High Level Of Consensus Research Articles

Talent Management for Enterprises in Guangdong–Hong Kong–Macao Greater Bay Area: Analysis of Current Situation and Suggestions for Countermeasures

In response to the above findings, this study concludes that enterprises should strengthen the construction of talent echelon and cultivate talents adapted to the development of the enterprise through the combination of industry-university-research and emphasizing the development of innovation ability. Secondly, enterprises need to build a scientific talent evaluation system, oriented by ability and performance, and utilize talent evaluation techniques to ensure the fairness and accuracy of evaluation. In addition, enterprises should design career development channels to provide employees with opportunities for growth and promotion, as well as improve the working environment and provide competitive compensation and benefits to attract and retain talents. In terms of talent planning, enterprises should adopt a long-term perspective and develop talent planning that meets more than three years of business operation services to cope with the uncertainty of the future market. Finally, enterprises should strengthen communication with employees, establish a transparent feedback mechanism, and enhance employee job satisfaction and loyalty by empowering employees and high-level consensus. These countermeasures help enterprises build an effective talent management system and enhance competitiveness.

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

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

An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease.

The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

Class of international functioning disability and health core sets for autism spectrum disorder: Occupational therapists’ perspective

Purpose: This study was conducted to examine the ICF Core Sets prepared for autism from the perspective of occupational therapists within the scope of the International Classification of Functioning, Disability, and Health. Materials and Methods: Data were collected from 70 occupational therapists working with children diagnosed with autism spectrum disorder. Opinions of the participants were collected using the three-stage Delphi technique. Results: In the first Delphi round in which 70 occupational therapists from our country participated, a total of 2952 concepts related to autism spectrum disorder were named. The collected responses were associated with 142 ICF categories, excluding personal factors, and then the number of categories was reduced to 132 because 10 of them were mentioned by less than 5% of the respondents. While consensus was achieved in 82% of the 111 categories in the comprehensive ICF Core Sets for autism spectrum disorder . Discussion and Conclusion: According to the results of this study, ICF-CSs prepared for autism spectrum disorder overlap with the perspective of occupational therapists to define the physiological, occupational, environmental, and personal factors affecting individuals with autism spectrum disorder . The high level of consensus among occupational therapists underscores the practical applicability and acceptance of ICF Core Sets in the field.

Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study.

For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message-based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions.

Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results.

Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European research consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis, and linkage to specialty care for European PC settings. Based on the lessons from this project, the latest research evidence, and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral, and management of MASLD in PC. The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology, and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in the first round. Then, in a hybrid meeting, the experts discussed findings from round one, adjusted the statements, and reassessed the updated recommendations in a second round. In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high degree of agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD-lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management, and other referrals to specialists. The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackling MASLD and supporting European PC providers by integrating the latest evidence into practice.

Agreement for Recovery: First Spanish Consensus on the Concept of Alcohol Addiction Recovery.

Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD. The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid. A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities. This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.

Recommendations for Deprescribing of Medication in the Last Phase of Life: An International Delphi Study

ContextMedications may become inappropriate for patients in the last phase of life and may even compromise their quality of life. ObjectiveTo find consensus on recommendations regarding deprescribing of medications for adult patients with a life expectancy of six months or less. MethodsExperts working in palliative care or other relevant disciplines were asked to participate in this international Delphi study. Existing tools for deprescribing of medication in the last phase of life were integrated in a list of 42 recommendations regarding potential deprescription of various medication types. In two Delphi rounds, experts were asked to rate their agreement with each recommendation on a 5-point Likert-scale (strongly agree—strongly disagree). Recommendations were accepted, if at least 70% of the experts (strongly) agreed, the interquartile range (IQR) was one or less, and less than 10% strongly disagreed. ResultsAbout 47 experts from 10 countries participated (response rate 53%). In most cases (76%), consensus was reached on deprescribing recommendations for patients with a life expectancy of six months or less. The highest level of consensus was reached for recommendations on the deprescription of diuretics in case of decreasing fluid intake or increasing fluid loss, lipid modifying agents if prescribed for primary prevention, and vitamin K antagonists and direct oral anticoagulants in case of high bleeding risk. ConclusionA high level of consensus was reached on recommendations on potential deprescription of several medications for patients with a life expectancy of six months or less.

