Expert Panel Discussion Research Articles

Developing a Shared Decision-Making Model for Diabetic Patients: A Qualitative Study

Background: Patient participation in healthcare leads to increased satisfaction and trust, reduction of anxiety, and a better understanding of patients’ needs. The components of shared decision-making (SDM) are well documented in the literature. The purpose of this study was to design an SDM model for diabetic patients. Materials and Methods: This qualitative content analysis study was performed in three steps. First, a descriptive comparative study was conducted using the widely-used George Brady method. Next, the perceptions of participants (both physicians and patients) were collected via interview and in focus group discussions (FGDs). Content analysis was used to categorize the comments made by participants. In the final step, the model of SDM for diabetic patients was designed based on expert panel discussions. Results: Twelve components were extracted from the comparative study. Two themes and six sub-themes were extracted from data resulting from physicians’ interviews, and two themes and ten sub-themes were extracted from data resulting from the FGDs involving patients. The model of SDM for diabetic patients was designed in light of three concepts; practitioners’ behavior, participatory decision-making process, and patients’ autonomy. Conclusion: This model was valuable because it recognizes the process of SDM in the context of Iran. The model’s main purpose was to help choose optimum strategies for the care of diabetic patients within the health sector. [GMJ.2021;10:e1735]

Principles of Economic Evaluation in a Pandemic Setting: An Expert Panel Discussion on Value Assessment During the Coronavirus Disease 2019 Pandemic.

As the coronavirus disease 2019 (COVID-19) pandemic continues to generate significant morbidity and mortality as well as economic and societal impacts, the landscape of potential treatments has slowly begun to broaden. In the case of a novel disease with widespread consequences, society is more likely to place significant value on interventions that reduce the outsized economic burden of COVID-19. Treatments for severe disease will have a different value profile to that of large-scale vaccines because of their application in targeted and potentially small subsets of those with symptomatic disease vs broad deployment as a preventative measure. Where vaccines reduce transmissibility of COVID-19, use of therapeutics will target symptoms, up to and including death for infected individuals. This paper describes discussions from a virtual expert panel that met to attempt a consensus on how existing principles of economic evaluation should be applied to therapeutics that emerge in a pandemic setting, with specific focus on severe hospitalised cases of COVID-19. The panel concluded that the core principles of economic evaluation do not need to be drastically overhauled to meet the challenges of a pandemic, but that there are several additional elements of value such as equity, disease severity, insurance value, and scientific and family spillover effects that should be considered when presenting results to decision makers. The panel also highlighted the persistent challenges on how society should value novel therapies, such as the appropriate cost-effectiveness threshold to apply, which are particularly salient during a pandemic.

Hypogonadism in Adult Males with Prader-Willi Syndrome-Clinical Recommendations Based on a Dutch Cohort Study, Review of the Literature and an International Expert Panel Discussion.

Prader-Willi syndrome (PWS) is a complex genetic syndrome characterized by hyperphagia, intellectual disability, hypotonia and hypothalamic dysfunction. Adults with PWS often have hormone deficiencies, hypogonadism being the most common. Untreated male hypogonadism can aggravate PWS-related health issues including muscle weakness, obesity, osteoporosis, and fatigue. Therefore, timely diagnosis and treatment of male hypogonadism is important. In this article, we share our experience with hypogonadism and its treatment in adult males with PWS and present a review of the literature. In order to report the prevalence and type of hypogonadism, treatment regimen and behavioral issues, we retrospectively collected data on medical interviews, physical examinations, biochemical measurements and testosterone replacement therapy (TRT) in 57 Dutch men with PWS. Fifty-six (98%) of the patients had either primary, central or combined hypogonadism. Untreated hypogonadism was associated with higher body mass index and lower hemoglobin concentrations. TRT was complicated by behavioral challenges in one third of the patients. Undertreatment was common and normal serum testosterone levels were achieved in only 30% of the patients. Based on the Dutch cohort data, review of the literature and an international expert panel discussion, we provide a practical algorithm for TRT in adult males with PWS in order to prevent undertreatment and related adverse health outcomes.

