Greater Consensus Research Articles

Patient Insight With Collagenase Treatment for Dupuytren: A Prospective Study

There appears to be controversy regarding differing patient and physician perceptions of adverse effects (AEs) in the treatment of Dupuytren disease with collagenase clostridium histolyticum (CCH). The aim of this study was to compare the number, type, and severity of AEs perceived and reported by patients and by their physician METHODS: To assess AEs following CCH injection in a standardized way, patients were given a list of predefined complications and asked to rate their severity on a 4-point Likert scale ranging from 1 (serious) to 4 (insignificant). Eighty-five patients were included. Patients reported fewer AEs than their physician (mean, 1.48 vs 2.18). There was no agreement between physician- and patient-reported AEs except for skin lacerations, which showed fair agreement (κ= 0.257). Patients and physicians differ in their evaluation of AEs due to CCH treatment in Dupuytren disease. A fair level of agreement was observed for skin lacerations. Greater consensus is needed when defining AEs associated with CCH in the treatment of Dupuytren disease.

Ten steps toward a better personality science – a rejoinder to the comments

We respond to the comments (https://doi.org/10.5964/ps.9227) on our “Ten Steps” paper (https://doi.org/10.5964/ps.6029), focusing on the most prominent themes: (1) What motivates scientists?, (2) Consensus-building (Is our field ready? May there be adverse side-effects? How shall we do it?), (3) How may institutional change be facilitated?, (4) Diversity (of participants, stimuli, methodology, measures, and among researchers), (5) The reliability of our proposed scoring system, and (6) The real-world relevance of personality research. We stand by our call for more concerted consensus-building and offer a few clarifications in this regard. We also issue four specific calls to action to our colleagues in the field: (a) specify legitimate paths to greater consensus, (b) explicate what constitutes good “qualitative” research, (c) help establish a widely used, public domain item database, and (d) determine what the most important contemporary goals of personality research are.

Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective.

Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective.

Towards a participatory approach to risk communication: the case of contaminants and Inuit health

Indigenous populations residing in the Arctic commonly rely on country foods for nutritional, spiritual and cultural benefits. However, some food sources have become contaminated with heavy metals or persistent organic pollutants. As a result of these contaminants, it is critical that risk communicators develop effective and culturally appropriate health messages about the risks and benefits of eating country foods. To address this challenge in the Canadian Inuit region of Nunavik, a working group was formed to advance risk management, determine health advisories, and communicate recommendations about local country foods. The Nunavik Child Development Study (NCDS) Communications Working Group included local hunters, educators, health care professionals, researchers, and communicators, among others. In-depth interviews with members of the NCDS Communications Working Group were completed to provide insight into the risk management approach and how communication messages and materials were developed and delivered. Study results reveal the importance of including members of the Inuit population affected by the risk in the design and dissemination of communication material. In addition, researchers and healthcare professionals were able to: (1) access important local knowledge; (2) better understand the perceptions of the populations; and (3) assess behaviors that contributed to contaminant exposure. By incorporating multiple perspectives and including members of the population in the affected region in the decision-making process, there was greater consensus in risk management and communication design. We discuss the benefits and challenges of utilizing an approach that includes participatory elements, and how lessons from this case can contribute to participatory risk communication literature more broadly. This study ultimately provides insight into how using elements of a participatory approaches to risk management and communication – that considers different experiences, knowledges, and skills – can result in potentially more culturally relevant health advisories and risk communication campaigns.

Systematic Review of Radiologist and Medical Student Attitudes on the Role and Impact of AI in Radiology

The introduction of AI in radiology has prompted both excitement and hesitation within the field. We performed a systematic review of original studies evaluating the attitudes of radiologists, radiology trainees, and medical students towards AI in radiology. We searched PubMed for studies published as of August 24, 2021 for original studies evaluating attitudes of radiologists (attendings and trainees) and medical students towards AI in radiology. We summarized the baseline article characteristics and performed thematic analysis of the questions asked in each study. Nineteen studies were included evaluating attitudes across different levels of training (medical students, radiology trainees, and radiology attendings) with representation from nearly every continent. Medical students and radiologists alike favored increased educational initiatives, and displayed interest in learning about and implementing AI solutions themselves, despite reporting of a current gap in formal AI training. There was general optimism about the role of AI in radiology, although radiologists and trainees had greater consensus than medical students. Although there is interest in incorporating AI into medical education and optimism among radiologists towards AI, medical students are more divided in their views. We propose that outreach to and AI education for medical students may help improve their attitudes towards the potentially transformative technology of AI for radiology.