Avoidable emergency admissions: defining the concept.

The transfer of end-of-life patients to hospital via admission to an emergency service mainly happens because of a lack of community support nearby and a lack of resources in palliative care. This study aimed to define the concept of avoidable admission to an emergency department for palliative patients. An integrative literature review was performed. The results of this were put to a panel of palliative care experts via a Delphi process to determine their consensus and agreement with the statements. The results of the two-step Delphi process reached a high level of consensus and agreement that patients with palliative needs accompanied by home palliative care teams should not go to the emergency department. There was a low level of consensus and agreement about the appropriate admission of a patient in pain in the absence of any information about previous community support. The findings allowed the definition of an 'avoidable emergency admission', which is an emergency admission for any symptom or condition that could be supported in a home context or primary health care, or any emergency admission that does not require immediate nursing or medical intervention, nor leads to greater comfort or quality of life for the patient.

Temperaments as Basic Bias.

In this work, we argue that the lack of a solid theoretical basis and the absence of an integrative movement in psychological science within evolutionary perspectives has meant that the various attempts to explain and define the phenomenon of "temperaments" offer notions that are either too broad or simply imprecise and, as a result, they failed to reach a high level of consensus among researchers in this science. In this regard, we understand that the evolutionary theory proposed by Osmo (Integrative Psychological and Behavioral Science 57:205-234, 2023) is promising for reaching such a consensus. Thus, the objective of this article is, from this theory, to offer a better understanding of the phenomenon of "temperaments", and, based on it, to develop a precise and parsimonious definition of this term.

Use of Delphi methodology to select sustainability indicators on dairy farms: an exploration of environmental, economic, social and animal welfare dimensions

Sustainable livestock production is essential to ensure the availability of food and resources, and to address the social, economic, and environmental challenges that threaten conventional livestock production. While there is consensus among economic, social, and scientific groups on the need to assess sustainability to make decisions that protect resources for present and future generations, there are few sustainability assessment tools that address it holistically. The aim of this study was to develop an assessment tool applicable to farms by identifying the indicators currently applied in dairy farms, based on a systematic literature review and expert opinion. This study used the Delphi methodology to explore sustainability indicators at the farm level. A panel of seven expert researchers and academics in livestock sustainability and animal welfare participated in the study. A high level of consensus was found for 15 economic indicators, 14 social indicators, 20 environmental indicators, and 16 animal welfare indicators. Some indicators, such as financial autonomy, transmissibility, cow and labor productivity, husbandry system, labor intensity, community bonding, labor satisfaction, biodiversity, crop rotation, fertilization, manure management, and water management, showed a high level of consensus and were considered useful in assessing sustainability on dairy farms. In addition, livestock sustainability experts reached a high consensus on 16 animal welfare indicators that could be useful in assessing farm sustainability. These results provide a solid basis for sustainability indicators in the economic, social, environmental, and animal welfare dimensions, which could serve as a basis for developing a sustainability assessment tool for dairy farms.

Management from a multidisciplinary perspective of phlebitis related to peripheral venous catheter insertion: An international Delphi study.

To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines. PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous. Delphi method. Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them. Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work). The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities. Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice. Delphi studies (CREDES). Experts contribution.

Factors influencing IoT adoption for sustainable facilities management in Saudi Arabia: a stakeholder assessment

PurposeThis paper evaluates the factors influencing the utilization of the Internet of Things (IoT) for sustainable facilities management (SFM) practices in Saudi Arabia.Design/methodology/approachA mixed approach, combining a literature review, pilot-testing and questionnaire survey, was adopted to evaluate the factors. Twenty-seven factors were identified and grouped into four groups: technical, business and organizational, operational and security and privacy. The questionnaire was distributed to 30 facilities managers and 30 IoT specialists, totaling 60 practitioners, to determine the effect index of each factor. The practitioners' consensus on the ranking of the factors was then determined.FindingsThe study identifies the top-ranking factors as: “Difficulty in ensuring data security and protection,” “Difficulty in ensuring data privacy and confidentiality” and “Limited awareness and understanding of IoT benefits and capabilities.” These factors highlight the challenges to successful IoT implementation in the FM sector. The FM sector could benefit from utilizing IoT while maintaining the security, privacy and effectiveness of building operations by successfully addressing these concerns. A high level of consensus on the ranking of the factors was observed between facilities managers and IoT specialists. This was substantiated by a Spearman’s rank correlation coefficient of 0.79.Originality/valueThis study enriches the literature by combining practical insights from facilities managers with technical expertise from IoT specialists on the factors impacting IoT implementation in the Saudi Arabian FM sector. Beyond academic contributions, it provides practical insights for industry professionals, fostering a culture of knowledge-sharing and guiding future research in this field.

