Final List Research Articles

Enabling sustainable circular economy in Indian municipal solid waste management system: an ISM and fuzzy MICMAC approach

PurposeMismanagement of municipal solid waste (MSW) has led to resource depletion, ecosystem degradation and socio-economic risks, emphasizing the necessity to promote sustainable circular economy (SuCE) practices. This article identifies relevant enablers and unveils their interconnected roles in facilitating a municipal solid waste management (MSWM) system aligned with the principles of SuCE.Design/methodology/approachTo identify pertinent enablers for MSWM systems based on SuCE principles, the study conducted a literature review and engaged experts from waste management sectors and academia to consolidate the final list of enablers. Following this, the study investigated the inter-relationships among these enablers using both Interpretive Structural Modeling (ISM) integrated and fuzzy Matrix Impact Cross-Reference Multiplication Applied to a Classification (fuzzy MICMAC) with MATLAB.FindingsThe study identified a comprehensive set of 23 enablers and categorized them into four control measures instrumental for the effective integration of SuCE principles in the context of the Indian MSWM system. Notably, the analysis highlighted that “authoritative pressure” and “policy transformation” are the highly influential enablers.Practical implicationsThe study emphasizes actionable implications for stakeholders in the Indian MSWM sector. Policymakers and governmental bodies can enforce “authoritative pressure,” “policy transformation” and “budget allocation”. Meanwhile, managers can focus on “promotion of SuCE awareness”, “formalizing the informal workforce”, “infrastructure modernization”, “stakeholder engagement and alignment”, “segregation strategy”, “disruption preparedness”, and “local-based strategy”.Originality/valueThis study proposed a unique ISM diagraph and cluster of enablers to enhance the novelty of the study.

Moving towards a core measures set for patient safety in perioperative care: An e-Delphi consensus study.

A Core Measures Set (CMS) is an agreed standardized group of measures that should be assessed and reported in research for a specific condition or clinical area. This study undertook the development of a CMS for Patient Safety through a two-round, web-based Delphi consensus approach, in the context of the "Improving quality and patient SAFEty in surgical care through STandardisation and harmonization of perioperative care in Europe" (SAFEST) project-a collaborative, patient-centered and evidence-based European Union-funded project that aims to generate action-oriented evidence in perioperative care. We developed an Initial List of Measures via an umbrella review following the deployment of an e-Delphi method with an inclusive panel of experts to prioritize measures towards a consensualized Final List of Measures. All measures were rigorously assessed for both importance and feasibility. After the two rounds of the e-Delphi consensus method we observed 13 preoperative measures (40.6% of the initial number), 24 intraoperative measures (66.7%), 25 postoperative measures (20.3%) and 23 mixed period measures (41.1%) met consensus criteria for both importance and feasibility. Higher scores were detected in importance ratings compared to feasibility across all groups of measures. Importantly, numeric averages regarding pain-related measures differed in the assessment of patients when compared to that of Healthcare Professionals (HCPs). This work not only informs future SAFEST iterations but also sets a precedent for research into valid, patient-centered, and action-oriented perioperative safety measures.

Development and Validation of the Emergency Medical Technicians Occupational Stress Scale