Use of External Approach for Severe Genu Valgo Knee Arthroplasty

The deformities of the lower limbs (genu valgus and genu varus) are alterations frequently developed properly by physiological processes which usually disappear at 2 years (genu varus) and at 7-8 years (genu valgus), being considered in adults normal a 4º-6º genu valgus, however the appearance of the latter is also related to various metabolic pathologies, tumors, traumatic sequelae, infections, skeletal dysplastic and idiopathic genu valgus. In the bibliography, there is a greater consensus on the approach to varus deformity, not so in valgus deformities, where there is no bibliography with a level of evidence that defines established protocols to treat severe valgus deformities>20, currently good treatment results have been demonstrated by means of knee arthroplasty to correct genu valgus deformities, which showed good results in the alignment of the lower extremities through the balance of ligaments in patients with severe genu valgus with pain reduction. , improvements in knee function and with a low rate of complications, the use of these alternatives such as the external approach in total knee replacement in patients with severe genu valgus and medial collateral ligament insufficiency allows correcting large deformities using a technique simple and in most cases without the use of a prosthesis that generates a degree of constraint, progressively improving their living conditions.

The imperative to transform global food systems

Never before, perhaps, has there been greater consensus that our food systems need to be radically reimagined and transformed. However, there is also much contention among those working to advance these transformations over the solutions and futures that ought to be pursued. So, while there is great opportunity to enact truly radical actions that reduce hunger, rebuild and steward biodiversity, and redress the many harms and dispossessions of colonialism and extractive development, there is also great risk that the need for rapid change will be coopted by powerful elites as a shroud for advancing technocratic agendas and gaining further control of global food systems.

The Role of Diet Modification in Atopic Dermatitis: Navigating the Complexity

Diet has long been understood to have an intricate association with atopic dermatitis, although much remains unelucidated. Skin barrier dysfunction with dysbiosis and consequent impairment of immune tolerance likely underly the pathogenesis of coincident atopic dermatitis and food allergy. There is a wide range of possible skin reactions to food, complicating the diagnosis and understanding of food allergies. Many patients, parents, and providers incorrectly suspect diet as causative of atopic dermatitis symptoms and many have tried elimination diets. This frequently leads to inaccurate labeling of food allergies, contributing to a dangerous spiral of inappropriate testing, referrals, and dietary changes, while neglecting established atopic dermatitis treatment essentials. Alternatively, certain dietary supplements or the introduction of certain foods may be beneficial for atopic dermatitis management or prevention. Greater consensus on the role of diet among providers of patients with atopic dermatitis is strongly encouraged to improve the management of atopic dermatitis.

Surgical Infections and the Future of Research: Re-Defining the Research Agenda for the Surgical Infection Society.

Background: Infections represent a major component of surgical practice. Risk mitigation, seeking eradication and optimal patient outcomes, require a concerted, multifocal effort to understand disease and microbiology, prevent infections, and treat them. The present study was undertaken to re-define the Surgical Infection Society (SIS) research agenda for the next decade. Hypothesis: We utilized the expertise of the SIS membership to identify research questions regarding surgical infections, hypothesizing that consensus among participants could be used to re-define the future research agenda. Methods: Members of the SIS were surveyed using a modified Delphi. The three rounds of the survey were targeted at: question generation; question ranking; and reaching consensus. Each of the 15 questions to emerge was evaluated according to level of consensus, feasibility, and data availability. Results: One hundred twenty-four participants contributed. Initially, 226 questions were generated that were condensed to 35 unique questions for consideration in the subsequent two rounds. The 35 questions encompassed several research themes, with antibiotic prophylaxis (n = 8), prevention of surgical site infections (SSIs; n = 6), and improved diagnostics (n = 5) being most common. Standard deviation of importance scores was inversely proportional to the question rank, indicating greater consensus among higher ranking questions. All 15 questions had a feasibility score of greater than three (five-point Likert scale), and the majority (12/15) had a mean data availability score of less than three. In the final round of the survey, the top three topics for further research surrounded non-antimicrobial treatments, optimal treatment duration for bacteremia, and treatment duration for necrotizing soft tissue infections. Conclusions: Using a modified Delphi process, 15 research questions addressing surgical infections were identified. Such questions can assist the SIS and the SIS Foundation for Research and Education in prioritizing and enabling research efforts, and development of a strategic research plan for the next decade.

Cause of death in fatal cases associated with positive COVID-19 PCR tests

The response to the COVID-19 pandemic is heavily influenced by reported fatalities from the virus and, by implication, the criteria used to determine those fatalities. Given complications, such as the presence of comorbidities and limitations in testing, the World Health Organization (WHO) guidelines recommend counting both confirmed and suspected COVID-19 deaths as fatalities. While easily implementable, this method does little to indicate the degrees of certainty for a COVID-19 death, and thus concerns have arisen that this may overcount the number of COIVD-19 fatalities. In response, we developed and implemented a scoring system to determine the likelihood that COVID-19 contributed to patient death. Three reviewers independently assessed records of 47 patients who reportedly died from COVID-19. Greatest consensus was observed at the ends of the scoring spectrum, with twelve patients having complete consensus among reviewers. Intraclass correlation among the three reviewers was 0.52 (95% CI, 0.25-0.72). Middle scores had the greatest variability, possibly due to plausible alternative diagnoses, suggesting the potential for variability in death certification and the need for a scoring system that reports degrees of certainty. Although scoring rules can guide reviewers toward greater consensus about cause of death, in the absence of an objective criteria for COVID-19 disease, the determination of cause of death in paitents with positive PCR tests for SARS-CoV-2 who also have significant comorbid conditions will remain subjective.
 Keywords: COVID-19; fatality; cause of death

Rapid diagnostic testing for antimicrobial stewardship: Utility in Asia Pacific.

Rapid diagnostic testing (RDT) can provide prompt, accurate identification of infectious organisms and be a key component of antimicrobial stewardship (AMS) programs. However, their use is less widespread in Asia Pacific than western countries. Cost can be prohibitive, particularly in less resource-replete settings. A selective approach is required, possibly focusing on the initiation of antimicrobials, for differentiating bacterial versus viral infections and identifying locally relevant tropical diseases. Across Asia Pacific, more data are needed on RDT use within AMS, focusing on the impact on antimicrobial usage, patient morbidity and mortality, and cost effectiveness. Moreover, in the absence of formal guidelines, regional consensus statements to guide clinical practice are warranted. These will provide a regionally relevant definition for RDT; greater consensus on its role in managing infections; advice on implementation and overcoming barriers; and guidance on optimizing human resource capacity. By addressing these issues, the outcomes of AMS programs should improve.

Short- and long-term outcomes of aortic root-sparing repair and replacement in acute type A aortic dissection repair

Acute type A aortic dissection is a surgical emergency with a high mortality rate if left untreated. Management of the aortic root in this setting constitutes an intricate decision-making framework, further complicated by the emergent nature of the dissection. There exists much controversy regarding pursuit of the aggressive aortic root replacement versus a conservative root-sparing repair, alongside considerations for valve-sparing root replacement. In this review, we critically appraise the current controversy in the literature considering the fate of the aortic root, discussing the aforementioned root interventions for which provides better outcomes for mortality and risk of re-intervention. Literature search was performed using electronic database through PubMed, Google scholar, and Embase focussing on studies reporting outcomes and re-intervention rates for these approaches. Limited by the heterogeneity in surgical strategy, with most studies being single-centred retrospective experiences, further fuel this ongoing debate. The literature reveals rather contrasting results whilst comparing root-sparing repair, versus the extensive root replacement; whilst some studies report no statistically significant difference, others show one superior over the other. There is greater consensus when considering risk of re-operation, with studies showing higher rates of re-operation in root-sparing group compared to replacement; however, many others show no statistically significant difference. In conclusion, the conflicting outcomes reported in the literature, with their inherent limitations, results in the current inability to reach a definitive answer. There remains support in the current literature for both approaches with much of the decision-making being surgeon-bound with many significant influencing factors on a case-by-case basis.

