Optimizing research-to-practice translation time through the mountain model:A Delphi study.

Multicentre Delphi consensus-based development and validation of the Tele-ESSI-KAP scale: Assessing epilepsy competencies among school teachers.

Structure-based design of new pyrazole inhibitors targeting Plasmodium falciparum dihydroorotate dehydrogenase (PfDHODH).

Adolescent and young adult (AYA) patients with cancer face complex decisions about family building, often compounded by misconceptions about hereditary cancer risk. Although guidelines recommend early discussion of fertility- and genetics-related risks, these topics are inconsistently integrated into routine care. To address this gap, we developed Reproductive Education and Fertility Links for Cancer Treatment (REFLECT), a digital health application designed to provide education and decision support related to fertility, genetic risk, and future family building for AYAs with cancer. This study developed and pilot-tested REFLECT to support informed decision-making. REFLECT was developed using evidence-based content and implemented on a web-based platform integrating multimedia education and decision support. Two iterative rounds of user testing were conducted with AYA survivors (ages 18-39) using a Learner Verification framework to assess comprehension, usability, relevance, and acceptability. Participant feedback informed iterative refinements. Participants (N = 16) reported that REFLECT was engaging, easy to navigate, and relevant to fertility, genetics, and future family-building concerns. Iterative testing identified opportunities to improve navigation, accessibility, and content organization, which were addressed through refinement. Participants reported increased confidence in discussing fertility preservation and genetic risk with providers and emphasized the value of an integrated patient-centered tool, particularly at the time of diagnosis. This pilot demonstrates that REFLECT is feasible, acceptable, and usable among AYAs. By integrating fertility and genetic risk education with decision support in an accessible digital format, REFLECT addresses a critical gap in AYA oncology care. These findings support further evaluation in clinical settings.

Alzheimer disease (AD) affects cognition, treatment adherence, family connections, and health care resource allocation. Most patients with AD have low adherence to medication therapy due to the limitations associated with cognitive impairment. Therefore, increasing the involvement of patients and their family members in medication management is important to improve treatment outcomes and reduce the burden of care. This study explores the potential application of artificial intelligence (AI) in medication management for Chinese patients with early- to mid-stage AD focusing on enhancing medication adherence. The study first predicts and evaluates key factors through an online Delphi study, which provides a basis for their subsequent incorporation into the AI model as input variables to enable prediction of medication-taking behaviors. Since AI research in medication management for this population is still undeveloped, this paper further explores the multiple potentials of AI from a theoretical view, including drug dosage optimization, multidrug interaction detection, and family education support. It will provide a preliminary direction and theoretical basis for the development of an intelligent medication management system in the future. The exploratory online Delphi study with no modification predicted the key factors influencing medication adherence. Based on the results, the study confirmed the potential of AI to improve adherence. Participation by 12 experts in 3 rounds systematically assessed the core elements influencing patients' adherence to their medication. Family care, social support, environmental factors, emotional support, and patient behaviors were identified as the primary factors influencing medication adherence among Chinese patients with AD. These factors were validated and ranked through iterative Delphi rounds, with family care and social support receiving the highest importance scores. The Wilcoxon signed-rank test indicated no significant difference between rounds (P=.06), supporting the stability of the consensus. These findings establish a foundational set of variables for AI systems that predict and enhance medication adherence. This study highlights the critical factors affecting medication adherence by Chinese patients with AD. It was designed as an exploratory online Delphi study to identify and prioritize key influencing factors, rather than to validate a specific AI-based system, and the findings provide a theoretical foundation for future AI-informed interventions. The results also indicate theoretical potential roles for AI in supporting medication management, such as optimizing drug dosage, detecting multidrug interactions, and enhancing family education.

