing the Turkish translation of the English poems in The Sun and Her Flowers by Rupi Kaur based on Dryden’s translation types

The Canadian poet Rupi Kaur, a child of an immigrant family, is a rising figure in contemporary poetry which particularly focuses on immigration and womanhood. The English poems in the “rooting” chapter of her book The Sun and Her Flowers (2017a) reflect what she has experienced as a first-generation female immigrant. To analyze this experience in the target culture, this study concentrates on the poems translated into Turkish in Güneş ve Onun Çiçekleri (2017b) by Gizem Aldoğan in the "rooting" chapter. The study follows an eclectic method. The theoretical framework is based on John Dryden's three translation types (1992): Metaphrase, paraphrase and imitation. For the data analysis, the original and the translated poems are classified in terms of Hewson's macro-micro-macro methodological design (2011). Interrater reliability is ensured with the participation of three field experts during the data analysis. The macro-level analysis represents the final agreement of the field experts on the overall type of the translated poems in the defined chapter. The micro-level analysis, on the other hand, aims at finding out any unusual lines within a specific poem that fits into a translation type different from its macro-level type. The findings of the study show that the Turkish translations of Kaur's poems hold 100% paraphrastic translation style on the macro-level while there is a slight deviation on the micro-level.

Magnetic resonance imaging of pilonidal sinus disease: interobserver agreement and practical MRI reporting tips

ObjectiveTo evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized checklist for reporting PSD on MRI.Materials and methodsForty MRI studies of 39 discrete patients with PSD were retrospectively evaluated by five independent radiologists using a standardized checklist. Fleiss’ Kappa (k) coefficients of agreement were used to test the agreement between categorical variables. The MRI features of the natal cleft sepsis associated with PSD were classified into four main categories: morphology, branching and extensions, external skin openings, and the relationship of the PSD to the coccyx. A survey was created and disseminated online among general surgeons who treat patients with PSD to assess the relevance of the MRI features proposed in the standardized checklist.ResultsThe overall agreement regarding the identification of morphology of the natal cleft sepsis was moderate (k = 0.59). Lateral and caudal extensions interobserver agreement was substantial (k = 0.64 and 0.71, respectively). However, the overall agreement regarding the individual parts of anal sphincter involved was moderate (k = 0.47). Substantial interobserver agreement was found in assessing the proximity of the PSD to the coccyx (k = 0.62).ConclusionPreoperative MRI can delineate the extensions and branching of PSD with substantial agreement. MRI is superior in describing the deep extensions of PSD with better reliability than assessing the number and locations of the external openings. Expert consensus agreement is needed to establish the MRI features necessary for optimal reporting of PSD.Clinical relevance statementMRI can offer valuable information about the extent of sepsis associated with pilonidal sinus disease, particularly in cases with involvement of critical anatomical structures such as the coccyx and anal triangle. MRI can potentially contribute to more accurate patient stratification and surgical planning.Key Points• The interobserver agreement for assessing PSD’s lateral and caudal extension on MRI is substantial.• MRI can describe deep extensions and branching of PSD with superior reliability than assessing the number and site of external openings.• Reporting the relationship between natal cleft sepsis in PSD and the anal region may influence the surgical approach and postoperative healing.

Quantifying the subjective: length-to-height ratio characterizes achalasia esophageal tortuosity.

Esophageal morphology in achalasia is thought to affect outcomes, with "end-stage" sigmoidal morphology faring poorly; however, evaluation of morphology's role in outcomes has been limited by lack of objective characterization. Hence, the goals of this study were twofold: characterize the variability of timed barium esophagram (TBE) interpretation and evaluate an objective classification of TBE tortuosity: length-to-height ratio (LHR). We hypothesized that the esophagus must elongate to become sigmoidal such that sigmoidal morphology would demonstrate a larger LHR. Ninety pre-operative TBEs were selected from an institutional database. Esophageal morphology was categorized as straight, intermediate, or sigmoidal. Esophageal length was measured by a mid-lumen line from the aortic knob to the esophagogastric junction on TBE; height was measured vertically from the aortic knob to the level of the esophagogastric junction. The length divided by the height generated the LHR. Descriptive statistics and frequency of expert agreement were calculated. Median LHR was compared between consensus morphologies. A receiver operating characteristic (ROC) determined the optimal LHR for sigmoidal vs non-sigmoidal characterization. From a total of 90 pre-operative TBEs, expert consensus morphology was reached in 56 (62.2%) cases. Pairs of experts agreed on morphology in 62-74% of TBEs, with all three experts agreeing on 46.7-48.9% of cases. Median LHR between expert consensus morphologies was 1.03, 1.09, and 1.24 for straight, intermediate, and sigmoidal morphologies, respectively (p < 0.001). ROC demonstrated that an LHR cutoff of 1.13 was 100% sensitive and 95% specific (AUC 0.99) for ruling out sigmoidal morphology. These findings confirm our anecdotal experience that subjective morphology interpretation is variable, even between experts at a high-volume center. LHR provides an objective method for classification, allowing us to overcome the limitations of inter-observer variability, thus paving the way for future study of the role of morphology in achalasia outcomes.

