Greater Consensus Research Articles

"Short" Versus "Long" Duration of Untreated Psychosis in People with First-Episode Psychosis: A Systematic Review and Meta-Analysis of Baseline Status and Follow-Up Outcomes.

Duration of untreated psychosis (DUP) has been linked to worse mental health outcomes in psychotic disorders. We meta-analytically studied the relationship between "long" vs. "short" DUP and mental health outcomes. This PRISMA/MOOSE-compliant meta-analysis searched for nonoverlapping individual studies from database inception until November 01, 2023, reporting data from author-defined "short"/"long" DUP (according to author's definition) in patients with first-episode psychosis (FEP). We compared differences between "short"/"long" DUP groups at baseline and/or follow-up in continuous and binary outcomes. We conducted random-effects meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO: CRD42023479321). From 16,055 citations, 34 studies were included (n = 6,425, age = 27.5 ± 7.1 years, males = 60.4%, white = 70.2%, DUP: mean = 60.8 ± 43.8 weeks, median = 52.5, interquartile range = 31.3, 68.0 weeks, follow-up = 19.2 ± 35.0 months). The definition of "short"/"long" varies significantly between the studies. Compared to "short" DUP (mean = 10.2 ± 11.2 weeks), "long" DUP (mean = 58.8 ± 76.4 weeks) was associated with higher baseline Positive and Negative Syndrome Scale (PANSS) negative (k = 14, ES = 0.45, 95%CI = 0.16, 0.74) and Scale for the Assessment of Negative Symptoms (k = 7, ES = 0.29, 95%CI = 0.11, 0.47) scores, lower remission (k = 7, OR = 0.40, 95%CI = 0.24, 0.67) and more suicide attempts (k = 4, OR = 2.01, 95%CI = 1.36, 2.96). At follow-up, compared to "short" DUP, "long" DUP was associated with lower Global Assessment of Functioning (k = 4, ES = -0.63, 95%CI = -0.83, -0.43) and higher PANSS negative subscale scores (k = 5, ES = 0.66, 95%CI = 0.05, 1.27). In FEP, longer DUP is related to greater baseline negative symptoms, less remission, and more suicide attempts, as well as greater postbaseline negative symptom severity and functional disability. To what degree longer DUP contributes to poorer outcomes or whether DUP only correlates with these outcomes requires further study. A greater consensus on the definition of long DUP is needed to make comparisons between studies more feasible.

Beyond functionality: topographical complexity as a driver of aesthetic value in urban green infrastructure

Cities face growing challenges from stormwater: flooding, pollution, and habitat loss. Green infrastructure offers solutions, yet the aesthetic dimension is often overlooked. This study introduces the Buras Beauty Scale for objectively assessing the beauty of wetland configurations and emphasises its integration into green infrastructure projects. Our methodology involved surveying diverse groups, including non-architecture students and non-traditional architects, who perceived higher beauty in wetland configurations compared to traditional architects and architecture students (mean beauty scores: 7.8 and 7.5 vs. 6.2 and 6.4, respectively). Statistical analysis revealed a strong correlation (r = 0.731, p < 0.05) between beauty assessments and Shannon-Weaver entropy, highlighting the importance of topographic diversity. We also observed that higher beauty scores correlated with greater consensus among respondents, as evidenced by a decrease in the coefficient of variation from 0.52 to 0.34. Multicriteria analyses, integrating beauty with functionality, identified optimal wetland configurations for urban landscapes.

Promoting Standardization of Clinical Evidence With Severity-Guided Treatments for Idiopathic Granulomatous Mastitis: A Narrative Review.

Idiopathic granulomatous mastitis (IGM) is a benign disease of the breast which causes a great deal of discomfort for patients. More comparable data and greater consensus in treatment are needed to better understand the disease and help with evidence-based clinical decision making. This narrative review aims to discuss the literature available on IGM and illustrate the need for consensus on treatment. We highlight the existing severity scores for this disease in the literature and discuss the value of severity-guided treatment. In our review, 81 studies out of 319 reviewed publications met established criteria. With the selected results from our search results, the available research on IGM etiology, risk factors, diagnosis, and treatment is summarized with an emphasis on the existing severity scores. A total of four proposed severity scores were found in our review. Consensus on the treatment of IGM must be established. There are varying severity scores on IGM severity. We suggest using an established standardized severity score to guide treatment and recommend one such score.

Assessing Psychological Remission in Adolescent Anorexia Nervosa: A Comparison of Patient and Parent Report.

The definition and assessment of remission in anorexia nervosa (AN) needs greater consensus. Particularly in adolescents, the use of patient-reported composite indices (such as the Eating Disorder Examination [EDE] Global Score) as the sole measure of psychological remission has the potential to obscure patients' true clinical status, given developmental factors and the propensity towards symptom minimization in AN. End of treatment (EOT) data from a randomized controlled trial comparing two formats of manualized family-based treatment for adolescents with AN (N = 106) were analyzed. Participants completed the EDE, and their parents completed a parent-as-informant version of the EDE (Parent Eating Disorder Examination; PEDE). Rates of remission were compared across indices (i.e., EDE Global Score vs. diagnostic item analysis) and informant (i.e., adolescent vs. parent), both independently and in combination with the achievement of a percent median body mass index (% mBMI) greater than or equal to 95%. For both adolescent and parent reports, there were higher rates of remission when defined by Global Score than when defined by EDE or PEDE diagnostic items. There were no significant differences in remission rates based on informant. In the assessment of remission in AN, the EDE Global Score may not detect some adolescents who continue to exhibit clinically significant psychological symptoms. This study supports a detailed, multidimensional approach to assessing remission in adolescent AN to optimize sensitivity to patients' diagnostic profile. Future research should explore whether parent-child concordance on measures of ED psychopathology varies over the course of treatment.

Consensus-based ethical best practices for performing educational point-of-care ultrasonography in the emergency department.

There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent. This study sought to define principles for ethical application of educational POCUS and develop consensus-based best practice guidance. A questionnaire was developed by a trained ethicist after literature review with the help of a medical librarian. A diverse panel including experts in medical education, law, and bioethics; medical trainees; and individuals with no medical background was convened. The panel voted on their level of agreement with ethical principles and degree of appropriateness of behaviors in three rounds of a modified Delphi process. A high level of agreement was defined as 80% or greater consensus. Panelists voted on 38 total items: 15 related to the patient consent and selection process, eight related to practices while performing educational POCUS, and 15 scenarios involving POCUS application. A high level of agreement was achieved for 13 items related to patient consent and selection, eight items related to performance practices, and 10 scenarios of POCUS application. Based on expert consensus, ethical best practices include obtaining informed consent before performing educational POCUS, allowing patients to decline educational POCUS, informing patients the examination is not intended to be a part of their medical evaluation and is not billed, using appropriate draping techniques, maintaining a professional environment, and disclosing incidental findings in coordination with the primary team caring for the patient. These practices could be implemented at institutions to encourage ethical use of educational POCUS when training physicians, fellows, residents, and medical students.

Price above all else: an analysis of expert opinion on the priority actions to scale up production and consumption of plant-based meat in Brazil

IntroductionPlant-based meats (PBM) are an emerging set of food technologies that could reduce the environmental impacts of food systems by mitigating consumer demand for animal products. However, scaling up the production and consumption of plant-based meats requires overcoming multiple technological, regulatory, political, and market barriers. An evidence-based prioritization of needs and actions may help actors (e.g., investors, funders, policymakers) who wish to help scale PBM achieve desired outcomes with limited resources.Research questionWhat actions could most effectively help to scale up the production and/or consumption of plant-based meat in Brazil?MethodsWe selected Brazil as a case study of a country with a significant animal agriculture sector and a burgeoning PBM sector. We constructed a panel of nine experts and employed the Delphi technique during two rounds of an online survey to iteratively assess the degree of consensus and disagreement around the relative priority of 14 possible actions (identified from relevant literature) that could help to scale up the production and/or consumption of PBM in Brazil. We used the Importance, Neglect, and Tractability framework.ResultsThe panelists collectively concluded that the top priority action for scaling up both the production and the consumption of plant-based meat in Brazil was to reduce the price of products for consumers. For most priority actions, there was greater consensus among panelists in the second round of the survey.DiscussionOur findings contribute to an improved understanding of (a) which actions may be of highest priority for investors, funders, and policymakers, (b) synergies and differences between priority actions to scale up the production versus consumption of PBM in Brazil, (c) the relative merits of focusing on scaling up PBM production versus consumption, and (d) the strengths and limitations of assessing expert opinion on alternative protein futures using the Delphi technique.

Greater consensus on improving the Middle Corridor

Western sanctions have curtailed much of the East–West trade that had been occurring via the so-called northern route through Russia, leading to a revival of interest in the Middle Corridor passing through Central Asia and the South Caucasus. China has shifted more export traffic to this route and is paying greater attention to Georgia, in particular. Despite challenges, including geopolitical uncertainties and infrastructure limitations, the outlook suggests continued growth, with ongoing projects such as Georgia’s Anaklia port contributing to the expansion of the Middle Corridor and the reduction of overall transit times.

Word differences in news media of lower and higher peace countries revealed by natural language processing and machine learning.

Language is both a cause and a consequence of the social processes that lead to conflict or peace. "Hate speech" can mobilize violence and destruction. What are the characteristics of "peace speech" that reflect and support the social processes that maintain peace? This study used existing peace indices, machine learning, and on-line, news media sources to identify the words most associated with lower-peace versus higher-peace countries. As each peace index measures different social properties, they can have different values for the same country. There is however greater consensus with these indices for the countries that are at the extremes of lower-peace and higher-peace. Therefore, a data driven approach was used to find the words most important in distinguishing lower-peace and higher-peace countries. Rather than assuming a theoretical framework that predicts which words are more likely in lower-peace and higher-peace countries, and then searching for those words in news media, in this study, natural language processing and machine learning were used to identify the words that most accurately classified a country as lower-peace or higher-peace. Once the machine learning model was trained on the word frequencies from the extreme lower-peace and higher-peace countries, that model was also used to compute a quantitative peace index for these and other intermediate-peace countries. The model successfully yielded a quantitative peace index for intermediate-peace countries that was in between that of the lower-peace and higher-peace, even though they were not in the training set. This study demonstrates how natural language processing and machine learning can help to generate new quantitative measures of social systems, which in this study, were linguistic differences resulting in a quantitative index of peace for countries at different levels of peacefulness.

A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID).

This scoping review identifies and describes psychological interventions for avoidant restrictive food intake disorder (ARFID) and summarizes how outcomes are measured across such interventions. Five databases (Cochrane, Embase, Medline, PsycInfo, Web of Science) were searched up to December 22, 2022. Studies were included if they reported on psychological interventions for ARFID. Studies were excluded if participants did not have an ARFID diagnosis and if psychological interventions were not delivered or detailed. Fifty studies met inclusion criteria; almost half were single-case study designs (23 studies) and most studies reported on psychological interventions for children and adolescents with ARFID (42 studies). Behavioral interventions (16 studies), cognitive-behavioral therapy (10 studies), and family therapy (5 studies), or combinations of these therapeutic approaches (19 studies) were delivered to support patients with ARFID. Many studies lacked validated measures, with outcomes most commonly assessed via physical health metrics such as weight. This review provides a comprehensive summary of psychological interventions for ARFID since its introduction to the DSM-5. Across a range of psychological interventions and modalities for ARFID, there were common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement. Currently, studies reporting on psychological interventions for ARFID are characterized by small samples and high levels of heterogeneity, including in how outcomes are measured. Based on reviewed studies, we outline suggestions for clinical practice and future research. Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food. We reviewed the literature on psychological interventions for ARFID and the outcomes used to measure change. Several psychological interventions have been developed and applied to patients with ARFID. Outcome measurement varies widely and requires further development and greater consensus.

TAVI-PREP: A Deep Learning-Based Tool for Automated Measurements Extraction in TAVI Planning.

Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery for treating severe aortic stenosis. Despite its benefits, the risk of procedural complications necessitates careful preoperative planning. This study proposes a fully automated deep learning-based method, TAVI-PREP, for pre-TAVI planning, focusing on measurements extracted from computed tomography (CT) scans. The algorithm was trained on the public MM-WHS dataset and a small subset of private data. It uses MeshDeformNet for 3D surface mesh generation and a 3D Residual U-Net for landmark detection. TAVI-PREP is designed to extract 22 different measurements from the aortic valvular complex. A total of 200 CT-scans were analyzed, and automatic measurements were compared to the ones made manually by an expert cardiologist. A second cardiologist analyzed 115 scans to evaluate inter-operator variability. High Pearson correlation coefficients between the expert and the algorithm were obtained for most parameters (0.90-0.97), except for left and right coronary height (0.8 and 0.72, respectively). Similarly, the mean absolute relative error was within 5% for most measurements, except for left and right coronary height (11.6% and 16.5%, respectively). A greater consensus was observed among experts than when compared to the automatic approach, with TAVI-PREP showing no discernable bias towards either the lower or higher ends of the measurement spectrum. TAVI-PREP provides reliable and time-efficient measurements of the aortic valvular complex that could aid clinicians in the preprocedural planning of TAVI procedures.

Intrapartum fetal heart rate monitoring: Rationalise, refine or replace?

Monitoring the fetal heartbeat underpins assessment of fetal wellbeing in labour. Although commonly employed in clinical practice, shortcomings remain. A recent review of clinical practice guidelines highlights the variation in definitions of the fetal heart rate that will lead to differences in interpretation. Will intrapartum care be improved by greater consensus around clinical practice guidelines through rationalisation or refinement of guidelines, or will the future see this technique replaced by more accurate forms of fetal monitoring?

Republication of "Evidence Versus Practice: Operative Treatment Preferences in Hallux Valgus".

There is substantial variability in the operative treatment of hallux valgus despite the existence of high quality evidence to guide treatment decisions. The purpose of this study was to determine the current trends in the treatment of mild, moderate, and severe hallux valgus and if greater degrees of consensus correlate with the presence of higher-level evidence. Members of the American Orthopaedic Foot & Ankle Society completed a 14-item survey. A total of 131 (14%) of 922 members completed the survey. Three cases representing 3 stages of HV were presented, and respondents selected their preferred treatment. Preferred forms of proximal and distal metatarsal osteotomies, as well as mode of fixation for each, were inquired. In the treatment of mild hallux valgus without second metatarsalgia, 80% of those surveyed chose a distal metatarsal osteotomy, while, if second metatarsalgia was present, 56% chose a distal metatarsal osteotomy with a second metatarsal-shortening osteotomy. In the treatment of moderate hallux valgus, there was generally less consensus, while, in the treatment of severe hallux valgus, a majority of those surveyed chose a Lapidus procedure, with the addition of a second metatarsal-shortening osteotomy in the presence of second metatarsalgia. The most popular distal and proximal metatarsal osteotomies, respectively, were chevron osteotomy (80%) and opening wedge osteotomy (33%). The presence of Level I evidence did not significantly correlate with higher degrees of consensus. Despite the existence of high-quality evidence supporting the use of certain procedures in the treatment of HV, there exists an apparent lack of consensus among surgeons about the choice of surgical procedures. Moreover, higher-level evidence was not correlated with greater consensus in hallux valgus. Level II.

