National Experts Research Articles

Developing a quality and safety assessment framework for Iran’s military hospitals

BackgroundThe first crucial step towards military hospitals performance improvement is to develop a local and scientific tool to assess quality and safety based on the context and aims of military hospitals. This study introduces a Quality and Safety Assessment Framework (Q&SAF) for Iran’s military hospitals.MethodsThis is a literature review which continued with a qualitative study. The Q&SAF for Iran’s military hospitals was developed initially, through a review of the WHO’s framework for hospital performance, literature review (other related framework), review of military hospital-related local documents, consultations with a national and sub-national expert. Finally, the Delphi technique used to finalize the framework.ResultsBased on the literature review results; 13 hospital Q&SAF were identified. After reviewing literature review results and expert opinions; Iran’s military hospitals Q&SAF was developed with 58 indictors in five dimensions including clinical effectiveness, safety, efficiency, patient-centeredness, and Responsive Management (Command and Control). The efficiency dimension had the highest number of indictors (19 indictors), whereas the patient-centered dimension had the lowest number of indices (4 indictors).ConclusionRegarding the comprehensiveness of the developed assessment framework due to its focus on the majority of quality dimensions and important components of the hospital’s performance, it can be used as a useful tool for assessing and continuously improving the quality of hospitals, particularly military hospitals.

Educational Model and Prevention on Prediabetes: A Systematic Review.

Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future. This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review. Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

International Conference on AeroSpace Science and Technology (ICASST) 2023

1. Introduction Welcome to the publication of the Proceedings of the International Conference on Aerospace Science and Technology (ICASST) 2023, which was hosted at the facilities of Centro de Desarrollo Aeroespacial (CDA), Instituto Politécnico Nacional (IPN), in the historical centre of Mexico City, Mexico, from November 19th to November 24th, 2023. ICASST 2023 was a scientific forum for the dissemination of basic research and/or technological development projects, which allows interaction between professionals, scholars and industrialists, promoting scientific-technological collaborations in the aerospace field and related areas. The program included presentations, round tables, courses/workshops as well as keynote lectures given by widely recognized national and international experts in their area. The Conference was held in a hybrid way, face-to-face/virtual.

An Analysis of the Potential of Philippine Sports as a Tool for Public Diplomacy

With the growing lapses of sports-based strategies in the Philippine setting, the gap between its theoretical foundation and its praxis has ballooned, predominantly attributed to the need for more academic work in this area. Correspondingly, this study provides implications for sports-related strategies for predicting a positive public image of the Philippines and harboring peaceful state cooperation through the merits of soft power. To achieve this, this paper has contrived the objectives, including (1) identifying the implications of hosting the SEA Games 2019 for the country by examining the management of the Philippine government, (2) determining the implications of the elite sporting success of Filipino athletes in sports tournaments, and, lastly, (3) identifying the potential of sports through the implementation of sports-related strategy by the Philippines. Moreover, this paper implements qualitative methods, including document review and key informant interviews, to gather pertinent testimonials from various sub-sectors in sports, including national elite athletes, professional coaches, and sports experts, to assess the state of Philippine sports and significantly determine its potential as a serious form of public diplomacy, particularly in achieving its intended outcomes. This study infers that Philippine sports have the capability to influence the country's stature with consideration of the global media as well as advance its foreign policy of international cooperation.

Design and deployment of the STEEER-AF trial to evaluate and improve guideline adherence: a cluster-randomized trial by the European Society of Cardiology and European Heart Rhythm Association.

The aim is to describe the rationale, design, delivery, and baseline characteristics of the Stroke prevention and rhythm control Treatment: Evaluation of an Educational programme of the European society of cardiology in a cluster-Randomized trial in patients with Atrial Fibrillation (STEEER-AF) trial. STEEER-AF is a pragmatic trial designed to objectively and robustly determine whether guidelines are adhered to in routine practice and evaluate a targeted educational programme for healthcare professionals. Seventy centres were randomized in six countries (France, Germany, Italy, Poland, Spain, and UK; 2022-23). The STEEER-AF centres recruited 1732 patients with a diagnosis of atrial fibrillation (AF), with a mean age of 68.9 years (SD 11.7), CHA2DS2-VASc score of 3.2 (SD 1.8), and 647 (37%) women. Eight hundred and forty-three patients (49%) were in AF at enrolment and 760 (44%) in sinus rhythm. Oral anticoagulant therapy was prescribed in 1543 patients (89%), with the majority receiving direct oral anticoagulants (1378; 89%). Previous cardioversion, antiarrhythmic drug therapy, or ablation was recorded in 836 patients (48.3%). Five hundred fifty-one patients (31.8%) were currently receiving an antiarrhythmic drug, and 446 (25.8%) were scheduled to receive a future cardioversion or ablation. The educational programme engaged 195 healthcare professionals across centres randomized to the intervention group, consisting of bespoke interactive online learning and reinforcement activities, supported by national expert trainers. The STEEER-AF trial was successfully deployed across six European countries to investigate guideline adherence in real-world practice and evaluate if a structured educational programme for healthcare professionals can improve patient-level care. Clinicaltrials.gov, NCT04396418.

CHILD LABOUR IN AGRICULTURE IN THE REPUBLIC OF MOLDOVA: FEATURES AND ONGOING CHALLENGES

In the Republic of Moldova, the issue of the child labour in agriculture presents a significant challenge. This study has the aim to evaluate the participation of the Moldovan children in agricultural work and its effects on their well-being, safety, and education. Highlighting a lack of updated data and research within Moldova, especially in the agricultural sector, this study employs a detailed methodology encompassing national statistics, expert surveys, and international convention reviews. The findings indicate the involvement of children in various agricultural tasks, including hazardous ones, affecting their education and health, with children aged on average 12.7 to 15.3 years working over 20 hours weekly. The research distinguishes between harmful child labour and beneficial work, advocating for a comprehensive strategy to improve educational opportunities, family incomes, and alternative employment options. It stresses the importance of effective policies and legislation to safeguard children from exploitative labour in both formal and informal sectors. Although there has been some advancement in tackling child labour in Moldova, considerable obstacles persist. The research advocates for a comprehensive strategy that includes refining policies, strengthening the enforcement of current laws, and executing specific initiatives aimed at decreasing child labour in the agricultural sector. The research calls for joint efforts from the government, international bodies, NGOs, and communities to protect and promote child welfare, aiming to integrate children into safe environments and offering them better future prospects.

Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (2024 edition)

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 pulmonary hypertension, characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction, progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and even death. Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field. More and more patients with CTEPH have been accurately diagnosed and assessed in time. Nevertheless, there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center. To better guide clinical practice in our country, Pulmonary Embolism & Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism & Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, National Cooperation Group on Prevention & Treatment of Pulmonary Embolism & Pulmonary Vascular Disease, National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension, convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the "Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension (2024 edition) ". These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country. The key areas covered include definitions, epidemiology, pathogenesis, diagnosis and assessment, treatment, and management, with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.

Chinese expert consensus on the guidance of anti-tumor drugs for patients with tumor combined chronic kidney disease (2024 edition)

The incidence of malignant tumors has steadily increased year by year in China in recent decades. The emergence of innovative anti-cancer drugs has bolstered the prognosis of cancer patients, making it a chronic disease. Kidney injuries are frequent complications of cancer treatment clinically manifested as acute kidney injury (AKI), chronic kidney disease (CKD), proteinuria, and electrolyte disorders, etc. Although kidney injuries affect up to 50% of the patients, there is a lack of professional management guidance for anti-cancer drug dosage adjustment. The clinical pharmacology branch of the Chinese Medical Association has initiated the "Chinese expert consensus on the guidance of anti-tumor drugs for patients with tumor combined chronic kidney disease (2024 edition)". We unified national multidisciplinary experts to analyze clinical evidence with the Delphi method, and conducted expert interviews and seminars focusing on kidney function assessment, anti-tumor drug dosage adjustment for kidney disease patients. We make recommendations on selection and dose adjustment of anti-tumor drugs (chemotherapy, small molecules and antibodies) according to chemotherapeutic drug classifications, providing practical and feasible scientific guidance for clinicians.

Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)

To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China. .

Expert consensus on neurophysiologic monitoring and evaluation of neurocritical care patients (2024 version)

Neurophysiological monitoring is important for the assessment and prediction of regression in patients with severe neurocritical illnesses due to various etiologies. At present, the popularity of neuroelectrophysiological monitoring technology for severe neurocritical patients in China is not widespread enought, the level of monitoring varies, and there is a lack of relevant consensus and norms. This expert consensus combines the opinions of national experts in neuroelectrophysiology and neurocritical care medicine, and providess 13 expert opinions on neuroelectrophysiology technology and application. Commonly used Neurophysiologic monitoring in the Neuro-Intensive Care Unit (NICU) includes three categories: electroencephalogram, evoked potentials and electromyography. The main applications include assessment of coma level and prognosis prediction, reflection of intracranial pressure level, identification of nonconvulsive status epilepticus, assessment of sedation level, determination of brain death, and monitoring of severe peripheral neuropathy. It is recommended that NICU at all levels apply neurophysiologic monitoring techniques to severe neurocritical patients according to the expert consensus.

Is who they are, what they prefer? Understanding bureaucratic elites' policy preferences for European integration of government accounting

AbstractBureaucratic elites and national public administrations' experts play a key role in the preparation of supranational policies and in shaping global governance instruments. However, we know surprisingly little about what factors drive their preferences and support for supranational solutions. Drawing on the results of a vignette and conjoint experiment and the case of the European Commission's policy initiative to develop European Public Sector Accounting Standards, this study analyzes the effect of the communicative framing of a policy's objective and how experts' attitudes influence their preferences for policy outcomes. The study shows that the communicative framing of a policy's objective based on functional needs rather than on normative grounds increases support among national administrations' experts. Moreover, the study finds evidence that experts who internalized a public service motivation and those with a supranationalist collective identity are more willing to give up national sovereignty in favor of supranational policy solutions.

(134) EFFECTIVE TREATMENT OF MENOPAUSAL HOT FLASHES IMPROVES DOWNSTREAM FEMALE SEXUAL COMPLAINT

Abstract Introduction Approximately 75% of women aged between 45 years and 55 years suffer from symptoms of menopause. Untreated hot flashes have many downstream effects including but not limited to fatigue, low energy, memory complaints, lowered libido, sexual dysfunction and may even be linked to increased cardiovascular disease. While the gold standard for effective treatment is hormonal therapy, many women (especially those with a family history of breast cancer) may decline their use due to concerns regarding efficacy and safety. Lack of sensitivity training and level of comfort to disclose menopausal symptoms is often a significant barrier to effective treatment. Dose optimization, close surveillance of efficacy of hormone utilization is essential to maintain patient compliance. Objective Menopausal hot flashes are associated with a variety of downstream sexual complaints including lowered libido. This retrospective study was done to assess if optimal treatment of hot flashes with hormones and over the counter products would have a downstream effect on concurrent reported sexual complaints. Methods A retrospective review of a random convenience sample was conducted to assess women who presented with complaints of hot flashes. Concurrent associated symptoms were also reported. Treatment interventions and symptom resolution was evaluated. Data was collected and stored in private HIPPA protected database. Results A random convenience sample (n=56) from the HerMD centers (Cincinnati and Kentucky) was assessed for women (mean age 51.3; range 30-73) who presented with complaints of hot flashes. Associated symptoms included: brain fog/memory complaints (66%); sleep disturbances including insomnia (59%), decreased libido (49%), weight management concerns (38%), vaginal dryness (31%) and dyspareunia (14%). A family history of breast cancer was present in 18% of the sample. Treatment included: behavioral intervention counseling (100%), over the counter supplements n=2, (3.5%) and systemic hormonal therapy n=54 (96.5%) and over the counter recommendations (100%). All patients (100%) with a family history of breast cancer received hormonal therapy. Overall, 96% of patients responded to their intervention with self-reported improvement in hot flashes, and improvement in dyspareunia, vaginal dryness and improved libido at scheduled follow up visits. Patients had multiple office/telehealth visits to ensure dose optimization, efficacy of symptom resolution and ensure no treatment emergent adverse effects. There were n=3 (5%) reported adverse effects (minimal vaginal spotting) yet no patients discontinued treatment Conclusions Hot flashes are associated with a variety of sexual complaints including but not limited to decreased libido (49%), vaginal dryness (31%) and dyspareunia (14%). Optimal treatment of hot flashes will have downstream efficacy with FSD complaints. At HerMD, HCP have internal continuing menopausal medical education which includes standardized clinical algorithms, bibliotherapy, article data base, 1-1 didactic education/supervision and preceptorships with national menopausal experts. Systemic hormones will help with vaginal dryness and dyspareunia. HerMD advocates close clinical surveillance with treatment efficacy and safety review which allows for interventions to be modified henceforth allow for outcome optimization and enhance compliance. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Michael Krychman is a consultant for exeltis pharmaceuticals, Astellas, Uberlube and CEEK.

National Identity and Democracy Ratings

Global performance indicators, such as democracy ratings, are influential tools of global governance and can have a direct bearing on foreign policy, aid, and investment. Many of these indicators rely on expert assessments. Although expert assessments are generally understood to be objective, this article suggests raters’ identities may shape their assessments. It specifically examines how national identity shapes democracy ratings. Two data sources—an original survey of experts on Uganda and the Varieties of Democracy Institute—reveal significant differences in the ratings provided by national and non-national experts. In most cases, ratings by nationals are more positive. This article explores three potential reasons for the difference, finding some support for each: national differences in information access and consumption, national differences in conceptions of democracy, and in-group–out-group bias. The findings have implications for our understanding of global performance indicators, which are overwhelmingly a product of Global North organizations.

Diagnosis and treatment of Parkinson´s disease (guideline of the German Society for Neurology)

IntroductionThe aim of this German national guideline is to optimize the clinical care of patients with Parkinson's disease (PD) in terms of diagnostics, drug and surgical treatment and care.Summary or definition of the topicThis guidance was prepared for the German Society of Neurology (DGN) in collaboration with the Austrian Society of Neurology (ÖGN) and the Swiss Neurological Society (SNG) for German-speaking countries. The guidelines for the diagnosis and treatment of PD have been revised by a national expert group and the guideline commission of the DGN at S2k level. The main objective of these guidelines is to optimize the clinical care of PD patients regarding diagnosis, including early detection, technical diagnostic examinations, and pharmacological as well as invasive treatment options.RecommendationsThe updated PD diagnosis and treatment guidelines are emphasizing optimized clinical care. Key revisions include preferring the name "Parkinson's disease" over previous terms and adopting International Parkinson and Movement Disorder Society (MDS) diagnostic criteria. Recommendations cover genetic and imaging diagnostics, initial pharmacotherapy considering efficacy and patient factors, and tailored pharmacological combinations for complications. Guidelines extend to managing cognitive, affective, psychotic, and autonomic symptoms, along with non-oral therapies like pump therapy and deep brain stimulation. Special situations like akinetic crisis, driving ability, and care concepts are addressed, ensuring comprehensive management for PD patients at various stages and conditions.ConclusionsThis guidance reflects the state of the art at the beginning of 2024.

Optimization of the emergency obstetric and neonatal care network in Benin through expert-based sub-national prioritizations.

To reduce maternal mortality by 2030, Benin needs to implement strategies for improving access to high quality emergency obstetric and neonatal care (EmONC). This study applies an expert-based approach using sub-national travel specificities to identify and prioritize a network of EmONC maternities that maximizes both population coverage and functionality. We conducted a series of workshops involving international, national, and department experts in maternal health to prioritize a set of EmONC facilities that meet international standards. Geographical accessibility modeling was used together with EmONC availability to inform the process. For women in need of EmONC, experts provided insights into travel characteristics (i.e., modes and speeds of travel) specific to each department, enabling more realistic travel times estimates modelled with the AccessMod software. The prioritization approach resulted in the selection of 109 EmONC maternities from an initial group of 125 designated maternities. The national coverage of the population living within an hour's drive of the nearest EmONC maternity increased slightly from 92.6% to 94.1% after prioritization. This increase in coverage was achieved by selecting maternities with sufficient obstetrical activities to be upgraded to EmONC maternities in the Plateau and Atlantique departments. The prioritization approach enabled Benin to achieve the minimum EmONC availability, while ensuring very good geographical accessibility to the prioritized network. Limited human and financial resources can now be targetted towards a smaller number of EmONC facilities to make them fully functioning in the medium-term. By implementing this strategy, Benin aims to reduce maternal mortality rates and deliver effective, high-quality obstetric and neonatal care, especially during emergencies.

24P Standardizing data collection in adjuvant colon cancer trials: A consensus project from the IDEA and ACCENT international consortia and national experts

24P Standardizing data collection in adjuvant colon cancer trials: A consensus project from the IDEA and ACCENT international consortia and national experts

CONfidence: Developing an app to promote bladder and bowel health.

The CONfidence app was developed to address an unmet need for access to self-help advice and information for bladder and bowel incontinence. The app was developed by the Bladder and Bowel CONfidence Health Integration Team and Expert Self Care and this paper describes the evolution of this innovation to empower patients and the public with bladder and bowel leakage. The app is intended to provide a proactive approach to continence promotion and not replace formal healthcare. Crucial steps were identified to ensuring this resource was accessible and understandable for the intended audience including: input from national clinical experts and individuals with lived experience to co-produce content, clear definition of scope, technical expertise in app development, clear language avoiding jargon or medical terms, credibility assurance and a strategic plan for dissemination. The app is free to download and will remain so to ensure evidence-based continence advice can be in the palm of all with a smartphone. The CONfidence app has been downloaded approaching 7000 times and is in use in 10 countries. A continual effort is required to share this resource as disclosure of these symptoms is shrouded in secrecy and many people could benefit from its content.

Are cancer screening recommendations from top US cancer centers concordant with the USPSTF guidelines?