Lithium Therapy in Old Age: Recommendations from a Delphi Survey.

While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients. Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement. Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li. According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

Integral rating system approbation of the Russian Federation regions using weight coefficients based on indicators characterizing the effectiveness of the organization of medical care in cardiovascular surgery

Aim. Integral rating system approbation of the Russian Federation regions using weight coefficients based on indicators characterizing the effectiveness of the organization of medical care in cardiovascular surgery.Methods. The study included 6 indicators with the highest final rating and expert agreement coefficient (based on data from the previous study). The values of the indicators were calculated for 38 Russian Federation regions supervised by the national medical research centers in cardiovascular surgery based on the statistical data provided by the Russian Federation regions and compared with the data of federal statistical observation forms. Further, all indicators were transferred to a point scale to form a single integral rating. The value in points for each of the indicators was multiplied by the corresponding weight coefficient for each subject of the Russian Federation. At the end, we performed a comparative analysis of the two integral ratings and expert validation.Results. It was found that the Moscow Region is in first place (880.00 points) based on the results of building an integral rating using weight coefficients. In second place instead of the Tambov region is the Republic of Bashkortostan (760.71 points). The third position of the Lipetsk region is occupied by the Samara region (750.89 points). The Smolensk region (259.28 points) occupies the 38th place in the integral rating with the use of weight coefficients, as well as in the ranking without the use of weight coefficients. The Republic of Ingushetiya (+18 seats) and the Republic of Dagestan (+17 seats) are characterized by the greatest positive change in the number of seats. The Kirov region (-16 places), the Penza region (-16 places), as well as the Tula region (-11 places) and the Vladimir region (-11 places) are characterized by the greatest change in the number of seats in the negative direction.Conclusion. Presented system of integral rating of the Russian Federation regions with weight coefficients demonstrated the principal adequacy of all proposed approaches in relation to the real situation with the organization of medical care in the Russian Federation regions, and also made it possible, through the use of weight coefficients, to take into account the varying degree of contribution of the indicators used to the integral rating of the Russian Federation regions. In the same time the indicators should be choose very careful.

Medical competence as a multilayered construct.

The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment. Three layers are elaborated. This first is a core layer of canonical knowledge and skill, 'that, which every professional should possess', independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's 'self-actualisation', may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different. The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.

Consensus on occupational health competencies for UK first contact physiotherapists

BackgroundPatients at risk of preventable sickness absence frequently attend at primary care. First contact physiotherapists (FCP) may provide an optimal way of reducing this risk; however, there is significant variability in clinical practice, limited research directing best practice and this work and health role is traditionally seen as outside of the ‘therapeutic relationship’. If FCP’s training and development in this area is considered, FCP’s will be able to effectively conduct fitness for work and sickness absence certification within UK primary care settings. AimsThis study aimed to reach expert consensus for work-related competencies for FCP practice for patients at risk of preventable sickness absence. MethodsA modified Delphi technique involved a UK-wide FCP expert panel completing three rounds of an online questionnaire. The initial 30-competency questionnaire, based on two separate Nominal Group Techniques in a FCP and Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) physiotherapist cohort and Health Education England’s published Roadmap to Practice, covered occupational health specific items (knowledge and skills) related to the topic. Consensus threshold was set a priori at 70% level of group agreement. Items not reaching consensus were modified and new items added based on themes from qualitative data from the open-ended free text questions present in each section. Items that reached values greater than or equal to 70% of agreement among experts were considered definitive for the competency items. Items between 51% and 69% of agreement were included for the next round and those items with less than or equal to 50% of agreement were considered unnecessary and were excluded. In the third round, the occupational health (OH) specific contents for primary care were classified according to the degree of consensus as follows: strong (≥70% of agreement), moderate (51–69% of agreement) and weak (50% of agreement) based on the maximum consensus reached. ResultsOf the 30 initial competencies, 20 (67%) reached a strong degree of consensus and 2 (7%) reached a moderate degree of consensus and 8 (27%) competencies were not recommended (≤50% of agreement). 20 OH specific competencies reached a priori consensus level of agreement to provide the final group list. ConclusionsThis paper provides an empirically derived list of OH competencies for FCP education in primary care ‘first point of care’ physiotherapy with a high level of expert agreement and high retention rate between rounds. Contribution of the paper•The role of certifying sickness absence and providing fitness for work advice within primary care settings has normally been conducted by General Practitioners, largely due to the legislative aspects that require a ‘Fit Note’.•FCPs may be ideally suited in ensuring that work is considered at an early stage to help support and prompt conversations about work.•Most individual’s health needs are addressed within Primary Care (first point of contact in the NHS).•There is a lack of empirical evidence on the competencies needed for the new ‘first point of contact role’ whereby FCPs manage undiagnosed and undifferentiated musculoskeletal (MSK) conditions.

Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC-ET-tool)

BackgroundPatient participation is advocated in various healthcare settings. Instruments for assessment and feedback have been developed to strengthen clinician-patient interaction. In an emergency department context, such instruments are still missing.The study aimed to develop and test an observation tool for emergency teams’ behaviour regarding patient involvement and collaboration.MethodsThe development of the behavioural observation tool followed a systematic approach. The tool’s content was based on various data sources, i.e., published literature, interview and observational data, and expert consensus. An international expert panel reviewed the content and the rating scale and rated its importance for patient involvement and collaboration in a Delphi process. The feasibility and reliability of the tool were tested by trained observers using video recordings of simulated emergencies. Intraclass correlation (ICC) and Kappa-statistics were performed to test the tool’s inter-rater reliability.ResultsThe PIC-ET tool, a 22-item observation instrument was developed in which patient involvement and collaboration behaviours are rated from ‘no’ to ‘high’ using behavioural anchors. Expert agreement was obtained after three Delphi rounds on the tool content, the behavioural anchors and its importance for patient involvement and collaboration.The content validity was assessed as high, and the tool was found feasible for research. Overall inter-rater reliability was fair (Kappa 0.52).ConclusionsA novel tool for assessing emergency teams’ behaviour regarding patient involvement and collaboration is introduced. The tool’s psychometric properties were fair to good. Further validation of the PIC-ET tool is recommended for more robust evidence. Future adaptation to different contexts and areas of use, as well as further validity testing may be of value.

Predictor of failed cancer resuscitation by expert agreement

Purpose: Cardiopulmonary resuscitation (CPR) in end-of-life and critical patients, specifically cancer in hospitals, often faces a dilemma between resuscitation or non-resuscitation. This study will determine the predictors of resuscitation failure for cancer patients by expert agreement. Materials and Methods: Predictor’s variables were collected from review 20 research journals based on cancer patients who expired and were not successfully resuscitated. From 20 research journal, we found only 11 articles that mentioned the variables involved in resuscitation failure and death in cancer patients. To find out which predictors occur the most in Indonesia, we asked 5 expert palliative anesthesiologists as an expert from a palliative center hospital in Indonesia to choose the predictor that relate to resuscitation failure. To measure the agreement, we use Fleiss–Kappa statistic method with SPSS software ver. 20. Results: Based on the agreement of the experts (k &gt;0.8), eight of 44 predictors were noted for cardiopulmonary resuscitation failure in cancer patients that are expected to occur in Indonesia, namely: AIDS (acquired immunodeficiency syndrome), CPR &gt; 15′, non-recovery of heart rate after CPR &gt;20 min, electrocardiogram (ECG) rhythm asystole, early coma, hepatic insufficiency, non-shockable heart rhythm, and pulseless electrical activity (PEA). Conclusions: Experts agree that AIDS, CPR &gt;15′, non-recovery of heart rate after CPR &gt;20 min, ECG asystole rhythm, early coma, hepatic insufficiency, non-shockable heart rhythm, and PEA are dominant predictors for CPR failure in cancer patients.