Diagnosis, Prognosis, and Treatment of Canine Hemangiosarcoma: A Review Based on a Consensus Organized by the Brazilian Association of Veterinary Oncology, ABROVET

Hemangiosarcoma is a mesenchymal neoplasm originating in the endothelial cells of blood vessels; they can be classified as non-visceral and visceral types. Non-visceral hemangiosarcomas can affect the skin, subcutaneous tissues, and muscle tissues; visceral hemangiosarcomas can affect the spleen, liver, heart, lungs, kidneys, oral cavity, bones, bladder, uterus, tongue, and retroperitoneum. Among domestic species, dogs are most affected by cutaneous HSA. Cutaneous HSA represents approximately 14% of all HSA diagnosed in this species and less than 5% of dermal tumors, according to North American studies. However, Brazilian epidemiological data demonstrate a higher prevalence, which may represent 27 to 80% of all canine HSAs and 13.9% of all skin neoplasms diagnosed in this species. Cutaneous HSA most commonly affects middle-aged to elderly dogs (between 8 and 15 years old), with no gender predisposition for either the actinic or non-actinic forms. The higher prevalence of cutaneous HSA in some canine breeds is related to lower protection from solar radiation, as low skin pigmentation and hair coverage lead to greater sun exposure. Actinic changes, such as solar dermatosis, are frequent in these patients, confirming the influence of solar radiation on the development of this neoplasm. There are multiple clinical manifestations of hemangiosarcoma in canines. The diagnostic approach and staging classification of cutaneous HSAs are similar between the different subtypes. The definitive diagnosis is obtained through histopathological analysis of incisional or excisional biopsies. Cytology can be used as a presurgical screening test; however, it has little diagnostic utility in cases of HSA because there is a high risk of blood contamination and sample hemodilution. Surgery is generally the treatment of choice for dogs with localized non-visceral HSA without evidence of metastatic disease. Recently, electrochemotherapy (ECT) has emerged as an alternative therapy for the local ablative treatment of different neoplastic types; the use of radiotherapy for the treatment of dogs with cutaneous HSA is uncommon. There is greater consensus in the literature regarding the indications for adjuvant chemotherapy in subcutaneous and muscular HSA; doxorubicin is the most frequently used antineoplastic agent for subcutaneous and muscular subtypes and can be administered alone or in combination with other drugs. Other therapies include antiangiogenic therapy, photodynamic therapy, the association of chemotherapy with the metronomic dose, targeted therapies, and natural products. The benefits of these therapies are presented and discussed. In general, the prognosis of splenic and cardiac HSA is unfavorable. As a challenging neoplasm, studies of new protocols and treatment modalities are necessary to control this aggressive disease.

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB).

Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. This consensus aims to provide guidance on the most effective medical management of adult patients with UC. A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

Regulatory utility of mechanistic modeling to support alternative bioequivalence approaches: A workshop overview.

On September 30 and October 1, 2021, the US Food and Drug Administration (FDA) and the Center for Research on Complex Generics cosponsored a live virtual workshop titled "Regulatory Utility of Mechanistic Modeling to Support Alternative Bioequivalence Approaches." The overall aims of the workshop included (i) engaging the generic drug industry and other involved stakeholders regarding how mechanistic modeling and simulation can support their product development and regulatory submissions; (ii) sharing the current state of mechanistic modeling for bioequivalence (BE) assessment through case studies; (iii) establishing a consensus on best practices for using mechanistic modeling approaches, such as physiologically based pharmacokinetic modeling and computational fluid dynamics modeling, for BE assessment; and (iv) introducing the concept of a Model Master File to improve model sharing between model developers, industry, and the FDA. More than 1500 people registered for the workshop. Based on a postworkshop survey, the majority of participants reported that their fundamental scientific understanding of mechanistic models was enhanced, there was greater consensus on model validation and verification, and regulatory expectations for mechanistic modeling submitted in abbreviated new drug applications were clarified by the workshop.