Introduction. The population of interested workers for this study included Emergency Medical Technicians (EMTs) in the United States. This group of workers was chosen because of the nature of their work, which requires their presence at the scenes of life and death situations. Certainly, their work conditions can have an effect on their psychological well-being. Yet, the work of these workers, with all of its stressors, has not been adequately studied through the use of appropriate measuring instruments. Emergency Medical Technicians are not unknown in occupational stress research. This report discusses previous studies on EMT workers and occupational stressors and explains the curative process through the development and validation of an EMT Occupational Stress Scale. The report also highlights the psychometric investigation of this scale. Paramedics/EMTs face increased risk of physical and psychological stress due to the nature of their work. It is crucial to understand the stressors affecting their well-being in order to develop appropriate management strategies. Research suggests that EMTs may lack preparation for their roles, requiring additional training in empathy and emotional intelligence. The relationship between stressors experienced and clinical service provided needs further investigation. Standardized measures of stress for paramedics/EMTs are lacking and more comprehensive instruments are needed. This report aims to develop a comprehensive stress scale specifically for EMTs/paramedics, addressing validation concerns and incorporating environmental stress within a larger theoretical framework. Methods. This study was This study was conducted using a mixed-methods approach to develop and validate the Emergency Medical Technicians Occupational Stress Scale. The scale was pilot tested with a sample of EMTs to ensure reliability and validity. by the ethics committee and is based on a literature review. The Canadian EMT Job Satisfaction Questionnaire was used to measure organizational stress levels of EMTs. The questionnaire was reviewed by professionals and academics, resulting in the inclusion of five new items. The final item list consisted of 58 questions. Permission was obtained. Results. The outcomes and findings obtained from the comprehensive study conducted on the Development and Validation of the Emergency Medical Technicians Occupational Stress Scale have shed light on significant discoveries pertaining to the intricate realm of stress levels experienced by our dedicated EMT professionals. Conclusion. The rapidly evolving scope of Emergency Medical Services (EMS) practice has placed increasing demands on the relatively small professional community that consists of EMTs and paramedics. An Occupational Stress model was developed to examine interpersonal work stressors unique to the EMT role, and a measure was developed to assess the construct. Initial results suggest that the OSM is an accurate, reliable, and potentially valuable assessment tool. High levels of interpersonal stress may influence the EMTs to cope with their daily activities by seeking outlets for tension and depression through increased use of alcohol, legal drugs, and caffeine. Alcohol is used more frequently than other legal drugs are to modify interpersonal stress symptoms. The EMTs are in a prime position to help each other identify these symptoms when arising and offer assistance. Staff stress management programs are essential in solving and preventing occupational stress. A move toward prevention rather than reaction to such stress, which for many results in alcoholism, drug addiction, or job related emotional illness, will serve to preserve the health of the EMTs. The medical community has a vested interest in the health of these dedicated professionals. Not only does such prevention attempt to manage the human tragedy of alcoholism, legal drug addiction, and job related emotional illness, but it also prevents the more tangible, but no less important cost factors to the EMT.

Written Narrative in Patients with Different Mental Disorders

Language disorders are criteria of psychopathology diagnostics listed both in the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistic Manual of Mental Disorders (DSM). However, structure and grammar remain understudied in this aspect, which makes structural analysis a relevant research topic. A structural analysis of written narrative may objectivize particular language disorders, thus facilitating psychodiagnostics of different mental disorders. The research objective was to describe the structural features of written narratives obtained from 127 patients with schizophrenic, bipolar, and personality disorders. The narratives were subjected to structural and statistical analyses. Schizophrenic narratives demonstrated a poor vocabulary, a low volume, and a high degree of formality with a passive narrator. Bipolar texts tended to be long, detailed, egocentric, and active, with multiple participles. Patients with personality disorders emotionally relived their memories, producing reflective written narratives with a lot of actors. The final list of written speech indicators to be used to distinguish between schizophrenic, bipolar, and personality disorders included such variables as text volume, verb tense, non-finite verb forms, first-person singular pronoun, number of actors, passive / active narrator, and laconic / detailed narration.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study

IntroductionBehaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy...

Identifying potential outcomes of patient engagement in primary care quality improvement: a modified Delphi study.

A barrier to dedicating resources towards patient engagement in primary care quality improvement is the lack of clearly identified outcomes that might result from these initiatives. We sought to identify these potential outcomes at three healthcare levels as defined by the Institute of Medicine: 1) Micro/Direct Care; 2) Meso/Microsystem; and 3) Macro/Clinic/System using a Modified Delphi technique. Two focus groups of patients and primary care clinician leaders generated a first set of outcomes. These outcomes were then vetted and expanded through three web-based surveys sent to twelve national experts. Experts indicated the level of agreement with prior elicited outcomes and generated potential new outcomes. Included outcomes achieved at least 80% agreement. The final list of 46 consensus-derived outcomes was categorized across levels. 22 were at the Micro-level, 9 were at the Meso-level, and 15 were at the Macro-level. Our findings suggest outcomes across all health system levels have the potential for progress when patients are engaged in primary care quality improvement initiatives. Future programs should consider validating and measuring these outcomes as part of their interventions.

Selecting and ranking female candidates under PR: Evidence from a two‐stage conjoint experiment with party elites

AbstractDoes gender affect candidate selection and list placement under proportional representation (PR)? Existing research argues that PR systems have a positive effect on women's representation due to a more inclusive candidate selection process. However, analysing the actual process of candidate selection under PR before observing the final party list is challenging, and little is known about the preferences and strategies of party elites when selecting and ranking candidates. To address this lacuna, we conduct a novel two‐stage conjoint experiment with party elites in Austria, which allows us to differentiate between two distinct mechanisms in candidate nomination under PR: selection and ranking. Our findings indicate that women generally have an advantage with respect to selection but find themselves subject to same‐sex preferences when it comes to ranking on the list, for which they otherwise benefit from being low in supply. These findings have important implications for understanding patterns of female under‐representation in PR systems.

The legacy of Erich Mendelsohn – expression and context in the architecture of Modern Movement.

In 2021, the international community of architectural and art historians started the so called “Erich Mendelsohn Initiative”, with the goal of inscribing the architectural legacy of Erich Mendelsohn on the UNESCO World Heritage List. Despite some efforts, the final list of nominated buildings, along with the Statement of their Outstanding Universal Value (OUV) and the title of the nomination has not yet been established. This article presents a new, authorial look at Erich Mendelsohn’s legacy in view of the UNESCO World Heritage. It analyses the global significance of Erich Mendelsohn’s legacy in the opinions of leading architectural historians of the 20th century. The article puts forward the preliminary list of Mendelsohn’s realisations which should embody his legacy, the criteria for assessment their historical value and the proposed title of the nomination. The main part of the article is defining the first two sections of the “Statement of Outstanding Universal Value”, to be presented in the UNESCO World Heritage Committee. According to the Operational Guidelines for the Implementation of the World Heritage Convention they are: the “Brief synthesis”, and the “Justification for Criteria”. In conclusion, the author argues, that the most significant qualities of Erich Mendelsohn’s architectural works are their strong expression and their dialog with the local context. Therefore, these features should be the main subjects of the Outstanding Universal Value Statement, the title and in the main narrative points of the nomination dossier for the inscription of Erich Mendelsohn’s legacy on the UNESCO World Heritage List.

Priorities for multimorbidity management and research in cancer: a Delphi study of Australian cancer survivors, clinicians, and researchers.

Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity. A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked. In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers. Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors. Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.

Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes

ObjectivesTo co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being.Methods40 Team USA...

How professional development can be supported for health and care research methodologists: results of the PROfesSionnal develoPmEnt for Research methodologists (PROSPER) e-Delphi and consensus study

ObjectiveResearch methodologists play a pivotal role in health and care research, yet they face many challenges relating to their professional development. The PROfesSional develoPmEnt for Research methodologists study was designed...

Medicación pediátrica de alto riesgo: propuesta de listado a través de la técnica de consenso interdisciplinar

IntroductionPediatric patients are more likely to experience medication-related errors and serious associated harms. The identification of high-risk medications (HRM) and their study in special populations, such as children with excess body weight, is a part of safety improvement strategies. ObjectiveTo generate, through a consensus technique structured by an interdisciplinary group of pediatricians and hospital pharmacists, an operational and updated list of HRM for hospital use in children over 2 years of age. The document was part of a collaboration project between the Spanish Society of Hospital Pharmacists and the Spanish Society of Pediatric Hospital Medicine. MethodsThe study was carried out in two sequential phases: a) preparation of a preliminary list of HRM through bibliographic review and b) subsequent application of the double-round Delphi method to agree on a definitive list of HRM. The results obtained were validated by calculating the probability of chance agreement and the modified Kappa statistic for each drug. ResultsThe original list obtained by bibliographic review included 26 pharmacological classes and 96 drugs. Of the total of 37 experts, 32 (86.4%) completed both rounds of the Delphi. The final consensus list of HRM incorporated 24 pharmacological classes and 100 drugs. The modified Kappa statistic reflected a high percent agreement (94.9%) in the consensus reached by the participants. ConclusionThis list can establish a tool for future studies and interventions to improve the safety of medications in general pediatric population, as well as in high-risk subgroups, such as pediatric patients with excess body weight.

Impact of urban road characteristics on vehicle speed: Insights from Brescia, Italy

In managing road infrastructures, a key benchmark is the 85th percentile of vehicle speeds (V85). While V85 can be derived from spot speed samples, these are often lacking on each urban road. Thus, prediction models become valuable tools for examining the relationship between V85 and road characteristics. Although various models exist for rural roads, the impact of roadside characteristics and markings on V85 in urban road networks has been partially investigated, and the effect of traffic calming measures remains fragmented.This study aims to address these gaps by applying a methodology that sheds light on the effects of some variables that influence V85 on urban roads. Specifically, the methodology selects and segments roads along the urban road network of the municipality of Brescia (Italy) and collects data on both road characteristics and 48,000+ spot speed information. Following data cleansing, it processes these data according to three different multiple regression models to analyse the influence of various predictors on V85. Once the best model is estimated, its performance is evaluated, and the final list of significant predictors is obtained.The results revealed that V85 increases with longer homogeneous segments, greater distance to successive intersections, bituminous conglomerate roads with more lanes, and the presence of trees, visible road markings, and posted speed limits. Conversely, V85 decreases in the presence of on-street parking and other obstacles (e.g., walls and road posts), when the density of road intersections and pedestrian crossings increases, when the left crossbar width increases and when the land use crossed is commercial or office, residential or industrial. Nevertheless, no significant effect was found for several traffic calming measures included in the model.These findings can assist road authorities in verifying road operating conditions and planning infrastructure interventions to reduce speeds, thereby creating a safer urban environment for all users.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BackgroundElectronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.MethodsImplementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy’s feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.ResultsOf the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.ConclusionWe present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

Electoral Systems and the Autocrat’s Trade-Off: Evidence from the Russian Duma

abstract: Legislative elections sustain authoritarian regimes, but distinct electoral systems simultaneously benefit and hurt the political prospects of those regimes. The author theorizes about a trade-off between electoral systems that facilitate information on local elite preferences, and systems that maintain legislative control. An electoral system can achieve either, but not at the same time. The author undertakes an empirical study of Russian federal deputies, half of whom are elected in single-member districts, the other half on a nationwide closed-party list. Candidates can register on both lists (N = 515), and district results determine final list affiliation. Electoral incentives change abruptly for deputies who are barely winning or losing their district, a fact that the author exploits to identify the effects of local representation on pro- and antiregime parliamentary behavior. The results support a trade-off: district-list deputies convey more information on local preferences in their speeches than party-list deputies do, but they oppose law proposals more frequently. How autocrats weigh this trade-off determines the electoral system and illuminates electoral reform in autocracies.

Variables for reporting studies on extended - focused assessment with sonography for trauma (E-FAST): An international delphi consensus study

BackgroundThe Extended Focused Assessment with Sonography for Trauma (E-FAST) is a diagnostic ultrasound technique used in hospital and pre-hospital settings for patients with torso trauma. While E-FAST is common in emergency departments, its pre-hospital use is less routine. This study aims to establish a set of variables for designing studies on pre-hospital E-FAST through a Delphi consensus process involving international experts. MethodsA Delphi consensus process was utilized, involving four rounds of e-mail to the experts. The experts proposed variables for each category, assessed them using a 5-point Likert scale, and voted on whether they should be included in the final template. ResultsOut of 14 invited experts, 9 participated in the study. In total, the experts proposed 247 variables. After four rounds, a final list of 32 variables was approved by all experts. These variables related to the system, patient, process, training, imaging, outcome, and others. ConclusionsThis Delphi consensus study presents a list of 32 variables for future research studies concerning the use of E-FAST ultrasound in pre-hospital settings. The results of this study are significant as they provide a standardized set of variables that will facilitate the comparison of data obtained from various studies. This will ultimately contribute to the advancement of pre-hospital E-FAST research and practice.