PRACTICAL EXPERIENCE OF YOUNG ATHLETES’ TACTICAL TRAINING IN MODERN OLYMPIC COMBAT SPORTS

The present work studied specifics of tactical training as an important side of training process in modern Olympic combat sports. In most scientific papers and official documents, the views on tactical training are contradictory and do not reflect all current trends of the development of Olympic combat sports. The aim of the research was to analyze practical experience of athletes’ tactical training in modern Olympic combat sports at the stage of previous basic development. Material and Methods. We recruited 40 experts in Olympic fencing, boxing, wrestling, judo, taekwondo and karate. They were asked to fill out a form (questionnaire), which included 15 questions on athletes’ tactical training such as directions, means and methods, control of tactical preparedness, components of tactical knowledge. In order to confirm the accuracy of the answers, the concordance coefficient (W) was determined in each group of experts. To compare the answers in different expert groups we also used the average rank. Results. It was found that a lot of issues of tactical training were estimated as the most significant in most combat sports. The same was typical for he least significant issues. The agreement of experts' opinions in different sports within one question was average, strong, weak (p&lt;0.05) or unreliable (p&gt;0.05). In some questions expert’s answers were similar, but in other questions they were different inside groups and between them. Average (0.69W≥0.5, p&lt;0.05) and strong concordance (W≥0.7, p&lt;0.05) was found in such groups of experts: fencing – about visual methods of tactical training; wrestling – about visual and practical methods; boxing – about directions and verbal methods; judo – only about visual methods; taekwondo – in all questions except verbal methods; karate – in all questions. Conclusions. It is recommended to use the common algorithm for improving athletes’ tactical preparedness with the possibility of its modification in particular kinds of Olympic combat sports. This algorithm consists of six steps and is aimed to study the basic elements, techniques, options of tactical actions which are essential for modern Olympic combat sports.

Determination of Indicators of Implementation of Sea Transportation Safety Management System for Traditional Shipping Based on Delphi Approach

The implementation of the safety management system (SMS) in traditional shipping in Indonesia, known as “Pelra”, has not been implemented. The nature of the operation pattern and characteristics of Pelra, which are still traditional (non-convention), means that international maritime rules such as SOLAS, MARPOL, LLC, Collreg, and STCW, as well as Indonesian government regulations related to shipping safety, are not suitable for Pelra. As a result, Pelra ship accidents continue to occur every year in Indonesian waters without any efforts to deal with safety management. The aim of this study is to find indicators to assess the implementation of Pelra’s SMS that adopt the specific characteristics of Pelra sea transportation. The analysis was conducted with a Delphi approach, based on expert opinion in the field of ship safety, which was tested using non-parametric statistics (Kendall’s W test). The consensus results obtained 9 factors described in 44 assessment indicators to implement SMS on Pelra vessels. Several new indicators were found, including indicators related to ship stability, ship construction, and safety and navigation equipment. The level of expert agreement from the concordance W coefficient value is in the range of 0.3 (moderately strong) to 0.7 (very strong), which suggests that these findings are valid and feasible to be used as assessment indicators in order to implement SMS Pelra.

O-101 Add-ons in the ART lab

Abstract Study question Which laboratory based add-ons are effective and safe to use in ART treatment? Summary answer In total, more than thirty recommendations were formulated on the use of add-ons, with about a third being laboratory based tests or interventions What is known already Treatment add-ons are defined as not essential for the treatment, but optional additional treatments that are sometimes offered on top of routine fertility treatment. There are a wide range of treatment add-ons available, including diagnostic tests, drugs, equipment, holistic or alternative therapies, laboratory and surgical interventions, all claiming to potentiate the effect of the treatment and/or to lessen side effects, improve pregnancy or live birth rate, reduce the risk of miscarriage or shorten the time to pregnancy. Add-ons and can be at extra cost (or not), and evidence on efficacy and safety is often missing. Presumably they can be both beneficial or non-beneficial, as there may be absence of evidence to either. Study design, size, duration The ESHRE working group for good practice recommendations on add-ons in ART has produced recommendations useful for professionals, patients and policy makers. More than 30 add-ons were identified, and evaluated for efficiency and safety, and wherever possible also for cost. The literature was identified in a systematic search, reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the multidisciplinary development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Interventions were characterized in three sections: 1) Diagnosis and diagnostic tests, 2) Laboratory tests and intervention, and 3) Clinical management. Outcomes were efficacy (pregnancy or live birth rate), risk of miscarriage, time to pregnancy, cost, and safety/risk aspects. Some examples of add-ons in the group of laboratory tests and interventions are oocyte and sperm activation, mitochondria load and transfer, sperm selection, assisted hatching, genetic testing and addition of hyaluronic acid to media. Main results and the role of chance The guideline development group formulated more than 30 recommendations. This lecture will focus on the rationale and the recommendations of the laboratory add-ons currently used in fertility clinics. We will discuss the potential beneficial effects on the IVF treatment, its efficacy, and its safety. While most add-ons are not recommended for the general population of ART patients, where specific patient populations might benefit, indications were formulated. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reason for caution Of the recommendations, none are based on high quality evidence and only a few are based on moderate quality evidence. Hence 90% of the recommendations are supported only by low quality RCTs, observational data, professional experience, or consensus of the development group. Wider implications of the findings These recommendations aim to provide guidance to health care professionals and laboratory experts in the field of reproductive medicine, to help towards safe and efficient ART treatments for patients where they can participate in informed decision making with realistic expectations and be fully informed about their chances to pregnancy and live birth. Study funding and competing interest(s) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production.