10535 Background: The USPSTF is an independent volunteer organization of multi-disciplinary national experts in disease prevention that publishes evidence-based non-binding recommendations for screening diseases, including cancer. Herein we assessed the congruence of cancer screening recommendations between the USPSTF and the Top 10 US Cancer Centers (as per the U.S News and World Report). Methods: This cross-sectional study compared the published screening recommendations from the Top 10 US Cancer Centers for colorectal (CRC), lung (LC), cervical (CC), prostate (PC), and breast cancers (BC) in average risk patients, to those of the USPSTF. The variables of interest included: screening tests, recommendation direction (for/against), strength, frequency, age of start, age of end, and discussion about risks and benefits. Data extraction was done by 2 authors and discrepancies resolved by mutual consensus and discussion with a third author. Results: We demonstrate the differences between the screening recommendations from the Top 10 Cancer Centers relative to those from the USPSTF (Table). Conclusions: Our study found significant variability between the screening recommendations from the 2022-2023 USNWR top 10 cancer centers and the evidence-based USPSTF guidelines for BC, PC, CC, and CRC. The recommendations for LC were overall in line with those of the USPSTF. The discordance was almost always in the direction of the cancer centers recommending more screening beyond the USPSTF’s recommendations, and often without discussion of potential risks and harms. This inconsistency could create confusion to the public, and therefore, a consistent messaging across the cancer centers congruent with the USPSTF recommendations and including a nuanced discussion of benefits and risks may be in the best public health interest.[Table: see text]

Oral Fluid, Electrolytes, and Energy Management in Various Adult and Geriatric Illnesses beyond Diarrhea: An Indian Expert Panel Delphi Consensus Recommendation.

Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of hospitalization and mortality, only a few international guidelines provide recommendations regarding oral fluids, electrolytes, and energy (FEE) management in adults/geriatrics with dehydration due to nondiarrheal causes. Currently, there is a lack of comprehensive recommendations on the role of oral FEE in nondiarrheal dehydration in adult and geriatric Indian patients. A modified Delphi approach was designed using an online questionnaire-based survey followed by a virtual meeting, and another round of online surveys was used to develop this consensus recommendation. In round one, 130 statements, including 21 open-ended questions, were circulated among ten national experts who were asked to either strongly agree, agree, disagree, or strongly disagree with statements and provide responses to open-ended questions. The consensus was predefined at 75% agreement (pooling "strongly agree" and "agree" responses). Presentation of relevant literature was done during a virtual discussion, and some statements (the ones that did not achieve predefined agreement) were actively discussed and deliberately debated to arrive at conclusive statements. Those statements that did not reach consensus were revised and recirculated during round two. Consensus was achieved for 130/130 statements covering various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic nondiarrheal illness. However, one statement was not added as a recommendation in the final consensus (129/130) as further literature review did not find any supporting data. Oral FEE should be recommended as part of core treatment from day 1 of acute nondiarrheal illness and started at the earliest feasibility in chronic illnesses for improved patient outcomes. Appropriately formulated fluids with known electrolyte and energy content, quality standards, and improved palatability may further impact patient compliance and could be a good option. These consensus recommendations provide guidance for oral FEE recommendations in Indian adult/geriatric patients with various nondiarrheal illnesses.

Empowerment Among Adolescent Girls in Nepal: A Concept Mapping Exploratory Study.

The concept of empowerment is challenging to operationalize and measure; it is multidimensional, the outcomes are not always directly observable, and meanings of empowerment are highly contextual and socially and culturally situated. This study aimed to explore perspectives of empowerment among adolescent girls in Nepal to identify statements for inclusion in a context-specific empowerment measure. We used a participatory and mixed method research method called concept mapping in 3 districts in Nepal. Three sequential concept mapping sessions were used to solicit, organize, and process how participants responded to the prompt: "The life of an adolescent girl improves when she has/can…" The Concept Systems Global software was used to manage and analyze the concept mapping brainstorming, sorting, and rating data using established tools, such as multidimensional scaling and cluster analysis. Concept mapping was conducted with 113 participants, including national experts, program staff, adolescents, and their mothers. They identified 105 items that fall into a 4-cluster solution: education and knowledge, decision-making, supports and skills, and physical infrastructure. Rating data uncovered there was some overlap between the top 10 most important items between the national-level experts and other stakeholder groups; however, several components associated with empowerment differed by stakeholder group in terms of importance. This research represents a critical step in exploring definitions of empowerment among adolescent girls in the Nepal context and with expert input. These results led to the development of a contextually specific definition of empowerment. Researchers and practitioners interested in developing context-specific understandings of complex topics that incorporate community voices and perspectives could use a similar concept mapping approach in other countries to explore various topics with diverse populations.