High Level Of Consensus Research Articles

Establishing consensus on the best ways to educate children about animal welfare and prevent harm: An online Delphi study

AbstractMany animal welfare organisations deliver education programmes for children and young people, or design materials for schoolteachers to use. However, few of these are scientifically evaluated, making it difficult for those working in this field to establish with any certainty the degree of success of their own programmes, or learn from others. There has been no guidance specifically tailored to the development and evaluation of animal welfare education interventions. Accordingly, a three-stage online Delphi study was designed to unearth the expertise of professionals working in this field and identify degree of consensus on various aspects of the intervention process: design, implementation and evaluation. Thirty-one experts participated in Round 1, representing eleven of 13 organisations in the Scottish Animal Welfare Education Forum (SAWEF), and eleven of 23 members of the wider UK-based Animal Welfare Education Alliance (AWEA). Seven further professionals participated, including four based in Canada or the US. Eighty-four percent of the original sample participated in Round 2, where a high level of consensus was apparent. However, the study also revealed areas of ambiguity (determining priorities, the need for intervention structure and degree of success). Tensions were also evident with respect to terminology (especially around cruelty and cruelty prevention), and the common goal for animal welfare to be part of school curricula. Findings were used to develop a web-based framework and toolkit to enable practitioners to follow evidence-based guidance. This should enable organisations to maximise the quality and effectiveness of their interventions for children and young people.

Voice-Controlled Intelligent Personal Assistants in Health Care: International Delphi Study.

BackgroundVoice-controlled intelligent personal assistants (VIPAs), such as Amazon Echo and Google Home, involve artificial intelligence–powered algorithms designed to simulate humans. Their hands-free interface and growing capabilities have a wide range of applications in health care, covering off-clinic education, health monitoring, and communication. However, conflicting factors, such as patient safety and privacy concerns, make it difficult to foresee the further development of VIPAs in health care.ObjectiveThis study aimed to develop a plausible scenario for the further development of VIPAs in health care to support decision making regarding the procurement of VIPAs in health care organizations.MethodsWe conducted a two-stage Delphi study with an internationally recruited panel consisting of voice assistant experts, medical professionals, and representatives of academia, governmental health authorities, and nonprofit health associations having expertise with voice technology. Twenty projections were formulated and evaluated by the panelists. Descriptive statistics were used to derive the desired scenario.ResultsThe panelists expect VIPAs to be able to provide solid medical advice based on patients’ personal health information and to have human-like conversations. However, in the short term, voice assistants might neither provide frustration-free user experience nor outperform or replace humans in health care. With a high level of consensus, the experts agreed with the potential of VIPAs to support elderly people and be widely used as anamnesis, informational, self-therapy, and communication tools by patients and health care professionals. Although users’ and governments’ privacy concerns are not expected to decrease in the near future, the panelists believe that strict regulations capable of preventing VIPAs from providing medical help services will not be imposed.ConclusionsAccording to the surveyed experts, VIPAs will show notable technological development and gain more user trust in the near future, resulting in widespread application in health care. However, voice assistants are expected to solely support health care professionals in their daily operations and will not be able to outperform or replace medical staff.

Validation of a rapid wetland ecosystem services assessment technique using the Delphi method

Wetlands differ in their ability to provide ecosystem services, and thus there is a need to assess ecosystem service delivery in order to prioritize protection and restoration efforts. We used a Delphi-based expert-panel method to validate an ecosystem services assessment technique in a context where there is a paucity of field-level process-based research into the delivery of ecosystem services. The validation process entailed comparing scores from a panel of wetland experts to that derived by WET-EcoServices. Three wetlands were selected where detailed information relating to the supply of regulating services was available. At each site a selection of regulating services was assessed and then scored using the technique and independently by the panel of experts. The expert panel reached high levels of consensus (83%) on the scores for the three case studies used in the validation process. The consensus formed a useful basis for the validation of the technique. Statistical testing revealed no significant differences between expert and technique scores however, when considered practically, there were small differences in 53% of the scores, moderate differences in 23% and large in 20%. In most cases the technique over scored relative to the expert assessment. The results were useful for identifying specific refinements to the technique. The study demonstrates how a three-way “engagement” of a rapid-assessment technique, expert opinion and detailed research can be used to improve ecosystem services assessments in resource-limited situations. We reflected on the use of the Delphi method in a resource-constrained environment and advocate its careful application in similar contexts.

