Expert Opinion Research Articles

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion.

Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique. A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP. The group systematically reviewed existing literature, consensus statements, and expert opinions to identify key areas requiring standardization, including predonation evaluation, intraoperative management, postdonation procedures, and future research directions. The working group formulated recommendations encompassing donor evaluation and selection criteria, premortem testing and therapeutic interventions, communication protocols, and procedural guidelines for TA-NRP implementation. These recommendations aim to facilitate coordination among transplant teams, minimize variability in practice, and promote transparency and accountability throughout the TA-NRP process. The consensus guidelines presented herein serve as a comprehensive framework for the successful and ethical implementation of TA-NRP programs in organ procurement from donation after circulatory death donors. By providing standardized recommendations and addressing areas of uncertainty, these guidelines aim to enhance the quality, safety, and efficiency of TA-NRP procedures, ultimately contributing to improved outcomes for transplant recipients.

The Liver Cirrhosis Network Cohort Study: Cirrhosis Definition, Study Population, and Endpoints.

One of the primary goals of the Liver Cirrhosis Network (LCN) is to develop a cohort study to better understand and predict the risk of hepatic decompensation and other clinical and patient-reported outcomes among patients with Child A cirrhosis. The LCN consists of a Scientific Data Coordinating Center (SDCC) and 10 clinical centers whose investigators populate multiple committees. The LCN Definitions and Measurements Committee developed preliminary definitions of cirrhosis and its complications by literature review, expert opinion, and reviewing definition documents developed by other organizations. The Cohort Committee developed the study protocol with the input of the steering committee. The LCN developed a prospective cohort study to describe and predict the rates of incident clinical events pertaining to first decompensation and patient reported outcomes. The LCN developed a pragmatic definition of compensated cirrhosis incorporating clinical, laboratory, imaging, and histological criteria. Definitions of incident and recompensated ascites, overt hepatic encephalopathy, variceal hemorrhage, bleeding due to portal gastropathy, and hepatocellular carcinoma were also codified. The LCN Cohort Study design will inform the natural history of cirrhosis in contemporary patients with compensated cirrhosis. The LCN Definitions and Measures Committee developed criteria for the definition of cirrhosis to standardize entry into this multi-center cohort study and standardized criteria for liver-related outcome measures. This effort has produced definitions intended to be both sensitive and specific as well as easily operationalized by study staff such that outcomes critical to the LCN cohort are identified and reported in an accurate and generalizable fashion.

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion.

Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique. A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP. The group systematically reviewed existing literature, consensus statements, and expert opinions to identify key areas requiring standardization, including predonation evaluation, intraoperative management, postdonation procedures, and future research directions. The working group formulated recommendations encompassing donor evaluation and selection criteria, premortem testing and therapeutic interventions, communication protocols, and procedural guidelines for TA-NRP implementation. These recommendations aim to facilitate coordination among transplant teams, minimize variability in practice, and promote transparency and accountability throughout the TA-NRP process. The consensus guidelines presented herein serve as a comprehensive framework for the successful and ethical implementation of TA-NRP programs in organ procurement from donation after circulatory death donors. By providing standardized recommendations and addressing areas of uncertainty, these guidelines aim to enhance the quality, safety, and efficiency of TA-NRP procedures, ultimately contributing to improved outcomes for transplant recipients.

Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study.

To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). The study design was based on a three-round e-Delphi survey. A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.

Spatio-temporal forecasting for the US Drought Monitor

Abstract The US Drought Monitor is the leading drought monitoring tool in the United States. Updated weekly and freely distributed, it records the drought conditions as geo-referenced polygons showing one of six ordered levels. These levels are determined by a mixture of quantitative environmental measurements and local expert opinion across the entire United States. At present, forecasts of the Drought Monitor only convey the expected direction of drought development (i.e. worsen, persist, subside) and do not communicate any uncertainty. This limits the utility of forecasts. In this paper, we describe a Bayesian spatio-temporal ordinal hierarchical model for use in modelling and projecting drought conditions. The model is flexible, scalable, and interpretable. By viewing drought data as areal rather than point-referenced, we reduce the cost of sampling from the posterior by avoiding dense matrix inversion. Draws from the posterior predictive distribution produce future forecasts of actual drought levels—rather than only the direction of drought development—and all sources of uncertainty are propagated into the posterior. Spatial random effects and an autoregressive model structure capture spatial and temporal dependence, and help ensure smoothness in forecasts over space and time. The result is a framework for modelling and forecasting drought levels and capturing forecast uncertainty.