We used Delphi methodology to provide guidance on gender equality and equity issues in professional life in intensive care, where information is evolving and no clear standard exists. A 12-member Steering Committee (7 women, 5 men) from 7 countries and 46 international panelists [(23 women, 21 men, 2 preferred not to disclose; median age 52 (33-75) years] from 32 countries (43% low- and middle-income) including intensive care practitioners, scientists, researchers, and trainees voted on 57 statements addressing issues related to gender equality and equity in 10 domains of professional life. Delphi rounds were conducted using online surveys. Consensus (at least 75% of panelists voting for a response option) and stability (consistent responses on iterative rounds) were assessed. Six Delphi rounds were conducted between May and July 2025. A 100% response rate was achieved in each round. Consensus and stability were achieved on 43 (75%) of 57 statements from which 37 professional practice guidance statements were developed. Across domains, greater consensus was achieved on equality [23/27 (85.2%)] versus equity [12/18 (66.7%)] statements. Discordant equity statements primarily pertained to academia and engagement in multiprofessional meetings and the workplace. Using a Delphi method, international experts reached consensus to generate 37 professional practice guidance statements. The consensus statements provide needed guidance for professional engagement and highlight areas for policy development to advance gender equity and equality for healthcare workers in intensive care. The discordant statements highlight areas for future research.

Predicting Homeopathic Treatment Outcomes Systematically in Chronic Diseases: Development of Version 2 of the Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT) by Mixed-Methods Research.

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

To identify and establish core concepts through expert consensus, providing a standardized framework for curriculum development in pharmacy administration and leadership (PAL) training. A modified Delphi methodology was employed in the spring and summer of 2024, utilizing iterative rounds of surveys distributed via Qualtrics to an expert panel of 85 pharmacy administrators and leaders. The initial list of 13 core concepts was derived from prior research on healthcare management programs. Through multiple rounds of feedback and refinement, consensus was determined using an a priori 80% endorsement threshold, consistent with or more rigorous than previous Delphi studies in pharmacy education. Qualitative responses were analyzed using thematic analysis to refine definitions and core concept titles. In round 1, 11 of 13 core concepts met the consensus threshold, while "operations management" (79%) and "innovation and entrepreneurship" (74%) were refined based on feedback. "Supply chain management" was added as a standalone concept. In round 2, 14 concepts were reviewed, with 13 achieving consensus and "innovation and entrepreneurship" recommended to be further integrated into other concepts. Round 3 finalized 13 core concepts, 9 of which received 100% endorsement. The 13 core concepts provide a standardized framework to guide curriculum development in master's programs, residencies, and other PAL training initiatives. These core concepts can help address the leadership gap in pharmacy by ensuring graduates acquire the essential knowledge and competencies needed to lead healthcare organizations effectively. Future research should explore integrating these concepts into accreditation standards and assessing their impact on educational outcomes.

Shared decision-making is a collaborative process whereby clinicians and patients work together to decide on a treatment plan that is informed by evidence, clinical experience and individual patient characteristics and preferences. This process is particularly important for complex surgical decisions when the risks and benefits of treatment are finely balanced. However, shared decision-making has not been implemented consistently in peri-operative pathways and structured shared decision-making for patients requiring enhanced decisional support is not widely available. We aimed to develop clinical practice recommendations for peri-operative shared decision-making through an international consensus process. A modified nominal group technique was utilised, comprising seven stages. Idea generation (stages 1 and 2) was conducted online. Stages 3-7 occurred in person over 2.5 days and involved iterative rounds of deliberation, refinement and voting to develop consensus statements and recommendations. An international multidisciplinary group of 22 experts was purposively selected to represent diverse perspectives across healthcare settings and reflected relevant stakeholders in peri-operative shared decision-making. Three consumer advisors were also recruited who had lived experience of major surgery either as a patient or carer. Consensus for recommendations was defined a priori as 75% of all faculty indicating agreement across successive rounds of anonymous voting. Universal consensus was obtained on 25 recommendations, which included a definition of 'universal shared decision-making' for all patients contemplating surgery and referral criteria for 'specialised shared decision-making services' for patients with higher decisional-support needs. The core components of shared decision-making services and priority areas for research were also identified. This is the first consensus statement recommendations for peri-operative shared decision-making co-created by consumers and clinicians. It will support the implementation of shared decision-making for patients contemplating surgery.