The Provision of Public Services under Conditions of Financial Stress: Evidence from Spanish Autonomous Communities

The 2008 economic crisis had three consequences for Spanish regional governments: first, there was a substantial and sudden fall of their revenue, which they had no effective means to redress, while citizens demands for education, health and other services continued to increase as usual; second, their debt, which until then had been relatively small and stable, exploded to unknown levels; and third, there was a serious deterioration of the extent and quality of the set of public services provided by these governments. The first two consequences show up quite clearly in official statistics, while the third, on which arguably there is a high level of consensus among citizens, has not been systematically and formally documented. This article develops a simple model of public expenditure that explains these facts. It suggests that, under conditions of financial stress, it may be rational for regional governments to spend more than the resources they have, and thus to incur in debt finance, and at the same time to accept a deterioration of the extent and quality of the services provided to the public. More concretely, the model predicts that, if a meaningful measure of the gap between expenditure needs and revenue can be identified, then the optimal behaviour of governments is to absorb a part of this gap by borrowing and the rest by letting service provision to deteriorate. In a situation of financial stress, along with the traditional influence of revenue, demography plays a role of its own in the determination of governments’ behaviour. We test these hypotheses with a panel of data on expenditure, revenue and a series of indicators of expenditure need (essentially demographic indicators) of the fifteen “common regime” Spanish autonomous communities over the period that goes from 2007 to 2017. None of the predictions of the model is rejected by the data.

Proposals for person-centred care in the COVID-19 era. Delphi study.

BackgroundIn this COVID‐19 era, we need to rethink the criteria used to measure the results of person‐centred care strategies.ObjectiveTo identify priorities, and criteria that health services can use to pursue actually the goal of achieving person‐centred care.DesignThree‐phase online qualitative study performed during May–July of 2020 using the Delphi technique.Setting and ParticipantsAn online platform was used for a consensus meeting of 114 participants, including health planning experts, health‐care institution managers, clinicians and patients.Main Outcome MeasuresCriteria and indicators for the achievement of person‐centred care.Main ResultsThe first round began with 125 proposals and 11 dimensions. After the second round, 28 ideas reached a high level of consensus among the participants. Ultimately, the workgroup agreed on 20 criteria for goals in the implementation of person‐centred care during the COVID‐19 era and 21 related indicators to measure goal achievement.DiscussionNine dimensions and 28 priorities were identified. These priorities are also in accordance with the quadruple aim approach, which emphasizes the need for care for health‐care professionals, without whom it is impossible to achieve a better quality of care.ConclusionsPerson‐centred care continues to be a key objective. However, new metrics are needed to ensure its continued development during the restoration of public health services beyond the control of COVID‐19.Patient or Public ContributionTwelve professionals and patient representatives participated voluntarily in the construction of the baseline questionnaire and in the selection of the criteria and indicators using an online platform for consensus meetings.

Setting an International Research Agenda for Fear of Cancer Recurrence: An Online Delphi Consensus Study.

BackgroundFear of cancer recurrence (FCR) is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research.MethodsMembers of the International Psycho-oncology Society (IPOS) Fear of Cancer Recurrence Special Interest Group (FORwards) were invited to participate in an online Delphi study. Research domains identified in Round 1 were presented and discussed at a focus group (Round 2) to consolidate the domains and items prior to presentation in further survey rounds (Round 3) aimed at gaining consensus on research priorities of international significance.ResultsThirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified.ConclusionThe findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need.

Survey of Some Medicinal Plants Employed for Managing Diabetes Mellitus in Hadejia Town, Nigeria

Diabetes is a widely spread disorder that disturbs humans in the underdeveloped as well as the developed countries worldwide. The figure of those people suffering from the disease is shooting up specifically in Nigeria. A study of traditional plant use was carried out to formalize common herbal plants already in use for the management of Diabetes Mellitus (DM) in Hadejia town, Jigawa state, Nigeria. Formal meetings were organised to document details about the medicinal plants used in the treatment of DM and their topical names, methods of preparation/administration, plant parts in use, and the demographic characteristics of the interviewees in the study. Sixty (60) participants were interviewed, of which 45% were within the age group of 31-40 years, 38.3% were within the age group of 41-50 years, while 10% were within the age group of 51-60 years. Most of the participants were married (91.6%), male (71.6%), farmers (23.3%) and traditional medicine practitioners (26.6%). Further, half (50%) of the participants were attending Islamic schools; some were not having a formal education with a percentage of (33.3%). Also, fifteen (15) plants which belong to 12 families were documented as being used for the management of DM in Hadejia town. The families Amaryllidaceae, Fabaceae, Myrtaceae, and Combretaceae, were the highly pronounced families in this research, while leaves, stem bark, and roots were the most commonly used plant parts. A high level of consensus was observed (0.67) among the participants. This work was carried out in order to provide background data on the herbal plants in use traditionally for the management of DM in the study area.

Two decades of evolution in tourism competitiveness: a co-word analysis

Purpose The objective of this study was to analyze the evolution of tourism competitiveness over the years, ascertaining the state of the art and the degree of consensus among scholars on its constituent elements to propose an integrative and updated concept. Design/methodology/approach A set of 130 definitions on tourism competitiveness formulated between 1999–2018 was analyzed and segmented into three periods, allowing its historical evolution to be ascertained. It is a qualitative and quantitative exploratory research that uses a combination of techniques, namely, content analysis, analysis of co-words and consensus analysis. Findings The results indicated a low use of elements such as the quality of life and the environment in the authors' definitions during 1999–2018, although these elements were present in the first concept of tourism competitiveness by Crouch and Ritchie (1999, 2003). Another finding of this study shows a reduction in the analysis of tourism competitiveness based on the supply and demand side. Nowadays, the research tends to turn on the basis of the population directly affected. It also reveals the enrichment of the theoretical corpus with new lines of research arising and new groups of scholars of the subject, consequently a new frontier in tourism competitiveness. Research limitations/implications The authors recommend deepening the analysis in each category of conceptual elements of tourism competitiveness to identify the origins of the low consensus. The authors also suggest conducting further research on the largest invisible schools of thought on this subject to understand their relations and perspectives, and thus to advance in the theoretical streams of the field. Finally, it is imperative to develop research on new models and monitors of tourism competitiveness that meet its renewed concept and integrate dimensions to consider the perspective of supply, demand, tourists and residents, as well as not excluding the economic bias but including the social side. Practical implications Owing to the fact that monitors of tourism competitiveness have practically no variables related to the social, most of the surveys are carried out from the supply or demand perspective, leaving the resident distant from the process. In this way, the results allow authors to indicate that new models of competitiveness measurement should be formulated based on the vision of the community impacted by tourism, i.e. a new version of tourism competitiveness not based on productivity but rather on the social aspect. Originality/value The findings of this study contribute to the field literature by offering an integrative concept of tourism competitiveness based on the elements with a higher level of consensus among researchers. Furthermore, the results accentuate a worrying fact regarding the operationalization of this concept, as the theoretical basis is not expressed in the monitors of competitiveness. Thus, nor it is possible in the management of the tourism industry.

Pain Standards for Accredited Healthcare Organizations (ACDON Project): A Mixed Methods Study.

Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan.

Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient’s quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman’s rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted.

Twenty-one sports activities are recommended by the European Knee Associates (EKA) six months after total knee arthroplasty.

To elaborate recommendations for sports participation following TKA among the members of the European Knee Associates (EKA). A prospective online survey was conducted among the members of the European Knee Associates (EKA). The European Knee Associates (EKA) are a section of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). The survey investigated recommendations for 47 sports disciplines. Possible answers were: allowed, allowed if experienced, not allowed, no opinion. The survey was conducted separately for 4 specific time frames: within 6weeks after TKA; 6-12weeks after TKA; 3-6months after TKA; and more than 6months after TKA. Consensus among the respondents was then analyzed. EKA members (N = 120) participated in the survey. A high level of consensus was reached for a recommendation to allow 5 different sports in the first 6weeks after TKA, 7 sports 6-12weeks after surgery, 14 sports 3-6months after TKA, and 21 out of 47 activities 6months after surgery. In the first 6weeks after TKA walking, stair climbing, swimming, aqua fitness, and static cycling were recommended. Six to twelve weeks after TKA, cycling on level ground and yoga were recommended in addition to the aforementioned activities. Further sports activities recommended beyond 12weeks after TKA were: tennis doubles, golf, fitness/weight lifting, aerobics, hiking, Nordic walking and sailing. The sport for which the recommendation was "not allowed" following TKA was squash. The number of sports recommended by EKA surgeons increases stepwise over the postoperative time frames. The findings are regarded as clinically relevant as they may serve as a basis for answering patient questions on timing and giving recommendations for the resumption of sports activities following standard primary TKA and should be individualized by surgeons for their patients' expectations and goals. V.