Research on Coupling Effect Measurement and Coupling Risk Simulation of Green Building Construction Safety Risk Factors

The construction of green buildings is an important direction for the transformation and development of the construction industry, but it is beset with problems such as a lack of construction experience, immature new technologies, and unstable material properties; these issues bring risks to the construction stage of green buildings, and the coupling of uncertain risk factors in the construction process of green buildings may lead to unfavorable results. The purpose of this study is to explore the coupling degree of green building construction safety risk factors and the changing trend in their coupling combinations at the system risk level. First, the risk factor index system was defined by reading the literature and gathering expert opinions, and the coupling degree between risk factors was measured using an improved coupling degree model. Then, a system dynamics model was established to simulate and analyze the coupling effects among the risk factors and determine the combinations with the greatest influence. The results show that the risk probability is proportional to the risk coupling value, the human–environment coupling value is the largest, and the material equipment–management coupling value is the smallest. The human–environment system simulation shows that reducing the coupling value of system factors will promote a decrease in the total level of system risk. According to the research conclusions, measures to prevent risk coupling are proposed, which offer theoretical references for green building practitioners carrying out risk management; these measures hold a certain guiding significance for the risk control and future development of green buildings.

Dealing with Evidence in Dental Professional Liability Lawsuits-General Recommendations for Dental Expert Witness Work Using the Example of Germany: A Narrative Review.

Dental treatment can lead to disputes between patients and dentists, which are then brought before the civil courts as medical malpractice cases. The court regularly commissions a dental expert to answer questions of evidence in court. In the majority of cases, the expert is able to answer these questions based on his professional expertise and practical experience. In order to make the assessment comprehensible and credible for the judge and the parties, it can be helpful and reasonable to cite relevant literature references from dental textbooks and specialist journals. In individual cases, it may be necessary to carry out a systematic literature search on specific topics. Based on the situation in Germany, this narrative review makes recommendations of how to perform a literature search and make citations specifically for expert opinions that are generally applicable independent of national jurisdiction.

Natural Disaster Mitigation Strategies: A Comprehensive Review

The world is often rocked by the devastating effects of natural disasters, presenting a formidable challenge to communities everywhere. In order to address these challenges and minimize their impact, it becomes imperative for proactive measures to be taken. This comprehensive review delves into the wide array of strategies put in place to mitigate the vulnerability of both populations and infrastructure when faced with these hazardous occurrences. Taking into account an extensive range of literature, case studies, and expert opinions, this review strives to synthesize crucial findings that shed light on effective approaches towards mitigation. It commences by classifying natural disasters according to their distinct characteristics and geographical spread, bringing attention to their individual traits. Furthermore, it embarks on an analysis aimed at uncovering the root causes and driving factors behind these calamities - underlining how essential it is for us all to comprehend their dynamics in order to craft tailored mitigation plans. The significance of pre-disaster preparedness is emphasized through an exploration of risk assessment procedures, early warning systems implementation practices as well as land-use planning strategies. The critique emphasizes the importance of proactive measures, such as fortifying infrastructure and incorporating resilience principles into city planning. It also discusses the vital role of community engagement, education, and capacity building in bolstering disaster preparedness at a local level. The review delves into innovative methods for promoting community resilience, including participatory decision-making processes and initiatives focused on knowledge exchange. Furthermore, it evaluates the impact of technological advancements like remote sensing, geographic information systems (GIS), and predictive modeling on enhancing early warning systems, risk assessment protocols, and disaster response efforts. The analysis suggests various opportunities for utilizing technology to strengthen mitigation strategies effectively Post-disaster Response and Recovery: Analyzing the challenges and opportunities in postdisaster response and recovery efforts, emphasizing the importance of rapid and coordinated interventions to restore essential services, infrastructure, and livelihoods. The review explores strategies for promoting resilient reconstruction and long-term recovery. Policy Frameworks and International Cooperation: Evaluating the role of policy frameworks, international cooperation, and funding mechanisms in supporting effective disaster mitigation efforts. The review identifies policy gaps and barriers to implementation, along with recommendations for enhancing policy coherence and coordination at the national and international levels. In conclusion, this comprehensive review underscores the multidimensional nature of natural disaster mitigation and the importance of adopting integrated approaches that combine technical expertise, community engagement, and policy support. By synthesizing existing knowledge and best practices, this review provides valuable insights for policymakers, practitioners, and researchers striving to build more resilient and sustainable communities in the face of natural hazards. By synthesizing existing knowledge and best practices, this review provides valuable insights for policymakers, practitioners, and researchers striving to build more resilient and sustainable communities in the face of natural hazards.