Parents of autistic children (PAC) are at increased risk of psychological distress, including shame and self-criticism. Compassion-focused therapy (CFT) is a recommended transdiagnostic intervention for such difficulties, but to date, there is limited research around the use of CFT with PAC. The present study aimed to explore the adaptations needed for a guided self-help CFT intervention for wellbeing, and the potential factors influencing future implementation during feasibility testing, through engagement with relevant stakeholders. A two-stage qualitative research design aimed to (1) extract and configure stakeholder feedback for adaptations and (2) understand stakeholder views regarding the anticipated factors influencing implementation of the CFT resource during future feasibility testing. Five iterative rounds of stakeholder feedback and intervention refinement were facilitated, using focus groups and written commentary with PAC (n = 7), clinical psychologists working within children's autism services (n = 4) and a CFT expert (n = 1). Directed content analysis supported extraction of adaptation suggestions during each feedback round. Framework analysis was employed to all focus group data to meet the second research aim. Compassionate Mind Training for Parents of Autistic Children (CMT-PAC) guided self-help intervention was developed. Two key concepts from the framework analysis were recognised across focus groups: 'personal and social context of parents' and 'barriers and facilitators to engagement'. Stakeholders appeared optimistic about the use of CMT-PAC within a future feasibility study. However, some potential issues were raised relating to how CMT-PAC could be implemented amongst the target population. Implications for research and clinical practice are discussed.

Relevant tools are lacking to assess health equity specifically related to pharmacy services; therefore, there is minimal guidance on how to objectively and strategically evaluate the impact clinic-based pharmacists have in health equity efforts. The overall aims of this project were to (1) identify health indicators for a health equity scorecard in ambulatory care pharmacy practice and (2) create and refine a reproducible process for identifying key health indicators for a health equity scorecard. A modified Delphi methodology served as the primary framework for health indicator selection. This approach included gathering subject matter expert (SME) insights regarding the importance, usability, and validity of potential health indicators identified via an environmental scan. The primary objective for this project was to identify health indicators, with 8 selected at the end of the modified Delphi survey process. The process consisted of 2 iterative rounds and a final consensus meeting. Twenty SMEs were recruited to participate, with 90% (n = 18), 85% (n = 17), and 70% (n = 14) participating in the first and second rounds of the survey and the final consensus meeting, respectively. Through this project's use of a modified Delphi methodology, a standardized and reproducible process was successfully developed for the identification of health indicators for a health equity scorecard to evaluate clinic-based pharmacists' impact on closing health equity gaps. This process has the potential to fill a significant gap in the literature, and the future health equity scorecard will further demonstrate the value of pharmacists in the pursuit of health equity.

Abstract Current guidelines do not address the appropriate technique for accurate inpatient blood pressure (BP) measurement. Outpatient data suggest that technique matters for accurate readings. Given the substantial impact of BP treatment decisions, this study explored the relative importance of various factors for accurate inpatient BP measurement. This was a ranking-type Delphi survey conducted in two stages. Stage 1 involved document ratification (single round) where an international panel of 9 hypertension experts reviewed and validated source documents relevant to BP measurement. Stage 2 involved variable ranking across three iterative rounds: Rounds 1 and 2 required panellists to independently rank all 10 variables from most to least important with each variable receiving a unique rank; Round 3 used paired comparisons with forced choices to refine consensus. Binary decisions required > 80% agreement for consensus. Ranked order consensus required Kendall’s coefficient > 0.7. The panel agreed with high consensus on the following 10 variables in order of importance: (1) at least two measurements, (2) correct cuff size, (3) not talking during measurement, (4) correctly fitted cuff, (5) cuff at heart level, (6) seated position, (7) contemporary device calibration, (8) legs uncrossed, (9) bare arm below cuff, and (10) supported back (Kendall’s 0.97, P < 0.001). Understanding of true determinants of accurate inpatient BP measurement is still required. Meanwhile, expert consensus provides an intermediary step for prioritising factors in inpatient BP measurement to assess performance.

Objective Posttraumatic stress disorder (PTSD) frequently co-occurs with acquired brain injury (ABI), yet limited evidence guides treatment for this population. This study aimed to establish expert consensus on the applicability of trauma-focused PTSD treatments for adults with ABI, identify commonly used adaptations, and clarify treatment challenges. Method A Delphi study was conducted with Dutch clinicians experienced in delivering PTSD treatment to adults with ABI across mental health, rehabilitation, and hospital settings. Through two iterative survey rounds, participants evaluated statements regarding feasibility, safety, and modifications of psychological therapies for PTSD after ABI. Quantitative agreement ratings were supplemented with qualitative comments. Results Consensus across two Delphi rounds (51 and 50 experts) indicated that trauma-focused treatments were feasible for adults with ABI. Core therapeutic principles were considered valid, and procedural adaptations, such as shorter sessions, slower pacing, and simplified language, were sometimes recommended for cognitive or sensory impairments. Structural modifications were less commonly endorsed. Opinions diverged regarding side-effect profiles: some reported similarities to non-ABI patients, whereas others noted increased fatigue, irritability, or somatic complaints. No consensus emerged on the adequacy of current PTSD assessment instruments, with concerns about symptom overlap and a need for ABI-specific validation or adapted administration. Conclusions Clinicians agreed that trauma-focused treatments can be feasible for adults with ABI when adaptations are applied on a case-by-case basis. The study also highlights uncertainty regarding PTSD assessment tools and the need for systematic evaluation of treatment adaptations and adverse effects. These practitioner-informed findings provide direction for clinical practice and guideline refinement.