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence.

BackgroundEvidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population’s perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts.Methods and findingsWe searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data.ConclusionsThis systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.

A new comprehensive oral health literacy scale: development and psychometric evaluation

BackgroundIt has been widely accepted that oral health status is related to oral health literacy. The need to measure oral health literacy has led to the development of measurement instruments. This study aimed to develop a comprehensive instrument for adults and to examine its reliability and validity in China.MethodsA three-step design process was used. First, a literature review and expert panel discussion were used to draw up a 37-item pool covering oral health knowledge, belief, practice, skill, and functional oral health literacy. The Delphi method was used to delete and modify questions in the item pool. The draft instrument was evaluated by nine experts and the consensus among them was calculated using the content validity index. The scale was then used to conduct a psychometric study among 370 participants from community health centers in Beijing. Construct validity, discriminant validity and concurrent validity were examined. The Cronbach’s alpha coefficient, and test–retest methods were used to assess reliability.ResultsThe final scale included 30 items across four dimensions. The item–level content validity index was 0.90. Exploratory factor analysis extracted four fixed factors, and the result of the Kaiser–Meyer–Olkin and Bartlett’s tests was 0.752, with the model explaining 35.21% of the total variance. The four dimensions were associated with oral health knowledge, perceptions of oral health issues, oral health practice and skills, and functional oral health literacy. The mean score of the lowest 27% was significantly lower than the highest 27% (P < 0.01), suggesting adequate discriminant validity. The associations between comprehensive oral health literacy scores and educational level, income and self-reported literacy level were significant (P < 0.001), showing adequate overall concurrent validity. Internal consistency and test–retest reliability were acceptable, with a Cronbach’s alpha of 0.72 and a total test–retest reliability coefficient of 0.979.ConclusionsInitial testing of the comprehensive oral health literacy instrument suggested that it is a valid and reliable instrument to evaluate individuals’ oral health literacy, with four dimensions for evaluating knowledge, belief, skills, and functional oral health literacy.

Future research needs for environmental science in China

Environmental science is an interdisciplinary science developed in the process of understanding and solving ecological and environmental problems. In order to tackle these problems, environmental science research is expected to reveal the source, behavior, fate, exposure, and risks of pollutants in the environment and develop potential solutions to control pollution. It provides the scientific basis for decision-makers to establish environmental and economic policies, and promote concerted efforts for the sustainable development of society. Here, we articulate the development patterns, challenges, and future research needs of environmental science in China based on literature review and expert panel discussion. Environmental science research has evolved significantly in the past decade with an increasing diversity of environmental pollutants and health impacts, new technologies and methods, deepening fusion of multiple disciplines, and emerging solutions for pollution control. Its future development relies on the advances in our knowledge on the fate and transport of pollutants, regional environmental processes, ecotoxicological effects, environmental exposure and health effects, environmental analysis and monitoring, source control and reduction, environmental remediation, as well as environmental risk management. For each of these fields, we summarize the significant challenges and highlight the research demands for China. Based on the status quo of China's environmental science research and future needs, we provide recommendations to promote its future development, including encouraging innovation and interdisciplinary research, providing decision support for national needs, encouraging international collaboration, and improving collaboration mechanisms.

Addressing the challenges of purification and quality control in gene therapy

Recombinant adeno-associated virus (rAAV) vectors are a highly promising mechanism for therapeutic gene delivery. However, most industrial cell lines exhibit inefficient gene packaging, which results in a heterogeneous population of vectors composed of empty, partially-loaded, and fully-loaded capsids. Purifying, identifying and quantifying these different species is vital from a production and quality control standpoint. Improperly loaded viral capsids do not produce the desired therapeutic effect, but may still elicit an unintended immune response. This article and expert panel discussion will focus on a variety of pertinent topics in rAAV process development, with a focus on the benefits of analytical ultracentrifugation for vector purification and characterization.