21. Treatment of the cN0 neck in Oral Maxillary Squamous Cell Carcinoma: A retrospective analysis of our experience at a regional centre

Unlike other oral cavity subsites, the management of the cN0 neck in oral maxillary squamous cell carcinoma (MSCC) can vary. Valid options include surveillance, radiotherapy (RT) and elective neck dissection (END) with/without post-operative radiotherapy (PORT). Studies have shown that nodal metastasis in MSCC may behave as predictably as other oral cavity subsites, thus greater consensus is needed. We present our experience of the management of the cN0 neck in patients with cT1-4N0M0 MSCC.

American Head and Neck Society position statement on the use of PD-1 inhibitors for treatment of advanced cutaneous squamous cell carcinoma.

A position statement put forth by the American Head and Neck Society (AHNS) was constructed to provide evidence-based treatment recommendations for PD-1 inhibitor use in advanced cutaneous squamous cell carcinoma (cSCC). Secondarily, we sought to identify knowledge gaps warranting further investigation. A literature search utilizing key terms: cutaneous squamous cell carcinoma, cutaneous cancer, checkpoint inhibitors, systemic therapy, Program Cell Death, PD-1 (PubMed, Cochrane, and Google Scholar) was carried out to generate evidence-based statements. The statements were distributed among the AHNS membership. Delphi methodology was applied to identify statements achieving 70% or greater consensus among the leadership team. Twenty-six position statements achieved consensus. Knowledge gaps for future research included: impact of immunosuppression on cSCC staging and associated treatment; role of PD-1 inhibitors in immunosuppressed patients. This comprehensive position statement put forth by the AHNS represents majority consensus by practicing head and neck surgeons throughout the country.

Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique

BackgroundIn laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency....

(In)capacity to implement measures for increased cycling? Experiences and perspectives from cycling planners in Sweden

This article seeks to explore and analyse the capacity of Swedish municipalities to implement measures for increased cycling. Through the concept of local capacity and against the backdrop of interviews with local cycle planners, the aim of the article is to gain deeper insights into cycle planners’ experiences and perspectives on what the possibilities, obstacles and challenges are as regards achieving the aims of increased cycling. Although the interviews reveal that all capacity dimensions are important, financial and political capacity seem to be the most crucial dimensions. These two dimensions are also the ones that differentiate most between included municipalities, and thus also influence the local capacity. High staffing, earmarked funding, and a shift from the car to a sustainable mode of transport norm are all capacity-building measures. There also seem to be overarching difficulties in developing vertical linkages with the SwedishTransport Administration to increase the municipal capacity. The authority's responsibility for funding, operating, and maintaining the national public cycle network, and a lack of will to find common solutions are perceived as challenging by many municipalities. Greater consensus and collaboration between municipalities and the Swedish Transport Administration must be achieved to fulfil national and local policy aims on cycling.

Do judges prefer advisors with dependent or independent errors? Investigating judges' advice selection and advice weighting.

Advice stemming from sources with errors that are dependent on each other is usually less accurate than advice provided by sources with independent errors, while simultaneously exhibiting greater consensus. We investigate whether or not individuals express a preference for advice with dependent errors by choosing it over advice with independent errors and by weighting it more strongly. We test for this preference both in a situation where error interdependence does not negatively affect advice accuracy as well as in a situation where advice with dependent errors is less accurate than advice with independent errors. In a series of six studies, we show that, when being given the opportunity to choose between the two types of advice, participants only prefer advice with dependent errors if this is not detrimental for accuracy. However, when being sequentially provided with both types of advice, they generally weight advice with dependent errors more than advice with independent errors, even if the latter is more accurate. This effect is mainly driven by the fact that advice with dependent errors exhibits greater consensus, leading participants' initial estimates to lie outside the range of the advisors' judgments more frequently. (PsycInfo Database Record (c) 2022 APA, all rights reserved).