There are no established criteria to define the resolution of acute respiratory distress syndrome (ARDS). We aimed to develop an expert consensus definition of ARDS resolution. Modified Delphi consensus study with three iterative rounds. Electronic surveys. A panel of 19 ARDS experts participated in the Delphi process. Experts were identified using prespecified criteria. The Delphi process was conducted over three rounds. Item generation was performed in round 1 with all panelists invited to suggest defining characteristics for resolution of ARDS with corresponding operational definitions, which were then voted on by the panel. Item refinement in rounds 2 and 3. Thresholds for agreement were specified a priori and set at 70%. Nineteen panelists submitted complete responses to the first round with 16 panelists contributing to the final definition that met a priori consensus criteria after the third round questionnaire. The panel agreed on the following elements: 1) resolution of hypoxemia, defined as ratio of Pa o2 /F io2 greater than 300 (or ratio of oxygen saturation to F io2 > 315) for more than 24 hours and 2) normalization of level of respiratory support, defined as "if still intubated, this is for primarily nonrespiratory reasons (e.g. altered mental state, ICU-acquired weakness) and ventilatory assistance is minimal (i.e., positive end-expiratory pressure less than or equal to 5 cm H 2 O, and no adjunctive interventions); if maximal respiratory support was continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), then no longer requiring CPAP or NIV; if maximal respiratory support was oxygen via high-flow nasal cannula (HFNC), then no longer requiring HFNC; and if maximal respiratory support was standard oxygen, then longer receiving oxygen." A high level of consensus was achieved on criteria defining the resolution of ARDS. Future work is required to explore the epidemiology and performance characteristics of this definition.

Multi-pronged design enhances thermostability of zearalenone hydrolase ZenR for enzymatic detoxification of maize flour.

Faculty development is vital for sustaining and advancing medical education. While accreditation standards require US medical schools to offer faculty development, existing frameworks lack the specificity to guide program planning, implementation, and evaluation across all key domains-and none have been developed through a systematic, consensus-based process with national medical education leaders. To address this gap, authors launched a pilot initiative to derive a consensus-based framework, entitled the Medical Education Faculty Development Program Framework (FDPF), for undergraduate medical education. Over the course of 2021 to 2024, faculty development experts from 3 medical schools conducted a sequential, mixed-methods study in 7 phases to develop the FDPF. Phases included literature and expert conceptual reviews to generate an initial draft, followed by 4 iterative rounds of focus groups and semi-structured interviews with faculty development leaders from national medical education organizations to refine the framework. A short form with 27 quality indicators was then piloted at 2 US medical education conferences in 2023 with a combined sample of 55 faculty development participants. Focus group and conference participants endorsed the FDPF as potentially valuable for onboarding new faculty development professionals and for self-assessment of institutional programs or accreditation preparation. Across both pilot administrations of the short form, participants reported the highest agreement with quality indicators related to tracking faculty development participation and offering sessions on core teaching topics and learning science. Agreement was lower for indicators related to program alignment with teaching standards, access to faculty performance metrics, preceptor training programs, and support for instructional design. Iterative expert feedback through focus groups and leader interviews contributed to 2 distinct final products: (1) a concise short form, "27 Quality Indicators of Faculty Development Programs," designed for rapid self-assessment, and (2) a comprehensive FDPF checklist designed for systematic program benchmarking, design, and enhancement. Together, these tools offer faculty development professionals a systematic, consensus-based resource for driving continuous improvement and adaptability in medical education.