The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents.

The coronavirus disease of 2019 (COVID-19) pandemic has had a profound effect on surgical training programs, reflecting decreases in elective surgical cases and emergency restructuring of clinical teams. The effect of these measures on U.S. plastic surgery resident education and wellness has not been characterized. An institutional review board-exempted anonymous survey was developed through expert panel discussion and pilot testing. All current U.S. plastic surgery trainees were invited to complete a cross-sectional 28-question survey in April of 2020. Respondents were queried regarding demographic information, educational experiences, and wellness during the COVID-19 pandemic. A total of 668 residents responded to the survey, corresponding to a 56.1 percent response rate. Sex, training program type, postgraduate year, and region were well represented within the sample. Nearly all trainees (97.1 percent) reported restructuring of their clinical teams. One-sixth of respondents were personally redeployed to assist with the care of COVID-19 patients. A considerable proportion of residents felt that the COVID-19 pandemic had a negative impact on their education (58.1 percent) and wellness (84.8 percent). Residents found virtual curriculum effective and meaningful, and viewed an average of 4.2 lectures weekly. Although most residents did not anticipate a change in career path, some reported negative consequences on job prospects or fellowship. The COVID-19 pandemic had a considerable impact on U.S. plastic surgery education and wellness. Although reductions in case volume may be temporary, this may represent a loss of critical, supervised clinical experience. Some effects may be positive, such as the development of impactful virtual lectures that allow for cross-institutional curriculum.

A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case.

BackgroundDespite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions.ObjectiveThis study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery.MethodsWe adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases.ResultsIn stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient’s risk level, as informed by the person’s response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions.ConclusionsThis study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

ISET Expert Panel Discussion Series 2020–2021

The Innovations and Special Education Technology Professional Development Committee would like to extend its appreciation to the following leaders in the field of Special Education. Each of the following individuals volunteered to speak during the 2020–2021 ISET Expert Panel Discussion series and shared expertise on a variety of pressing topics during remote instruction due to the COVID pandemic. The information sharing is a testament to their unwavering support for the members of ISET and all of the stakeholders involved in supporting individuals with disabilities.

Development of Tuberculosis Spine Instability Score (TSIS): An Evidence-Based and Expert Consensus-Based Content Validation Study Among Spine Surgeons.

An expert-panel consensus-based content validation and case-based clinical validation study. To develop a novel scoring system for diagnosing instability in tuberculosis (TB) spine using an expert-panel consensus followed by clinical validation for validating the content. Currently, diagnosis of instability is primarily experience-based which may lead to considerable variability and misdiagnosis in the hands of a relatively in-experienced spine surgeon. Considering the potential complications this entity entails, a universally accepted scoring criteria is very important for accurate and uniform diagnosis of instability in TB spine. The development of TB spine instability score (TSIS) followed a two-step process, one designing the instrument and the other obtaining judgemental evidence. For judgemental evidence a panel of experts was appointed to make appropriate modifications and content validation for finalizing the scoring instrument. This score was applied on 30 patients of TB spine and receiver operating characteristic (ROC) curves were drawn for sensitivity and specificity analysis. The comprehensive scoring criteria to diagnose instability in TB spine was approved after three rounds of expert panel discussions with an index of content validation more than 0.75 after final round of panel discussion. On case-based validation after plotting ROC curves, sensitivity and specificity for diagnosing stable and potentially unstable lesions at a cut-off score of 6 was 92.9% and 86.8% respectively whereas for diagnosing potentially unstable and unstable lesions at a cut-off score of 10 was 94.3% and 81.9%, respectively. TSIS is a comprehensive scoring system integrating demographic, anatomical, clinical, and radiological factors aimed at diagnosing instability in TB spine. The classification determines indications for surgical stabilization in patients with TB spine, with no or little neurological deficit.Level of Evidence: 4.

