Expert Opinion Research Articles

Abuse of Circumstances as a Reason for Cancellation of Agreement in the Indonesian Legal System

This research aims to find out the development of the doctrine of abuse of circumstances as a reason for canceling an agreement in the Indonesian Legal System. The proposed problem formulation contains: How is the development of the doctrine of abuse of circumstances in the Civil Law Legal System, especially Indonesia? and how is the consideration of judges in Indonesia in giving court decisions related to the doctrine of abuse of circumstances? This research includes normative legal research, with data collected based on written regulations and expert opinions. The results of this study indicate that the development of the doctrine of abuse of circumstances has been recognized in the Netherlands which adheres to the Civil Law System in the form of legislation, while Indonesia only recognizes this doctrine as limited to court decisions or has not been adapted in the form of legislation. Nevertheless, some judges in deciding civil cases in Indonesia recognize and use the doctrine of abuse of circumstances as a reason for canceling agreements in several civil cases. This shows a dilemma in the enforcement of justice in Indonesia, especially in the context of civil law considering that Indonesia adheres to the Civil Law System so that the main reference for judges in deciding cases is the law. In this case, the doctrine of abuse of circumstances has not been regulated in written civil law in Indonesia.

Evaluation of the Cancer Awareness Measure in Adolescents in Turkiye: A Methodological Study.

Purpose: Cancer awareness can help reduce the associated morbidity and mortality. There is no scale for the assessment of general cancer awareness in Turkiye. This study aimed to evaluate the cultural relevance and psychometric properties of the cancer awareness measure (CAM) for use in adolescents in the Turkish population. Methods: This methodological study included 400 students attending seven high schools in western Turkiye, recruited by convenience sampling. The CAM was translated into Turkish and assessed for content validity by expert panel opinion and content validity index (CVI). The Turkish CAM was administered online, and its reliability was assessed using Cronbach's alpha coefficients, item-total and item-subscale correlation coefficients, and test-retest analysis. Results: The Turkish CAM had excellent content validity (scale CVI = 0.99). Cronbach's alpha for the entire scale was 0.72, and item-subscale correlation coefficients were 0.33-.75 (p < 0.001). Test-retest reliability was good, with an intraclass correlation coefficient of 0.83 for the entire scale (p < 0.001). The students' mean score on the Turkish CAM was 45.60 ± 7.23 (on a scale of 11-77), indicating moderate cancer awareness. Conclusion: The Turkish CAM is a valid and reliable measure that can be used to assess cancer awareness in adolescents in Turkiye. Interventional studies should be performed to measure and increase cancer awareness and promote cancer prevention among young people.

Determining Risk Management Priorities and Suggesting Strategies in the Management of Family Health Centres

Aim: The purpose of this study is to identify the risks faced by decision-makers in the management of Family Health Center (FHC) and to propose strategies according to their relative importance. Materials and Methods: Eight different risks were identified as a result of the literature review. In order to evaluate the identified risks, four different physicians with at least ten years of managerial experience in FHCs and two health managers with at least ten years of experience in their field were included in the study. SWARA (Stepwise Weight Assessment Ratio Analysis) method was used to evaluate and analyze the opinions. SWARA method is a weight calculation method based on expert opinions developed for the finalization of decision problems. Results: According to the results of the analysis, experts ranked financial risks (%27), clinical and patient safety risks (%21), and operational risks (%15) as the most important risks, respectively. Hazard risks (%4) were assessed as the least risky in relative terms. For FHCs to carry out their activities effectively, financial risks should be minimized first. Conclusions: Additional measures should be taken by the public for the use and rental of FHCs. Diversification of other sources of income can be ensured by expanding the health services provided beyond the resource transfer linked to the public budget. Regional investment and incentives can be developed by municipalities. Strengthening data protection policies to assess the compliance of medical practices with legal standards and to ensure the security of personal patient data can also reduce legal risks. In FHCs, general safety issues, especially patient safety, are also priority issues that should be investigated and legislation should be developed. In addition, management courses/training can be added to the family medicine specialty curriculum to improve the managerial skills of physicians.

Investigation of Professional Commitment Among Practicing Teachers in Higher Education Institutions

The present study aims to explore the phenomenon of professional commitment in the institutions of the Higher Education Department in the province of Punjab. The phenomenon is related to the teachers’ commitment to teaching, teamwork, and students’ welfare. The study framework follows the positivistic paradigm and quantitative approach through the survey method for hypothesizing phenomena and gathering and analyzing data. The study population consists of public-sector college teachers from Punjab, Pakistan. Through the multistage sampling technique, 803 public college teachers were selected as a sample of the study. The data was collected through a self-developed questionnaire, i.e., ‘measure for teachers’ professional commitment.’ For the validation purposes of the data tool, qualitative and quantitative analysis was carried out by seeking expert opinion and pilot testing for factor analysis to ensure the reliability and validity of the study instrument. Descriptive statistical analysis was applied to answer the study's research questions. The results reflect that professional commitment among teachers is at a low level, and commitment to teaching and teamwork is at a low level. Based on these conclusions, it is recommended that a low level of teachers’ professional commitment is critically important to be addressed through a selection of teachers who have taught as their first choice for the job to ensure intrinsic motivation. Furthermore, incentives, appreciation, and social recognition might be supportive for enhancing their commitment to teaching.

Variability of joint hypermobility in children: a meta-analytic approach to set cut-off scores

Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6% for studies reporting male data and 13% for studies reporting female data. Limited data reporting availability precluded further sub-analysis at a Beighton score of ≥ 7, age, pubertal status and ethnicity. Conclusion: The working threshold for identifying generalised joint hypermobility in children should be a Beighton score of 6 or more. Our analysis also suggests a Beighton score of 7 or greater may be appropriate in childhood, particularly for females.What is Known:• The working threshold for identifying generalised joint hypermobility in children previously was set based on expert opinion.What is New:• The threshold to identify hypermobility in children should be at a minimum of ≥ 6 on the Beighton score.

Enhancing Geosıte Accessibility Assessment: A New Mcdm Model

Geosites are significant geological heritage areas that serve as field laboratories for researchers. They offer insights into geological processes that have occurred from the past to the present and hold high potential for geotourism. To preserve and make geosites sustainable, their accessibility is a prerequisite. For this purpose, a model consisting of various parameters was developed in accordance with the Multi-Criteria Decision Making (MCDM) method, identifying 183 geosite areas that have been determined by experts and are subjects of literature. As a result, four evaluation criteria were established, including accessibility, access to service/attractiveness areas, scientific importance, and geomorphological features. Taking these parameters into account, a collective evaluation map was obtained using GIS-based AHP, drawing upon literature and expert opinions. The study concluded that the most critical parameter for accessibility to geosites is accessibility itself, accounting for 50% of the importance. Other parameters have influenced the accessibility of geosites in the following order of importance: 25% land, 15% scientific importance, and 10% service/attractiveness. Consequently, the areas where accessibility to geosites in Türkiye is most convenient are those with the highest road density. Road density, in turn, exhibits a pattern based on the characteristics of topography, population, and trade factors. Additionally, a parallel outcome emerged between areas that are more suitable in terms of these factors and the density of geosites. As a validation of the newly created model, the accessibility of Türkiye's areas recognized by UNESCO was found to be very high, indicating that the model is a suitable and convenient method that can be applied to different areas.

Social Sustainability Risk Assessment of Fresh Produce Supply Chain in China under Computer Technology and Digital Transformation

This paper investigates the social sustainability risks in China’s fresh produce supply chain amid ongoing digital transformation. As computer technologies reshape supply chain operations, understanding and mitigating associated social risks become paramount. This research aims to provide a comprehensive assessment of these risks, examining factors such as data and cyber security, inequality, and ethical sourcing concerns. Ten social risk criteria are identified through literature review and expert opinion. In a Sichuan case study, by integrating hybrid methodology Fuzzy Failure Modes and Effects Analysis (FMEA) and Fuzzy VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje), Data Privacy and Security Risks (SR1) stands out as the most critical risk criterion in the supply chain with the highest Q value, followed by Ethical Use of Technology (SR4) and Digital Dependency (SR5). This paper offers insights into how stakeholders can navigate the intersection of digitalization and social sustainability to foster more resilient and equitable fresh produce supply chains.

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Oxford Level 3.

Physiologically based trimester-specific serum ferritin thresholds for iron deficiency in US pregnant women

AbstractSerum ferritin (SF) concentration is the most widely used indicator for iron deficiency (ID). During pregnancy, the World Health Organization recently recommended SF thresholds for ID of <15 μg/L for the first trimester of pregnancy, based on expert opinion, and made no recommendations for the second and third trimesters. We examined the relationship of SF with 2 independent indicators of the onset of iron-deficient erythropoiesis, hemoglobin and soluble transferrin receptor 1, in cross-sectional data from US National Health and Nutrition Examination Survey for 1999 to 2010 and 2015 to 2018. We included 1288 pregnant women aged 15 to 49 years and excluded women with inflammation or potential liver disease. We used restricted cubic spline (RCS) regression analysis to determine SF thresholds for iron-deficient erythropoiesis. SF decreased during pregnancy; geometric mean SF was higher during the first and lower during the second and third trimesters. Using RCS analysis, the SF thresholds identified during pregnancy were <25.8 μg/L (18.1-28.5) during first trimester, <18.3 μg/L (16.3-22.9) during second trimester, and <19.0 μg/L (14.4- 26.1) during third trimester. These SF threshold levels track concentrations of hepcidin, the iron-regulatory hormone controlling the mobilization of iron stores. An SF concentration of <15 μg/L as the criterion for ID may underestimate the true prevalence of ID throughout pregnancy. In our study, an additional 1 of every 10 pregnant women would be recognized as iron deficient by using the physiologically based thresholds at SF of ∼25 μg/L during the first and ∼20 μg/L during the second and third trimesters.

Optimal Diagnostic and Treatment Practices for Facial Dysostosis Syndromes: A Clinical Consensus Statement Among European Experts.

Facial dysostosis syndromes (FDS) are rare congenital conditions impacting facial development, often leading to diverse craniofacial abnormalities. This study addresses the scarcity of evidence on these syndromes about optimal diagnostic and treatment practices. To overcome this scarcity, European experts from ERN CRANIO collaborated to develop a clinical consensus statement through the Delphi consensus method. A systematic search of Embase, MEDLINE/PubMed, Cochrane, and Web of Science databases was conducted until February 2023. The quality of evidence was evaluated using various tools depending on the study design. Statements were subsequently formed based on literature and expert opinion, followed by a Delphi process with expert health care providers and patient representatives. In total, 92 experts from various specialties and three patient representatives were involved in the Delphi process. Over 3 voting rounds, consensus was achieved on 92 (46.9%), 58 (59.2%), and 19 (70.4%) statements, respectively. These statements cover the topics of general care; craniofacial reconstruction; the eyes and lacrimal system; upper airway management; genetics; hearing; speech; growth, feeding, and swallowing; dental treatment and orthodontics; extracranial anomalies; and psychology and cognition. The current clinical consensus statement provides valuable insights into optimal diagnostic and treatment practices and identifies key research opportunities for FDS. This consensus statement represents a significant advancement in FDS care, underlining the commitment of health care professionals to improve the understanding and management of these rare syndromes in Europe.

Using crack width for shear, stiffness, and stirrup strain history predictions for reinforced concrete beams

Shear failures in reinforced concrete structures occur with little or no warning. Reinforced concrete members with shear cracks should be evaluated to ensure safety. Existing evaluation methods have large variability, require time-consuming modeling or expert opinion. This study uses machine learning to investigate correlations of crack width with shear loading, stiffness, and stirrup strain histories. Experimental literature enables the assembly of a database of rectangular reinforced concrete slender beams with crack width measurements for beams with shear reinforcement amounts smaller and larger than the minimum required by ACI 318-19. Measured data include crack widths from 122 beams, load–displacement relationship from 100 beams, and stirrup strains from 46 beams. Gaussian Process Regression is used to correlate crack width and geometric, material and design properties to shear loading, stiffness, and stirrup strain histories. Ten-fold cross validation training shows mean absolute percent errors of 18, 33 and 77% for shear, stiffness, and stirrup strain history predictions. The proposed algorithms can be used to accelerate the evaluation of in-service structures and can be updated upon availability of additional data.

A qualitative assessment of influenza vaccine uptake among children in Kenya

BackgroundInfluenza is a significant contributor to acute respiratory infections (ARI), and children < 5 years are at increased risk of severe influenza disease. In Kenya the influenza vaccine is not included in the Kenya Expanded Programme on Immunization (KEPI). To inform roll-out of a national influenza vaccination program, we implemented an influenza vaccine demonstration project in Nakuru and Mombasa counties in Kenya from 2019 to 2021 and set out to establish factors driving influenza vaccine acceptance and hesitancy among caregivers of children aged 6–23 months. MethodsUsing semi-structured questionnaires, we conducted eight focus group discussions among community members and twelve key informant interviews among healthcare workers to elicit both lay and expert opinions. Thematic analysis of the interviews was conducted using the World Health Organization’s “3 Cs” model of vaccine hesitancy to determine reasons for acceptance or hesitancy of the influenza vaccine. ResultsThe influenza vaccine was well received among community members and healthcare workers though concerns were raised. Vaccine hesitancy was fuelled by misconceptions about reasons for introducing the vaccine (confidence), perceptions that influenza was not a serious disease (complacency) and administrative fees required at some facilities (convenience). Despite the use of various advocacy, communication and social mobilisation strategies targeted at educating the community on the influenza disease and importance of vaccination, there remained a perception of inadequate reach of the sensitization among some community members. Contextual factors such as the COVID-19 pandemic affected uptake, and parents expressed concern over the growing number of vaccines recommended for children. ConclusionDespite lingering concerns, caregivers had their children vaccinated indicating that vaccine hesitancy exists, even among those who accepted the vaccine for their children. Efforts targeted at increasing confidence in and reducing misconceptions towards vaccines through effective communication strategies, are likely to lead to increased vaccine uptake.

Management of immune-mediated necrotizing myopathy.

The immune-mediated necrotizing myopathies (IMNM) are autoimmune myositides clinically characterized by proximal predominant weakness and elevated creatine kinase (CK). They may be associated with autoantibodies (anti-HMGCR, anti-SRP), triggered by statin use (e.g., anti-HMGCR myopathy), associated with cancer, or may be idiopathic. Immunotherapy is required to improve strength and decrease the CK level, but no therapies are currently approved by the U.S. Food and Drug Administration for the treatment of IMNM. The optimal treatment strategy for IMNM is currently unknown and wide practice variation exists in the management of this condition. However, observational studies and expert opinion suggest that certain therapies may be more effective for the different serological subtypes of IMNM. HMGCR IMNM often responds favorably to intravenous immunoglobulin (IVIG) even as monotherapy. Signal recognition peptide and seronegative IMNM typically require combination immunotherapy, most often consisting of an oral immunosuppressant, corticosteroids, and IVIG or rituximab. Patients often remain on immunotherapy for years and relapse is common during tapering of immunotherapy. Further studies are needed to guide the optimal management of these patients.

First modified Delphi consensus statement on robotic-assisted da Vinci sleeve gastrectomy

BackgroundSleeve gastrectomy (SG) is the most commonly performed metabolic and bariatric surgery (MBS) procedure. Technical considerations related to the performance of SG are well established and reported in the literature but not in relation to robotic-assisted (RA) SG. We report the results of the first modified Delphi consensus-building exercise addressing technical considerations of RA da Vinci (dV) SG. MethodsA consensus building committee (CBC) was created comprising 10 experts in the field of RA surgery and MBS based on strict selection criteria. The CBC developed 49 consensus statements which were then shared with 240 experts in RA surgery. Our stopping criterion was stability in responses (≤15%). The consensus cut point was 70%. ResultsThe overall response rate was 49%. In the first round of voting, there was consensus agreement on 25 statements (51%), consensus disagreement on 14 (28%), and no consensus on the remaining statements (21%). In the second round of voting, we reached agreement on 3 additional statements. Experts recommended the use of the number of pauses generated by the stapler to guide choice of staple height (91.2%) and to upsize the staple height when using buttressing (92%). There was also consensus (81.4%) that the use of the closed staple height of 1.00 mm (white) is acceptable and that stapling of the antrum using a 1.5-mm staple (blue load) is also acceptable (73%). ConclusionsCollective expert opinion structured through a modified Delphi consensus statement presents a practical guide for surgeons interested in performing dV-SG.

Compilation of a Tool to Measure Financial Knowledge and Skills of Hospital Managers

Introduction: The hospitals, as the most important organization providing healthcare services, need efficient and effective management more than any other organization. Therefore، knowledge, skills, and capabilities of hospital managers should be given special attention، and one of these skills is financial knowledge and skill. Therefore، this research has been done with the aim of developing and validating a tool for measuring the knowledge and financial skills of hospital managers. Methods: The present combined study was conducted in 1401-1402. The research community included managers of educational and therapeutic hospitals, academic faculty members, and graduate students of accounting and financial management as financial experts (Delphi panel). Sampling started purposefully and continued until data saturation. To collect data, interviews, focused group discussions and questionnaires were used, and fuzzy Delphi and fuzzy AHP methods were used to analyze the data. Results: The important dimensions and components were determined according to the fuzzy Delphi method, including 8 dimensions and 23 indicators, and with the help of the AHP method, the weight of each dimension was determined. Then, 68 multiple choice questions related to each of the identified dimensions were designed based on interviews with experts. In the next step, through questionnaire and fuzzy Delphi technique, the opinion of experts was obtained about the questions raised, and finally 46 four-choice questions were compiled as a tool to measure the knowledge and financial skills of hospital managers. Conclusion: Hospitals are important parts of providing health services and considering the limited resources of the health sectors, proper allocation of resources, application of scientific management, correct and principled planning will be an important step in achieving the goals of the health system. A proper understanding of the principles of financial management and how to present financial information and how to share costs in hospitals help the managers of hospitals to have a dynamic picture of their activities and goals and to be able to make more informed decisions for the future.

Development of wastewater quality index as an assessment tool of treated wastewater quality for sea discharge

AbstractThe evaluation of the effluent water quality from wastewater treatment plants is fundamental for human health and aquatic environment considerations. Therefore, this research presents a new and specific water quality index for evaluating the effluent water discharged into the sea by integrating the complex set of wastewater qualities into a single reliable value. Two approaches were utilized for this purpose: experts' opinions and statistical analysis using principal component analysis. In the first approach, the opinions of local experts shortlisted the parameters into six important parameters out of a list of 19 with assigned weights varied from 0.160 to 0.174. In the statistical approach, principal component analysis and correlation analysis reduced the parameters to seven accounting for 75% of the variation in the data. Their weights were calculated based on their eigenvalues and ranged from 0.063 to 0.435. The subindices rating curves were developed based on the Kingdom of Bahrain's legislated standards and the weighted arithmetic mean function was used for the aggregation stage. The established water quality indices were applied to effluents from a local wastewater treatment plant, and the obtained results revealed “Class 1: excellent category” discharge quality maintained throughout the year as per the categories proposed in this work. The developed indices proved their effectiveness and reliability in assessing the treated water. The study provides a comprehensive and reliable assessment of treated water quality, and its approach and outputs could have significant implications globally for ensuring the quality of treated water prior its discharge and promoting sustainable development.

A scale for seventh and eighth grade students’ attitudes towards skill-based mathematics questions

The aim of this study is to develop a theoretically sound, valid, and reliable scale to examine seventh and eighth grade students’ attitudes towards so-called skill-based mathematics questions (SBMQ). The sample of the study was 820 seventh and eighth grade students at three different middle schools in Etimesgut District of Ankara Province. A draft item pool was crafted after a detailed literature review and the scale was finalized for the implementation after receiving expert opinions. This version of scale was administered shortly before the national examination which included skill-based questions in the 2022-2023 academic year. Exploratory and confirmatory factor analysis methods were used to examine the construct validity of the scale. The analysis resulted in 16 items in three factors (affective, cognitive, and motivational) which explained 46% of the total variance. Cronbach’s alpha and composite reliability scores were above .70 for each factor and whole scale. The results indicated that the Attitudes Towards SBMQ Scale developed for seventh and eighth grade students is valid and reliable.

Middle Eastern Expert Opinion: Strategies for Successful Antifungal Stewardship Program Implementation in Invasive Fungal Infections.

In recent years, global public health efforts have increasingly emphasized the critical role of antimicrobial stewardship (AMS) in improving outcomes, reducing costs, and combating the growing threat of antimicrobial resistance. However, antifungal stewardship (AFS) has remained relatively overlooked despite the staggering impact of invasive fungal infections (IFIs). This burden is particularly pronounced in hospitals worldwide, with the Middle East facing significant unmet needs. The rising population of immunocompromised individuals vulnerable to IFI has prompted an increased reliance on antifungal agents for both prevention and treatment. Given the considerable mortality associated with IFIs and the emergence of antifungal resistance, implementing AFS programs in hospital settings is becoming increasingly urgent. In this article, we offer expert insights into the strategies that can be used for successful antifungal stewardship program implementation in IFI. Drawing upon the extensive clinical experience of a multinational and multidisciplinary panel, we present recommendations for optimizing AFS practices. We delve into the challenges and practical considerations of tailoring local AFS initiatives to the evolving landscape of fungal infections. Additionally, we provide actionable recommendations and position statements for the effective implementation of AFS programs, informed by the collective clinical experiences of panel members across their respective countries of practice.

Evaluation of Basic Shirt and Pant Fit Using Analytic Hierarchy Process-AHP and 3D CLO for 20-25 Years Bangladeshi Men

Background: The proportion of a garment to its body is known as garment fit. To ensure comfort between the human body and clothing, fit is very important. At present, 3D simulation of garment fit has great potential for business purposes. However, in previous analyses, there were expert opinions on manual fit analysis, which is very popular in the industry. Objectives: The main objectives of this research are to ensure manual clothing fits with a live model with 3D CLO software evaluation. Method: In this study, up to 50 textile experts from industries have chosen to analyze the analytical hierarchy process (AHP) to evaluate clothing fit. Findings: In this study, small, medium, and large-sized basic shirts and pants (20–25 years old) have been developed for live model fit evaluation. According to the analytical hierarchy process (AHP), among small, medium, and large-sized basic shirts and pants, one or two sizes of garments have been tested for garment fit evaluations. The results of these fit evaluations are satisfactory, according to 50 textile experts, and are the main output of the 3D CLO software. Novelty: The analytic Hierarchy Process (AHP) is fully adopted by the Bangladeshi newly developed size chart, which is enhanced by the 3D CLO software. Keywords: Analytic Hierarchy Process (AHP), 3D CLO, Shirts, Pant, Garments, Bangladesh

Navigating the Value of Experiences and Expert Opinions in Evidence-Based Medicine

In the context of our topic of evidence-based medicine, are our experiences and expert opinions a reliable source of evidence? If not, why not? If so, how much should we rely on experience and opinion (whether ours or others) to guide our clinical decision-making?