Towards Better Concordance among Contextualized Evaluations in FAST-GDM Problems

A flexible attribute-set group decision-making (FAST-GDM) problem consists in finding the most suitable option(s) out of the options under consideration, with a general agreement among a heterogeneous group of experts who can focus on different attributes to evaluate those options. An open challenge in FAST-GDM problems is to design consensus reaching processes (CRPs) by which the participants can perform evaluations with a high level of consensus. To address this challenge, a novel algorithm for reaching consensus is proposed in this paper. By means of the algorithm, called FAST-CR-XMIS, a participant can reconsider his/her evaluations after studying the most influential samples that have been shared by others through contextualized evaluations. Since exchanging those samples may make participants’ understandings more like each other, an increase of the level of consensus is expected. A simulation of a CRP where contextualized evaluations of newswire stories are characterized as augmented intuitionistic fuzzy sets (AIFS) shows how FAST-CR-XMIS can increase the level of consensus among the participants during the CRP.

The European Parliament and Covid-19: Organisational Adaptations and their Implications on Parliamentary Activity

As early as March 2020, the President of the European Parliament decided to shut down the assembly’s facilities in Brussels and to cancel the plenary sessions in Strasbourg . Impor­tant decisions were made to abandon in-person meetings, introduce teleworking for all staff, and implement remote deliberation and voting both in committees and in the plena­ry . The Rules of Procedure were adapted to formalize these organisational changes and make them ready for future crises . All in all, the European Parliament proved to be resilient and adaptive: it continued to discuss and adopt many legislative, budgetary, and non-legis­lative texts in the plenary . However, remote-work did have an impact on the political dynamics within Parliament . It was characterised by a very high level of consensus, as the result of a higher level of agreement between the two main party groups, the European People’s Party and the Socialists & Democrats . Those main groups also became much more cohesive .

Semantic adaptation of the Global Psychotrauma Screen for children and adolescents in the United States

ABSTRACT Background: The review of trauma screening tools for children and adolescents indicates a need for developmentally and linguistically appropriate, globally applicable, free, and easily accessible trauma screening instruments. Objective: The aim of this study is to adapt the Global Psychotrauma Screen (GPS) for children and adolescents in the United States. Method: Using the modified Delphi method, this study included the GPS Expert Consensus (GPS-EC) and the GPS Stakeholder Consensus (GPS-SC) substudies. In the GPS-EC, ten reviewers who specialize in trauma services independently revised the GPS child and adolescent versions in four rounds. In the GPS-SC, a stratified minimum sample of children and adolescents (n = 24) and their parents (n = 24) were interviewed to collect feedback on the revised GPS versions. Results: In the GPS-EC Round 1, a low level of consensus was observed on the anxiety (restlessness) and depression (loss of interest) items. In Round 2, a high level of consensus was achieved on all but PTSD hypervigilance and detachment, and CPTSD self-concept items. Round 3 indicated a low level of consensus on the exposure and functioning items. Full consensus was achieved in Round 4 on all items. In the GPS-SC, children had more difficulties than adolescents with the exposure, dissociation, and risk-protection items. Conclusions: Based on the results of this study, the semantic adaptation process concluded with implementation of six decisions on the final GPS versions for children and adolescents: adding a non-binary gender choice for adolescents; removing the exposure section; using a full-sentence structure for children and a phrase structure for adolescents; retaining the two-part items on PTSD intrusion and avoidance, retaining self-blame but removing other-blame in the PTSD-blame item; providing specific descriptions of depersonalization and derealization in the dissociation items; and removing risk-protection and functioning items for children.

Portuguese Consensus and Recommendations for Acquired Coagulopathic Bleeding Management (CCBM).

We aimed to determine how Portuguese physicians handle major bleeding. We also aim to establish global diagnostic and therapeutic recommendations to be followed in clinical practice by using a step-wise approach of evidence generation. This study followed a three-step process: a steering committee desk review, a Delphi technique, an expert panel meeting. A modified 3-round Delphi including 31 statements was performed. Questions were answered in a five-point Likert-type scale. Consensus threshold was established as a percentage of agreement among participants ≥90% in the first round, and ≥85% in the second and third rounds. The level of consensus achieved by panelists was discussed with the scientific committee (January-2020). Fifty-one physicians participated in the study (compliance rate >90%). Analyzing the three rounds, consensus was reached on 20 items (64.5%) in the first, 4/11 items (36.4%) in the second and 6/7 items (85.7%) in the third. One statement about administration of clotting factor concentrates for bleeding control did not reach consensus. A high level of consensus was reached toward the need for implementing Patient Blood Management strategies in Portuguese hospitals, reduce exposure to allogeneic blood components, to use goal directed therapies for acquired bleeding management, and the need for evaluating blood transfusion indirect costs. A final version with 12 recommendations was built, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Our results provide critically appraised and updated evidence on bleeding coagulopathies management in Portugal. Additional studies, mainly about indirect costs of blood transfusion, are needed.

Expert consensus on information sheet proposals for patients under treatment with lithium

IntroductionLithium is one of the first therapeutic options for bipolar disorder, which is characterised by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium. Materials and methodsA modified Delphi method in two rounds was used. The Scientific Committee—made up by nine psychiatrists—created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7–9] and in disagreement within the range of [1–3]. ResultsA high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists. ConclusionsThis study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.

Objective assessment of intraoperative skills for robot-assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative.

ObjectiveTo develop and seek consensus from procedure experts on the metrics that best characterise a reference robot‐assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety.Materials and methodsIn Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann–Whitney U‐ and Kruskal–Wallis tests were used for construct validation of the newly identified RARP metrics.ResultsAt the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. Limitations: VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five‐times as many errors as the other half of the group (P = 0.006).ConclusionsThe international Delphi panel reached high‐level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.

ECO Experts’ consensus on establishing renal cancer healthcare quality measures in Spain.

220 Background: The ECO Foundation (Excellence and Quality in Oncology) proposes to establish a set of healthcare quality measures (including indicators and standards) for the diagnosis, treatment and follow-up of renal cancer in Spain which all healthcare professionals involved can assume, being suitable for implementation in the continuous improvement process of our healthcare system. Methods: a) International literature review on the quality of healthcare in renal cancer; b) multidisciplinary driving group (9 oncologists with expertise in renal cancer plus 2 methodologists) to identify and choose possible quality measures to be applied in Spain; c) global evaluation of the relevance of these measures through experts’ consensus (Delphi modified by a stratified state panel, n = 55 oncologists specialized in renal cancer); d) selection of definitive measures, according to their feasibility and efficiency (information provided/effort in obtaining it) using a quantitative online priority grid; e) standard wording of the chosen measures: definition, indicator, sources of information, exclusions, clarifications, categorization and acceptable standard. Results: The nominal group proposed 43 quality measures for the Delphi panel. Consensus agreement rate = 84.5% (47/55). The professional consensus was reached on 40 measures (4 structural, 33 in healthcare procedures and 3 in clinical results). Therefore, there is a high level of consensus (93%) among Spanish oncologists who specialize in renal cancer on the content of the healthcare quality measures in the management of renal cancer. The final measures were chosen using a high confidence level (95%) in the unanimity of the experts (oncologists in the driving group) for prioritization depending on the feasibility and efficiency in the healthcare system. Finally, 25 measures were chosen (2 structural, 20 in procedures and 3 in results). Conclusions: The level of consensus and prioritization of measures achieved, will most likely translate in a widespread acceptance and viability for implementation in the National Health System. This could provide a valuable tool for quality assessment and equality in the care of renal cancer patients in Spain.

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

ObjectiveTo provide guidance on the management of multisystem inflammatory syndrome in children (MIS‐C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID‐19), the acute, infectious phase of SARS–CoV‐2 infection.MethodsA multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS‐C associated with SARS–CoV‐2 and hyperinflammation in COVID‐19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS‐C and hyperinflammation in COVID‐19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9‐point scale was used to determine the appropriateness of each statement (median scores of 1–3 for inappropriate, 4–6 for uncertain, and 7–9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting.ResultsThe ACR task force approved a total of 128 guidance statements addressing the management of MIS‐C and hyperinflammation in pediatric COVID‐19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS‐C.ConclusionOur understanding of SARS–CoV‐2–related syndromes in the pediatric population continues to evolve. The guidance provided in this “living document” reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.

Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care.

Background: A short TOP10 scale based on the Practice Environment Scale-Nursing Work Index questionnaire measures the characteristics of nursing work environments. Positive environments result in better quality care and health outcomes. Objective: To identify a small number of core elements that would facilitate more effective interventions by nurse managers, and compare them with the essential elements proposed by the TOP10. Method: Qualitative research by a nominal group of eight experts. The content analysis was combined with descriptive data. Results: Ten most important items were selected and analyzed by the expert group. A high level of consensus in four items (2, 15, 20, 31) and an acceptable consensus in five items was reached (6, 11, 14, 18, 26). The tenth item in the top ten was selected from content analysis (19). The expert group agreed 90% with the elements selected as essential to the TOP10. Conclusion: The expert group achieved a high level of consensus that supports 90% of the essential elements of primary care settings proposed by the TOP10 questionnaire. Organizational changes implemented by managers to improve working environments must be prioritized following our results, so care delivery and health outcomes can be further improved.