O7-4 Clinical utility of multi-disciplinary expert panel discussion in precision cancer medicine

O7-4 Clinical utility of multi-disciplinary expert panel discussion in precision cancer medicine

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach.

Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions.

Modification of Calgary Cambridge for Indonesian medical students: Communication guidelines

Effective communication skill applied by doctors in the doctor-patient consultation process becomes one of important factors that can improve the consultation outcomes such as patient satisfaction, adherence to treatment and recovery process. However, effective doctor-patient communication is rarely applied in practice. Limited consultation time, patient overload, doctor burnout, and poor communication skills are among the factors that cause ineffective doctor-patient communication process. This study aimed to develop a new effective communication guideline for doctor-patient communication in Indonesia by modifying the Calgary Cambridge medical interview guide. This study uses qualitative approach within four stages: expert panel, student panel and focus group discussion, expert review, and trials. Informants were chosen purposively. Three points of high category, 24 points of middle category and 44 points of low category are resulted from expert panel stage which consists of specialist representatives from 12 clinical divisions in Dr. Moehammad Hoesin central public hospital (RSMH), Palembang, South Sumatera, Indonesia. The high and middle category were discussed by two groups of internships doctors in RSMH in student panel and focus group discussion (FGD) session. The results were validated by a doctor-patient communication expert (expert reviewer) and then tested by the internship doctors through role play at the trial stage. The final result yields eight main points and eleven effective tips of the Calgary Cambridge Guide checklist modification with five to six minutes effective consultation time. This modified guideline is appropriately applicable for doctor-patient communication in daily consultation in Indonesian practical, social and cultural context.

Operationalising One Health in Nigeria: Reflections From a High-Level Expert Panel Discussion Commemorating the 2020 World Antibiotics Awareness Week.

Antimicrobial resistance (AMR) poses an important One Health challenge for all countries of the world. As human, animal and environmental health are closely linked, it is essential that interventions targeted at reducing the spread of AMR and those promoting antimicrobial stewardship are conducted with all sectors in mind. Tackling this global slow-moving pandemic (AMR) also requires action and strong commitment from all countries of the world. Nigeria, like many other countries, have made considerable progress in implementing the National Action Plan on Antimicrobial Resistance. The accomplishments and ongoing work led by the National Technical Working Group on AMR is commendable. However, gaps still exist in terms of operationalising One Health interventions for AMR, especially regarding rational antimicrobial use and antimicrobial stewardship. The 2020 World Antimicrobial Awareness Week presented an opportunity to convene a multi-sectoral expert panel from national government agencies, research, academia and the World Health Organisation across the Nigerian One Health space. The panel discussion analysed the progress made so far and identified the barriers and the opportunities for operationalising One Health interventions on AMR. The discussion highlighted poor awareness and the fear phenomenon, driven by technical and socio-economic factors, as a common cross-sectoral denominator at the heart of inappropriate antibiotic use within the country. At the system level, suboptimal use of antimicrobials fuelled by the ease of purchase, poor regulations and insufficient enforcement of prescription-only access to antimicrobials, and limited infection prevention and biosecurity measures resonated as drivers of AMR across One Health sectors in Nigeria. Looking forward, the panel discussion identified substantial investment in the governance of the existing One Health component structures, inclusive bottom-up institutional antimicrobial stewardship that fosters community participation and multi-level cross-sectoral collaborations as the next level strategic imperatives. In this respect is the need for a strengthened One Health infrastructure, including an operational workforce, educational strategies to elevate AMR and rational antimicrobial use into public consciousness, and the use of improved data systems as countermeasures to the challenge of AMR.

Policy Implications for Protecting Health from the Hazards of Fire Smoke. A Panel Discussion Report from the Workshop Landscape Fire Smoke: Protecting Health in an Era of Escalating Fire Risk.