A concept design stages protocol to support collaborative processes in architecture, engineering and construction projects

PurposeThis paper proposes and tests, through a series of structured multi-disciplinary design activities, a “Concept Design Stages Protocol” (CDS Protocol) to structure project initiation, to attain smoother collaboration and greater consensus among multi-disciplinary project teams.Design/methodology/approachA collaborative approach from the outset is imperative for project success, especially when considering multi-disciplinary teams in the architecture, engineering and construction (AEC) industry. However, involving different disciplines hinders communication paths and affects informed decision-making.FindingsBased on these findings, the research demonstrates that the CDS Protocol provides a solid foundation to aid in the optimal implementation of collaborative design, and with particular regard to multi-disciplinary working.Originality/valueThe research demonstrates the potential for significant improvement in the optimisation of the conceptual design stages, with positive implications for time, communication and whole-team engagement.

Digital Health Applications: A Qualitative Study of Approaches to Improve Access to Statutory Health Insurance

There is a lack of integration of appropriate digital health applications (DiGA) into the first healthcare market in Germany. In order to enable a valid and reliable use of previously examined digital health products, their implementation into services of the statutory health insurance (SHI) is necessary. The aim of this study was the development of strategies to modify and improve access of DiGA to SHI reimbursement. The recently introduced Digitale-Versorgung-Gesetz (DVG) is an initial step in this direction. Using a qualitative approach, focus group interviews were conducted with key stakeholders of existing access paths. Previously elaborated problem-solving approaches were discussed. The approaches ranged between adapting existing structures and implementing an original digital pathway. Subsequently, a comparison of the project results and legislative provision of the DVG was carried out. The proposed approaches were discussed heterogeneously and varied depending on the position of the participants. The implementation of an Advisory Council had a greater consensus than the introduction of a digital-specific pathway. Also individual measures like administrative support for generating the necessary evidence was considered as positive and beneficial. However, a deviation from the current evidence standards should be avoided. Furthermore, the legitimacy and time expenditure for the digital-specific pathway was called into doubt. In principle, a better focus on existing structures on digital health applications can be endorsed. For a short-term use of DiGA potentials, adaptions of existing structures are preferable. The DVG legislation, although conforming to the project results only to some degree, can be considered as a first step. An amendment, in particular from the viewpoint of diagnostic or therapeutic DiGA, appears to be necessary.

Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees

Plain English summaryThe World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes.The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison.BackgroundInsight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines.MethodsThe classification of pregnancy-related deaths in Suriname during 2010–2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement.ResultsOut of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32).ConclusionsMaternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

Pluralidad de concepciones en el pensamiento geográfico actual

A synthesis is offered of the changes that have taken place in Geography in the second half of this century - and innovative period of greater complexity for this discipline, which really appears as «new» as opposed to the «tradition», or earlier classic position.New tendencies, with afaster diffusion in the Anglo-Saxon schools of geography than in the others, were to follow, one after the other, from the fifties onwards ¿ those known as quantitative, theoretical, humanistic and radical are the best known and most relevant - However, following a lively and highly critical debate about each of these tendencies in previous years, there is now greater consensus and inter-relationship between them.