Co-designing interventions for patients with inflammatory arthritis (IA) can help optimise healthcare delivery and improve patient engagement in their care. We conducted a systematic review of co-designed interventions for people living with IA. We assessed the following: (a) Intervention effectiveness, (b) the co-design phases used, and (c) barriers and enablers to conducting a co-design study. We searched MEDLINE, Embase, CINAHL, and Science Citation Index (Web of Science) in October 2022, with an updated search conducted in March 2024. All study designs were eligible for inclusion. Experimental studies were quality assessed using the Cochrane risk-of-bias tool (RoB 2 and ROBINS-I). The study is reported according to the PRISMA guidelines. We screened 11,091 reports, and 22 met the eligibility criteria. A range of co-designed interventions was identified, such as patient decision-making tools, applications for monitoring clinical and patient-reported outcomes, rehabilitation, and educational interventions. There was a paucity of psychosocial support interventions. All projects involved several stages of intervention development, including needs assessment, ideation, prototyping, and evaluation. Fifteen projects conducted pilot testing of their interventions, mainly assessing usability, feasibility, and acceptability metrics. Common barriers to co-design included poor communication, issues withstakeholder representativeness, and resource constraints. Key enablers of successful co-design were iterative rounds of prototyping and feedback, engagement of diverse stakeholders, and utilisation of varied and flexible methods. Co-design is an adaptable approach for developing IA interventions and improving usability and feasibility through iterative, broad stakeholder engagement. However, its clinical effectiveness remains unproven, and common co-design barriers, such as communication challenges and limited stakeholder diversity persist. There is a need for more work on co-designed psychosocial support tools. Future work should also focus on establishing the clinical effectiveness of co-designed interventions to justify their continued development and implementation in IA care.

To address the current lack of standardized protocols for vestibular infant screening (VIS), this clinical consensus aims to establish a clinical consensus on VIS in infants aged 0-12 months. Given a frequent co-occurrence of vestibular dysfunction in children with sensorineural hearing loss (SNHL) and the significant impact of vestibular dysfunction on early development, early identification and management are critical. This clinical consensus was developed by a panel of 28 international experts in pediatric otolaryngology and vestibular disorders through a structured, multi-round Delphi process. Panelists were selected based on clinical and academic expertise, representing 26 institutions across Asia and Europe. A comprehensive literature review (2000-2024) informed the initial draft of consensus statements. The consensus was reached through three iterative rounds of anonymous rating and feedback, followed by virtual discussions. Statements achieving ≥ 80% agreement were retained in the final consensus, which focused on screening tools, target populations, optimal timing, and standardized cVEMP recording protocols for infants. The expert panel reached consensus on key recommendations in four domains: screening tool, target screening population, timing of vestibular function screening, and recording protocol for cervical vestibular evoked myogenic potential (cVEMP). This clinical consensus provides foundational guidance for the implementation of VIS in infants, advocating for standardized protocols to improve early diagnosis and intervention. Widespread adoption of these recommendations may enhance developmental outcomes by enabling timely detection and management of vestibular dysfunction in early childhood.

Insomnia is prevalent in adolescents with co-morbid mental health problems but is often overlooked due to limited access to training for practitioners in the assessment and treatment of insomnia. Whilst Cognitive Behavioural Therapy is the recommended treatment for insomnia in adults (CBTi), there are no standard treatment guidelines for adolescents and limited research with adolescents with co-morbid mental health problems. Therefore, our aim was to develop a CBTi intervention for adolescents with co-morbid mental health problems. This study utilised an iterative expert consultation approach to develop a CBTi intervention and define the appropriate target population, components and delivery. Eighteen experts were identified from literature searches and professional networks and invited to participate. Three iterative rounds of questionnaires were conducted and included both open-ended and closed-ended questions. In total, seven experts participated (R1 = 7, R2 = 5 and R3 = 1). In R1, four main themes emerged: (1) CBTi is appropriate for early-mid adolescents with anxiety/depression, (2) the proposed content and format were appropriate but required adaptation, (3) the proposed method of delivery was appropriate (i.e., in-person, by trained practitioner) and (4) parent/caregiver involvement is necessary. In R2, the intervention protocol was reviewed and finalised. In R3, the intervention materials were reviewed. The newly developed intervention comprises 4 weekly sessions, intervention materials and a training package for non-sleep experts. To our knowledge, this is the first study to utilise an iterative expert consultation process to develop an insomnia intervention for adolescents with co-morbid mental health.