Globally, and nationally in Australia, bushfires are expected to increase in frequency and intensity due to climate change. To date, protection of human health from fire smoke has largely relied on individual-level actions. Recent bushfires experienced during the Australian summer of 2019–2020 occurred over a prolonged period and encompassed far larger geographical areas than previously experienced, resulting in extreme levels of smoke for extended periods of time. This particular bushfire season resulted in highly challenging conditions, where many people were unable to protect themselves from smoke exposures. The Centre for Air pollution, energy and health Research (CAR), an Australian research centre, hosted a two-day symposium, Landscape Fire Smoke: Protecting health in an era of escalating fire risk, on 8 and 9 October 2020. One component of the symposium was a dedicated panel discussion where invited experts were asked to examine alternative policy settings for protecting health from fire smoke hazards with specific reference to interventions to minimise exposure, protection of outdoor workers, and current systems for communicating health risk. This paper documents the proceedings of the expert panel and participant discussion held during the workshop.

Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy

The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.

Developing network adequacy standards for VA Community Care.

To inform how the VA should develop and implement network adequacy standards, we convened an expert panel to discuss Community Care Network (CCN) adequacy and how VA might implement network adequacy standards for community care. Data were generated from expert panel ratings and from an audio-recorded expert panel meeting conducted in Arlington, Virginia, in October 2017. We used a modified Delphi panel process involving one round of expert panel ratings provided by nine experts in network adequacy standards. Expert panel members received a list of network adequacy standard measures used in commercial and government market and were provided a rating form listing a total of 11 measures and characteristics to rate. Items on the rating form were individually discussed during an expert panel meeting between the nine expert panel members and VA Office of Community Care leaders. Attendees addressed discordant views and generated revised or new standards accordingly. Recorded audio data were transcribed to facilitate thematic analysis regarding opportunities and challenges with implementing network adequacy standards in VA Community Care. The five highest ranked standards were network directories for Veterans, regular reporting of network adequacy data to VA, maximum wait time/distance standards, minimum ratio of providers to enrolled population, and qualitative assessments of network adequacy. During the expert panel discussion with VA Community Care leaders, opportunities and challenges implementing network adequacy standards were highlighted. Our expert panel shed light on priorities for network adequacy to be implemented under CCN contracts, such as developing comprehensive provider directories for Veterans to use when selecting community providers. Remaining questions focus on whether the VA could reasonably develop and implement network adequacy standards given current Congressional restraints on VA reimbursement to community providers.

An Expert Panel Discussion on the Current and Future State of Telepsychiatry for Children and Adolescents.

An Expert Panel Discussion on the Current and Future State of Telepsychiatry for Children and Adolescents.

Validation study of the Indonesian internet addiction test among adolescents.

Internet addiction is a serious problem that can negatively impact both the physical and mental health of individuals. The Internet Addiction Test (IAT) is the most common used instrument to screen internet addiction worldwide. This study sought to investigate the psychometric properties of an Indonesian version of the IAT. The IAT questionnaire was made the focus of forward translation, expert panel discussions, back translation, an item analysis (30 subjects), a pilot study (385 subjects), and field testing (643 subjects). Factor structure was analysed by exploratory (EFA) and confirmatory factor (CFA) analyses, whereas reliability was measured with Cronbach's alpha coefficient. Factor analysis revealed that the Indonesian version of IAT, consisted of 3 domains, and had good validity (χ2 p < 0.001; RMSEA = 0.076; CFI = 0.95; SRMR = 0.057, and AIC = 784.63). The Cronbach's alpha score is 0.855. A significant association was also observed between the level of internet addiction with gender (p = 0.027) and the duration of internet use per day (p = 0.001). The Indonesian version of IAT provides good validity and reliability in a three-dimensional model. Therefore, it can be utilised as a tool for screening internet addiction in the Indonesian population.