International Council for Standardization in Haematology (ICSH) recommendations for the performance and interpretation of activated partial thromboplastin time and prothrombin time mixing tests.

This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the performance and interpretation of activated partial thromboplastin time (APTT) and prothrombin time (PT) plasma mixing tests in clinical laboratories in all regions of the world. The following areas are included in this document: preanalytical, analytical, postanalytical, and quality assurance considerations as they relate to the proper performance and interpretation of plasma mixing tests. The recommendations are based on good laboratory practice, published data in peer-reviewed literature, and expert opinion.

The Influence of Land Subsidence on Risk of Constructing 150 kV Transmission Tower for South Sumatra – Bangka Belitung Interconnector

Transmission system is one of the national essential objects and should be reliable when functioning. Moreover, disturbances in transmission system can lead to disruption of the service function. A common risk to the reliability of electric distribution is land subsidence on transmission tower. Furthermore, the 150 KV interconnector of South Sumatra-Bangka Belitung (Sumsel-Babel) is located in the coastal area of Banyuasin Dua sub-district, South Sumatra. This area is a river delta with peat and clay soil structures and is prone to land subsidence. Therefore, this research aimed to identify environmental factors that affect land subsidence and cause risk to transmission tower. In the context of this research, Copras (Complex Proportional Assessment) and MCSA (Multi Criteria Spatial Analysis) were used for parameter weighting and risk assessment of tower location, respectively. The results of an expert survey to assess risk of potential land subsidence at tower location showed five parameters, namely, land use, distance to waters or potential flooding, land slope factor, soil type, and conus value. Individual parameters were weighted quantitatively and qualitatively based on the opinions of construction experts. Specifically, the qualitative method was performed by weighting based on criteria and sub-criteria, which were analyzed using Analytic Hierarchy Process (AHP). On the other hand, spatial analysis of locations at risk of land subsidence was conducted using GIS software. Based on the assessment results obtained, land use criteria had the largest weighting influence of 0.340 and the smallest weighting on the cone value was 0.08. Finally, tower location that are most at risk of land subsidence are on peatland, near water, and clay soil.

Enhanced Condition Monitoring of Gearboxes using Fuzzy Comprehensive Evaluation and Group Decision-making: A Case Study

In this study, we introduce a novel methodology for the condition monitoring of gearboxes by integrating fuzzy comprehensive evaluation and group decision-making. Traditional risk assessment methods often suffer from subjective biases and uncertainties inherent in expert evaluations. Our approach mitigates these limitations by aggregating expert opinions using fuzzy membership functions and assigning weights based on the similarity of individual evaluations to the group consensus. This converts qualitative judgments into quantitative measures, resulting in more precise and objective Risk Priority Numbers (RPNs). We validate the efficacy of our methodology through a case study involving a gearbox. The primary failure modes identified include gear tooth wear, misalignment, bearing failure, lubrication failure, and thermal overload. Our results indicate a significant improvement in condition monitoring accuracy, with calculated fuzzy RPN values closely aligning with historical data and expert feedback. Comparative analysis highlights the advantages of our methodology over conventional RPN calculations, particularly in reducing subjective biases and enhancing the reliability of risk assessments. Our findings demonstrate that this methodology can be effectively applied in various industrial settings, establishing a robust framework for mechanical system condition monitoring. Future research should explore integrating advanced data analytics and machine learning techniques to enhance the methodology's accuracy and efficiency.