Measuring what matters to older persons for active living: part I content development for the OPAL measure across four countries.

Many older persons do not think of themselves as "patients" but as persons wishing to live as actively as possible for as long as possible. However, most health-related quality of life (HRQL) measures were developed for use with clinical populations. The aim of this project was to fill that gap and to develop, for international use, a measure of what matters to older persons as they age and seek to remain as active as possible, Older Persons for Active Living (OPAL). For content development, interviews about active living were conducted with older persons from Canada, USA, UK, and the Netherlands in English, French, Spanish and Dutch, respectively with subsequent thematic analysis and harmonization. Analyses of transcripts from 148 older persons revealed that active living was a "way of being" and not merely doing activities. Saturation was reached and a total of 59 content areas were identified. After grouping similar "ways" together and after conducting a consensus rating of importance, 19 unique and important "ways" remained. In some languages, formulating was challenging for three of the 19, resulting in changes to two English words and dropping two other words, yielding a final list of 17 "ways of being" with harmonized wording in 4 languages. This study underscores the significance of listening to older adults and highlights the importance of considering linguistic and cultural nuances in measure development.

An Integrated Approach for Representing Knowledge on the Potential of Drugs to Cause Acute Kidney Injury.

The recent rise in acute kidney injury (AKI) incidence, with approximately 30% attributed to potentially preventable adverse drug events (ADEs), poses challenges in evaluating drug-induced AKI due to polypharmacy and other risk factors. This study seeks to consolidate knowledge on the drugs with AKI potential from four distinct sources: (i) bio(medical) peer-reviewed journals; (ii) spontaneous reporting systems (SRS); (iii) drug information databases (DIDs); and (iv) NephroTox website. By harnessing the potential of these underutilised sources, our objective is to bridge gaps and enhance the understanding of drug-induced AKI. By searching Medline, studies with lists of drugs with AKI potential established through consensus amongst medical experts were selected. A final list of 63 drugs was generated aggregating the original studies. For these 63 drugs, the AKI reporting odds ratios (RORs) using three SRS databases, the average frequency of ADEs from four different DIDs and the number of published studies identified via NephroTox was reported. Drugs belonging to the antivirals, antibacterials, and non-steroidal anti-inflammatory pharmacological classes exhibit substantial consensus on AKI potential, which was also reflected in strong ROR signals, frequent to very frequent AKI-related ADEs and a high number of published studies reporting adverse kidney events as identified via NephroTox. Renin-angiotensin aldosterone system inhibitors and diuretics also display comparable signal strengths, but this can be attributed to expected haemodynamic changes. More variability is noted for proton-pump inhibitors. By integrating four disjointed sources of knowledge, we have created a novel, comprehensive resource on drugs with AKI potential, contributing to kidney safety improvement efforts.

Sexual dysfunction in women living with HIV: an updated narrative review.

Female sexual dysfunction is a significant concern for many women worldwide, with chronic health conditions such as HIV infection contributing to its prevalence. However, there is a paucity of studies focusing this subject in the available literature. This narrative review aimed to provide a comprehensive and updated overview of the current state of knowledge regarding sexual dysfunction in women living with HIV (WLWH). References for this review were identified from MEDLINE, Embase, and Cochrane databases using the search terms "sexual dysfunction" AND "HIV" AND "female" OR "woman." The final reference list was generated based on the timeline, originality, and relevance to the scope of this narrative review. In the general population, female sexual function is influenced by various factors, including biological, psychological, physiological, sociocultural, and relational ones. In WLWH, the role of antiretroviral therapy in female sexual dysfunction is controversial. Although current international guidelines recommend collecting a thorough sexual life anamnesis during routine outpatient visits, sexual difficulties are often inadequately addressed. A tailored clinical approach that focuses on the multidimensional domains of sexual dysfunction may improve the sexual health and quality of life in WLWH.

Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech and language therapists.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.