The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

BackgroundThis study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area.MethodsQualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views.ResultsWomen varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head.ConclusionsThis research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

Red hot frogs: identifying the Australian frogs most at risk of extinction

More than a third of the world’s amphibian species are listed as Threatened or Extinct, with a recent assessment identifying 45 Australian frogs (18.4% of the currently recognised species) as ‘Threatened’ based on IUCN criteria. We applied structured expert elicitation to 26 frogs assessed as Critically Endangered and Endangered to estimate their probability of extinction by 2040. We also investigated whether participant experience (measured as a self-assigned categorical score, i.e. ‘expert’ or ‘non-expert’) influenced the estimates. Collation and analysis of participant opinion indicated that eight species are at high risk (>50% chance) of becoming extinct by 2040, with the disease chytridiomycosis identified as the primary threat. A further five species are at moderate–high risk (30–50% chance), primarily due to climate change. Fourteen of the 26 frog species are endemic to Queensland, with many species restricted to small geographic ranges that are susceptible to stochastic events (e.g. a severe heatwave or a large bushfire). Experts were more likely to rate extinction probability higher for poorly known species (those with <10 experts), while non-experts were more likely to rate extinction probability higher for better-known species. However, scores converged following discussion, indicating that there was greater consensus in the estimates of extinction probability. Increased resourcing and management intervention are urgently needed to avert future extinctions of Australia’s frogs. Key priorities include developing and supporting captive management and establishing or extending in-situ population refuges to alleviate the impacts of disease and climate change.

Consensus in the delphi method: What makes a decision change?

We examined whether giving feedback to participants in a Delphi study about the level of agreement across the expert panel had an effect on opinion change between rounds. We also considered the potential influence of participants’ sociodemographic and professional characteristics. Five three-round Delphi studies were conducted independently, in which a total of 628 mental health experts responded to all three rounds. In each study, participants had to decide, based on their experience, whether a series of categories were relevant. The percentage of group agreement (i.e., percentage of participants who considered each category as relevant) in round 2 was shown as feedback in round 3, and responses in rounds 2 and 3 were considered to analyze opinion change. Results showed that when the feedback given in round 3 indicated that ≥75% of experts considered a category to be relevant, there was a further shift in opinion towards the group opinion (i.e., the category then yielded even greater consensus), whereas if the feedback indicated <75% group agreement, individual opinions tended to shift against the group opinion (i.e., consensus over the category decreased). Neither sociodemographic nor professional variables had a significant effect in explaining opinion shift. These results show that in Delphi studies, feedback has an influence on individual responses and the achievement of consensus.

Interventions that support adults with brain injuries, learning disabilities and autistic spectrum disorders in dating or romantic relationships: a systematic review

Purpose To evaluate the current evidence on dating interventions, their theoretical underpinnings and effectiveness for adult neuro-atypical populations. Methods A literature search was completed using CINAHL, Communication Source, PsycARTICLES, PsycINFO, SocINDEX, MEDLINE, Embase, AMED and EMB Reviews (all), for English-language, peer-reviewed studies into interventions for relationships or dating among adults with acquired brain injuries (ABI), learning disabilities or autistic spectrum disorder (ASD). Demographic data and intervention details were extracted for all included studies. Standard checklists were used for methodological quality and intervention description. Narrative synthesis for studies rating above poor quality. Results A total of 11 studies (13 articles) were eligible, ABI (n = 6), learning disability (n = 4), ASD (n = 1). These comprised five comparison or control group studies, two pre-post studies and four case studies. The methodological quality was varied, but intervention descriptions were generally poor. While all studies reported positive outcomes, firm conclusions on their effectiveness are difficult due to the high number of before-after analyses and variation in content and outcome measures used. Conclusions More high-quality studies are needed to assess the effectiveness of interventions. Also, greater consensus is needed on the key behaviors for dating and relationships and the measures to assess these. IMPLICATIONS FOR REHABILITATION Intimate relationships are important to quality of life, but challenging for many people in neuro-atypical populations. There are a small number of researched interventions to support dating or marital relationships among adults with ABI, ASD or learning disabilities. Rehabilitation professionals should ask about dating and relationships and support people if this area is identified as important. Rehabilitation professionals should consider different interventions for dating skills and marital relationships.