People Attribute a Range of Highly-Varied and Socially-Bound Meanings to Naturalistic Sad Facial Expressions

Depictions of sadness are commonplace, and here we aimed to discover and catalogue the complex and nuanced ways that people interpret sad facial expressions. We used a rigorous qualitative methodology to build a thematic framework from 3,243 open-ended responses from 41 people who participated in 2020 and described what they thought sad expressors in 80 images were thinking, feeling, and/or intending to do. Face images were sourced from a novel set of naturalistic expressions (ANU Real Facial Expression Database), as well as a traditional posed expression database (Radboud Faces Database). The resultant framework revealed clear themes around the expressors’ thoughts (e.g., acceptance, contemplation, disbelief), social needs (e.g., social support or withdrawal), social behaviours/intentions (e.g., mock or manipulate), and the precipitating events (e.g., social or romantic conflict). Expressions that were perceived as genuine were more frequently described as thinking deeply, reflecting, or feeling regretful, whereas those perceived as posed were more frequently described as exaggerated, overamplified, or dramatised. Overall, findings highlight that facial expressions — even with high levels of consensus about the emotion category they belong to — are interpreted in nuanced and complex ways that emphasise their role as other-oriented social tools, and convey semantically related emotion categories that share smooth gradients with one another. Our novel thematic framework also provides an important foundation for future work aimed at understanding variation in the social functions of sadness, including exploring potential differences in interpretations across cultural settings.

Reconnecting systemic family therapy: How family therapy training can attend to the ecosystem and climate emergency, recommendations from a Delphi survey

AbstractWe are facing devastating effects of the climate emergency and systemic environmental breakdown. These impact on mental health and wellbeing. Family therapy has only marginally engaged with these crises and the relationship between people and ecosystem. This Delphi survey identifies key elements to include in family therapy training to attend to the ecosystem and the climate and ecological emergencies. Participants generated ninety‐six statements that were clustered into six overarching ‘topic areas’ (theories, orientations, schools, integrations/transformations, methods, and techniques). There were sixty‐six statements agreed at a high level of consensus and seventeen with a moderate level of consensus, while there was no consensus over the remaining thirteen items. All participants opted to suggest references, which form a reading list to accompany these ideas.

Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.

Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%). One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

Social Planning for Ageing Within the Framework of the Decade of Healthy Ageing (2020-2030)

Objective: The objective of this study is to investigate ageing planning with the aim of finding out the convergence with the guidelines of the Decade of Healthy Ageing. Theoretical Framework: This theme presents the main concepts underpinning the research such as the paradigms of active and healthy ageing, the principles set out in the Universal Declaration of Human Rights and others, such as the Decade of Healthy Ageing 2020-2030 adopted by the United Nations Assembly in 2020. These provide a solid basis for understanding the context of the research. Method: The methodology adopted consisted of a documentary analysis of the planning instruments on ageing developed by the Autonomous Communities of Spain. The analysis focused on the principles, lines, objectives and measures, and their alignment with the United Nations document. Results and Discussion: The results revealed a high level of consensus among the principles identified by the UN (1991). A high level of convergence was also found between the Decade of Healthy Ageing 2020-2030, the Spanish National Strategy (IMSERSO, 2017) and regional planning. Research Implications: The results of the research can be applied to the design of public policies aimed at promoting active and healthy ageing. Originality/Value: This study contributes to the strengthening of social intervention in the promotion of active ageing. The work is innovative in analysing regional policies with reference to the Decade. The relevance and value of the work is evidenced in the recognition of the need for comprehensive and interdisciplinary approaches.