Exploring the National Nursing Research Priorities in the Eastern Mediterranean Region and Overcoming the Associated Challenges: An Expert Opinion

Exploring the National Nursing Research Priorities in the Eastern Mediterranean Region and Overcoming the Associated Challenges: An Expert Opinion

Sequencing of Targeted Therapy in Psoriasis: Does it Matter?

With the continued development of biologics for the treatment of psoriasis, some patients have achieved optimal control, but a recommended biologic sequence if a biologic fails to initially improve the skin, termed primary nonresponse, or loses efficacy after initial improvement, termed secondary nonresponse, is still lacking. Primary and secondary nonresponse can occur with any class of biologics, and the type of nonresponse can drive the choice of whether to switch within a biologic class or to a different biologic class. The choice of biologic can also be challenging when managing psoriasis and concomitant psoriatic arthritis, as treatment differs on the basis of the severity of both diseases and further classification of axial and peripheral joint involvement. When choosing a biologic, each patient's comorbidities and preferences are also taken into account to provide the optimal therapy. With this lack of anestablishedbiologic sequence after biologic failure, the objective of our review is to define a therapy sequence for the tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitor classes in the treatment of psoriasis and psoriatic arthritis. Our proposed biologic sequence was derived through an analysis of the efficacy of each biologic class, primary and secondary nonresponse rates from clinical trials, and clinical experience with expert opinion.

Developing an airport resilience assessment model for climate change

Climate change is affecting the stability of all types of transportation systems, including air transport. Ensuring the disaster preparedness capability of an airport has become a crucial issue. Prior studies on assessing airport resilience and risk analysis have failed to consider the impact of the disaster at various stages and the interdependence between the factors or criteria. This study proposes airport resilience model that considers the various stages of disaster response. First, we collect criteria affecting airport resilience through literature review and experts' survey to develop a novel evaluation framework. Second, this study applies the modified DEMATEL (Decision Making Trial and Evaluation Laboratory) which was modified by introducing the concept of heterogeneous impact analysis and combined with the concept of centrality weighting. Then, the modified DEMATEL is further combined with the Dombi Weighted Aggregator method to explore the interdependence relationships among the criteria and effectively integrate expert opinions. Finally, modified VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje) analysis is applied to assess the resilience performance of Taiwan's major international airports and provide suggestions for improvement. The results indicate that pre-disaster preparation, with a weight of 0.338 among four stages, is the most crucial stage for enhancing airport resilience. This can be achieved through the implementation of effective emergency response procedures and evacuation plans in the event of a disaster. Additionally, this study suggests various improvement strategies based on the assessment results to enhance disaster resistance and resilience.

Budget Impact Analysis of Olaparib for the Management of Patients with Homologous Recombination Repair (HRR)-Mutated Castration-Resistant Metastatic Prostate Cancer in Argentina.

The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina. A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness. The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results. The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.

A trauma expert consensus: Capabilities are required early to improve survivability from traumatic injury.

Mortality reviews examine US military fatalities resulting from traumatic injuries during combat operations. These reviews are essential to the evolution of the military trauma system to improve individual, unit, and system-level trauma care delivery and inform trauma system protocols and guidelines. This study identifies specific prehospital and hospital interventions with the potential to provide survival benefits. US Special Operations Command fatalities with battle injuries deemed potentially survivable (2001-2021) were extracted from previous mortality reviews. A military trauma review panel consisting of trauma surgeons, forensic pathologists, and prehospital and emergency medicine specialists conducted a methodical review to identify prehospital, hospital, and resuscitation interventions (e.g., laparotomy, blood transfusion) with the potential to have provided a survival benefit. Of 388 US Special Operations Command battle-injured fatalities, 100 were deemed potentially survivable. Of these (median age, 29 years; all male), 76.0% were injured in Afghanistan, and 75% died prehospital. Gunshot wounds were in 62.0%, followed by blast injury (37%), and blunt force injury (1.0%). Most had a Maximum Abbreviated Injury Scale severity classified as 4 (severe) (55.0%) and 5 (critical) (41.0%). The panel recommended 433 interventions (prehospital, 188; hospital, 315). The most recommended prehospital intervention was blood transfusion (95%), followed by finger/tube thoracostomy (47%). The most common hospital recommendations were thoracotomy and definitive vascular repair. Whole blood transfusion was assessed for each fatality: 74% would have required ≥10 U of blood, 20% would have required 5 to 10 U, 1% would have required 1 to 4 U, and 5% would not have required blood products to impact survival. Five may have benefited from a prehospital laparotomy. This study systematically identified capabilities needed to provide a survival benefit and examined interventions needed to inform trauma system efforts along the continuum of care. The determination was that blood transfusion and massive transfusion shortly after traumatic injury would impact survival the most. Expert Opinion; Level V.

Management of diabetes-related hyperglycaemic emergencies in advanced chronic kidney disease: Review of the literature and recommendations.

Despite the substantial progress in the management of diabetes mellitus (DM), chronic kidney disease (CKD) remains one of the most common complications. Although uncommon, diabetic emergencies [diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS)] can still occur in stage 4 and 5 CKD, at times with less typical clinical manifestations due to the altered pathophysiology, presence of chronic metabolic acidosis and effect of haemodialysis on glycaemic control and metabolic parameters. The purpose of this article is to review the current literature and provide recommendations for the diagnosis and treatment of DKA, euglycaemic DKA and HHS in people with advanced CKD. Guidance on the management of diabetes-related emergencies mainly focuses on individuals with preserved renal function or early-stage CKD. Existing literature is limited, and recommendations are based on expert opinions and case reports. Given the clinical need for amended guidelines for this population, we are proposing a management algorithm for DKA and HHS based on clinical and metabolic parameters. In this review article, we propose treatment algorithms for diabetes-related hyperglycaemic emergencies in people with advanced CKD. Further research is needed to validate our proposed algorithms.

2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc.MethodsA systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed.ResultsSix recommendations were elaborated regarding the pharmacological treatment of Raynaud’s phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found.ConclusionThese guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.

Integrating Religious Moderation into Islamic Religious Education: Strategies and Impacts

This study examines the implementation of religious moderation values in Islamic religious education at SMK TI Bali Global Klungkung. Through a qualitative approach, the main finding of this research is the identification of ten religious moderation values being implemented: justice, balance, tolerance, centrism, love for the country, deliberation, improvement, pioneering, non-violence, and cultural friendliness. The implementation is achieved by integrating these values into the curriculum, evaluation techniques, and daily life practices, as well as through habituation and exemplification. The results have positive implications, such as establishing harmonious relationships between Muslim students and the community, increasing student achievement and creativity, and boosting the number of Muslim students in the school. The findings align with the concept of moderation in Islam, behavioristic theory, and expert opinions on religious moderation as a solution to the problem of radicalism. This research contributes to forming students with moderate, tolerant, fair, balanced, and non-violent characters who can adapt to a pluralistic environment following the objectives of Islamic education. The limitation of this study is that its scope is confined to one school.

Development of a Preoperative Screening Tool to Reduce Morbidity and Mortality of COVID-19-positive Hepatobiliary Patients

PurposeThis study aimed to create a preoperative risk assessment form for COVID-19-positive hepatobiliary patients to guide further prevention of complications after surgery and reduce morbidity and mortality. DesignBased on the literature, focus groups, and case studies, a multidisciplinary panel of 15 experts conducted three rounds of a Delphi study that resulted in the development of a preoperative risk assessment form to be used by healthcare professionals in the treatment of COVID-19-positive hepatobiliary patients. MethodsA preoperative risk assessment form for health professionals to use among COVID-19-positive hepatobiliary patients was developed based on literature, focus groups, and case studies. A 3-round Delphi study was conducted to validate and revise the risk assessment form using a multidisciplinary panel of 15 experts involved in hepatobiliary surgery. FindingsThe experts demonstrated high cooperation and familiarity with the research topic, with positive coefficients ranging from 93.33% to 100% and authority coefficients ranging from 0.83 to 0.86. The coordination coefficients were 0.33, 0.26, and 0.22, respectively, indicating good coordination among expert opinions. The final risk assessment form included 9 primary (first-level) indicators, 38 secondary (second-level) indicators, and 122 tertiary (third-level) indicators. ConclusionsThe preoperative risk assessment form for hepatobiliary surgery patients infected with COVID-19 is scientifically rigorous, reliable, and valid. This screening tool may be used by health providers to identify high-risk patients, prevent postoperative complications, and reduce morbidity and mortality.