Management of seizures in patients with primary mitochondrial diseases: consensus statement from the InterERNs Mitochondrial Working Group.

Primary mitochondrial diseases (PMDs) are common inborn errors of energy metabolism, with an estimated prevalence of one in 4300. These disorders typically affect tissues with high energy requirements, including heart, muscle and brain. Epilepsy may be the presenting feature of PMD, can be difficult to treat and often represents a poor prognostic feature. The aim of this study was to develop guidelines and consensus recommendations on safe medication use and seizure management in mitochondrial epilepsy. A panel of 24 experts in mitochondrial medicine, pharmacology and epilepsy management of adults and/or children and two patient representatives from seven countries was established. Experts were members of five different European Reference Networks, known as the Mito InterERN Working Group. A Delphi technique was used to allow the panellists to consider draft recommendations on safe medication use and seizure management in mitochondrial epilepsy, using two rounds with predetermined levels of agreement. A high level of consensus was reached regarding the safety of 14 out of all 25 drugs reviewed, resulting in endorsement of National Institute for Health and Care Excellence guidelines for seizure management, with some modifications. Exceptions including valproic acid in POLG disease, vigabatrin in patients with γ-aminobutyric acid transaminase deficiency and topiramate in patients at risk for renal tubular acidosis were highlighted. These consensus recommendations describe our intent to improve seizure control and reduce the risk of drug-related adverse events in individuals living with PMD-related epilepsy.

A Core Outcome Set for Efficacy of Acute Treatment of Hereditary Angioedema

BackgroundClinical trials investigating drugs for acute treatment of hereditary angioedema attacks have assessed many different outcomes. This heterogeneity limits comparability of trial results and may lead to selective outcome reporting bias and a high burden on trial participants. ObjectiveTo achieve consensus on a Core Outcome Set comprising key outcomes that should ideally be utilized in all clinical efficacy trials involving acute treatment of hereditary angioedema attacks. MethodsA Delphi consensus study was conducted involving all relevant parties: hereditary angioedema patients, hereditary angioedema expert clinicians and clinical researchers, pharmaceutical companies, and regulatory bodies. Two internet-based survey rounds were conducted. In round 1, panelists indicated the importance of individual outcomes used in clinical trials on a 9-point Likert scale. Based on these results, a core outcome set was developed and voted on by panelists in round 2. ResultsFifty-eight worldwide panelists completed both rounds. The first round demonstrated high importance scores and substantial agreement among the panelists. In the second round, a consensus of ≥90% was achieved on a core outcome set consisting of five key outcomes: change in overall symptom severity at one predetermined time point between 15 minutes and 4 hours after treatment, time to end of progression of all symptoms, need for rescue medication during the entire attack, impairment of daily activities, and treatment satisfaction. ConclusionThis international study obtained a high level of consensus on a core outcome set for acute treatment of hereditary angioedema attacks consisting of five key outcomes.

Challenges, opportunities, and priorities for tier-1 emergency medical services (EMS) development in low- and middle-income countries: A modified Delphi-based consensus study among the global prehospital consortium

IntroductionThough the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally. MethodsA steering committee coordinated a 9-round, modified Delphi-based expert discussion to identify current challenges, opportunities, and priorities in Tier-1 EMS development globally. 11 panelists represented seven Global Prehospital Consortium(GPC) member organizations with a mean 9.57 years of organizational Tier-1 EMS development/implementation experience(median = 9 years). The consortium represents the largest collaboration between organizations directing Tier-1 EMS programs globally across 12 countries on 3 continents(Americas, sub-Saharan Africa, and South Asia) with 22,000 first responders. ResultsThe GPC identified seven priority areas for Tier-1 EMS development: infrastructure/operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/equipment. A high level of consensus exists regarding priorities for investigation, including Tier-1 responder density/distribution, Tier-1 patient data variable standardization for trauma registries/quality improvement, dispatch technologies/protocols, modular curricula, broader cost-effectiveness and impact evaluation indices capturing secondary impacts of EMS, standardizing legal protections for first responders, and transportation/equipment standards. DiscussionConsensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts.