Consensus Process Research Articles

Attainment of consultative status by parties to the Antarctic Treaty: past, present and future

ABSTRACT Antarctica is governed through consensus-based decision-making by the 29 Consultative Parties to the Antarctic Treaty. Another 28 ‘non-Consultative Parties’ have acceded to the Treaty and agreed to be bound by its principles and the decisions of the Antarctic Treaty Consultative Meeting (ATCM) yet cannot participate in decision-making. Through the Treaty, acceding Parties can attain consultative status by demonstrating ‘substantial scientific research activity’ in Antarctica. Seventeen Parties have done so, with the Czech Republic the most recent in 2014. Since then, Venezuela, Belarus and Canada have made multiple unsuccessful bids to attain consultative status, representing an unprecedented failure rate. To understand this change, we determined the recent academic output of the five most recent Consultative Parties and the ten non-Consultative Parties currently most engaged in Antarctic affairs. We also examined how the ten non-Consultative Parties weighed up against other indicators that may be relevant to attainment of consultative status, such as organisational memberships (including the Scientific Committee on Antarctic Research and Council of Managers of National Antarctic Programs) and Treaty system engagement. We found that the very low levels of academic output deemed acceptable >20 years ago no longer appear sufficient to acquire consultative status. However, a number of non-Consultative Parties appear well-placed to attain consultative status once current wider geopolitical tensions have abated. In the meantime, there is a risk that if states feel there is no effective mechanism to attain a voice in Antarctic governance, then the legitimacy of the Treaty system may be called into question.

Acceptability of a city-wide transport plan: A thematic analysis of written consultation responses

IntroductionPolicy intervention to reduce car use is required for environmental and health benefits. Multi-component interventions with both positive (i.e. ‘carrot’) and negative (i.e. ‘stick’) strategies are effective in promoting modal shift, but ‘stick’ strategies are less acceptable and often abandoned before implementation. This study aims to understand the arguments surrounding policy acceptability for a multi-component transport plan including both carrot and stick strategies in Cambridge, UK. MethodsA series of public consultations between 2017 and 2022 informed transport priorities and provided feedback on a range of proposals. The final public consultation sought views on detailed proposals to expand the bus network and invest in sustainable travel infrastructure funded by the implementation of a road user charge. Following the consultation, concessions were made to the plans and they were later abandoned due to a lack of political consensus. We downloaded and analysed written responses generated during the consultation to identify arguments influencing policy acceptance. ResultsFrom 115 included responses, we identified five themes: (1) support for the overall vision of the transport strategy; (2) mixed support on proposals (favouring carrots but not sticks); (3) concerns about consultation process; (4) concerns about deliverability of proposals; and (5) the effects of the scheme on transport, inequalities and economic growth. ConclusionsOur findings suggest that policy design and communication should focus on perceived effectiveness and equity and building trust among agencies ahead of policy proposals to support the effective implementation of travel policy solutions.

Development of a risk of bias assessment tool specifically for meta-analysis of trials for surgical site infection

Background: Surgical site infections (SSIs) significantly impact patient outcomes, with rates reaching up to 20% after surgery, leading to higher morbidity, prolonged hospital stays, and increased costs. The assessment of randomized controlled trials (RCTs) related to SSIs has been challenging due to the lack of a specialized Risk of Bias (RoB) tool, as existing tools like the RoB-2 are not surgery-specific. To address this gap, we developed an adapted SSI-specific RoB-2 tool. Methods: This tool was created through a four-stage consensus process involving surgeons, trial statisticians, and methodologists with extensive experience in international SSI trials. Results: The process identified ten critical domains relevant to assessing RCTs on SSI interventions. Of these, eight domains were prioritized as essential for the final tool, while two were considered desirable but less critical due to the challenges of blinding in surgical contexts. Conclusion: The adapted RoB-2 tool is tailored to the unique aspects of SSI trials, offering a more focused and practical means of evaluating RCT quality. It not only improves the assessment of existing studies but also guides the design of future RCTs, enhancing the quality of evidence in SSI research. The tool's application in meta-analyses will likely lead to more reliable and generalizable results, informing clinical practice and policy decisions related to SSI prevention and management.

The dynamics of empowering women in the post-missionary Church of Christ in Zimbabwe

The evolution of the Ladies’ Circle into the Mother’s Union in the Church of Christ in Zimbabwe (COCZ) holds great significance in that circles in Africa symbolize collectiveness and consensual decision-making. The Ladies’ Circle emerged as a response by white women influenced by the Victorian Womanhood Cult with regard to the discontent they felt with patriarchy in the church. Black women supported white female missionaries in leadership roles, when they (black women), continued to face oppression due to (white and black) male resistance to change, as well as fear of losing male-privileges. Empirical evidence in the COCZ suggests that black women in Zimbabwe made significant progress in the secular world compared to their progress in church. This study uses a Critical Discourse Analysis (CDA) as a theoretical framework to examine how the transformation of the Ladies’ Circle into the Mothers’ Union empowered African women to deal with their own oppression. It aims to understand how white women overcame restrictive Victorian norms and the Womanhood Cult, which promoted submissiveness and domesticity as defining aspects of womanhood. The study further notes that inconsistencies in addressing race and gender differences in the church perpetuated the dominance of African men on women within the church. This study thus acknowledges that the Women’s Unions, like the Mothers’ Union, have the potential to empower COCZ women and challenge racial and gender oppression within that church.Contribution: The study reveals that denying women’s involvement in church can have debilitating effects on gender equality in Zimbabwe. The Ladies’ Circle, a platform created by the Church of Christ, provides women with a space for social and religious participation. The intersection of gender, race, and religion used by religious and cultural authorities to control women, call for a re-examination of the COCZ’s theological foundations on these subjects.

Updated consensus guidelines for management of moderate-to-severe atopic dermatitis in Singapore: Integrating biologics, Janus kinase inhibitors and conventional therapies.

Since 2016, several therapies have been approved for treating atopic dermatitis (AD) in Singapore, including biologics, oral Janus kinase (JAK) inhibitors and topical crisaborole. This study supplements the 2016 Singapore treatment guidelines for AD, focusing on newer therapies for moderate-to-severe disease, while revisiting older treatment regimens to accommodate changes in knowledge and practice. A modified Delphi panel was held, led by 2 co-chairs. The voting expert panel consisted of 12 dermatologists experienced in managing AD in Singapore. Delphi survey rounds were conducted between 24 July and 27 October 2023. Panellists indicated their agreement with drafted statements using a 5-point Likert scale. Consensus was defined as ≥80% agreement. An expert meeting was held to facilitate the consensus process between rounds 1 and 2 of voting. All expert panellists participated in both survey rounds, with a 100% response rate. Thirty-nine statements, classified into general principles, conventional treatments, biologics and JAK inhibitors, were proposed. Of these, 27 statements reached consensus at the end of round 1. After the expert meeting, 17 statements were included in round 2, of which 16 statements reached consensus. One statement did not reach consensus. Key updates are the inclusion of dupilumab and JAK inhibitors as potential first-line treatments for moderate-to-severe AD, in certain populations. This modified Delphi study generated consensus among Singapore dermatology experts, to update treatment guidelines in moderate-to-severe atopic dermatitis. The consensus statements developed are intended to supplement the 2016 Singapore treatment guidelines for AD. Further revisions may be required when new evidence and/or treatments become available.

Inclisiran for the treatment of hypercholesterolaemia.

Inclisiran is a synthetic small interfering RNA (siRNA) that inhibits the production of proprotein convertase subtilisin/kexin 9 (PCSK9) in hepatocytes by silencing the translation of PCSK9 mRNA. The result of this mechanism is a decrease in PCSK9 synthesis resulting in decreased degradation of the LDL receptor, leading to more LDL receptors being available to clear LDL cholesterol (LDL-C) from the circulation. Inclisiran received FDA approval in 2021 and EMA approval in 2020. The indication for inclisiran use is as an adjunct to diet and statin therapy for the treatment of adults with primary hyperlipidaemia, including those with heterozygous familial hypercholesterolaemia to reduce LDL-C. Inclisiran has demonstrated consistent LDL-C lowering in the range of 44-54%. Furthermore, inclisiran has been demonstrated to be a safe medication with indications of significant or serious adverse events when compared to placebo. Inclisiran is given as an initial subcutaneous dose followed by a repeat dose at 3 months and every 6 months thereafter. The 2022 American College of Cardiology Expert Consensus Decision Pathway includes inclisiran as an option for non-statin therapy in addition to maximally tolerated statin therapy in those at very high risk of atherosclerotic cardiovascular disease or those with LDL-C >190 mg/dL. The ORION-4, VICTORION-1 PREVENT and VICTORION-2 PREVENT trials are ongoing and designed to evaluate the ability of inclisiran to reduce major cardiovascular events in addition to LDL-C lowering but will not be completed for a few years.

A core outcome set for prophylaxis and perioperative treatment of von Willebrand disease: The coreVWD initiative.

Treatment options are expanding for von Willebrand disease (VWD). A core outcome set (COS)-a minimum set of agreed-upon outcomes to be used in every clinical trial for a given condition-provides guidance on which outcomes are most important to measure to ensure necessary data is collected for a variety of stakeholders and enable comparison across products and trials. coreVWD aimed to develop a COS for trials for prophylaxis and perioperative treatments for VWD. A modified Delphi consensus process was used to condense/prioritize a long list of potential outcomes. Over three Delphi rounds, a multi-stakeholder panel (patients, clinicians, pharmaceutical company representatives, HTA organizations, payer, and government organization representatives) rated each outcome from 1 (not important to include in a COS) to 9 (essential to include). Outcomes were eliminated or retained based on pre-determined criteria; a special provision to elevate patient priorities was included. An in-person consensus meeting was held after Delphi round 2. Thirty-nine panellists participated. The final COS for prophylaxis treatment included 18 outcomes, seven of which are part of a special subset selected for women, girls and people with the potential to menstruate. There were 11 outcomes in the final perioperative branch COS. Six outcomes overlapped both COS. The coreVWD COS represents a consensus list of outcomes for clinical trials for both factor and non-factor VWD therapies. These outcomes will be useful across the lifecycle of a product, from clinical development through regulatory and market access phases and into patient-provider decision-making.

Australasian hidradenitis suppurativa management guidelines.

Hidradenitis Suppurativa is a burdensome inflammatory skin disease with significant quality of life impact. These management guidelines were developed to direct appropriate clinical management in the Australasian context. A systematic review was used for the basis of the consensus guidelines. Thirteen clinical experts were involved in a modified Delphi consensus process to develop the guidelines and treatment algorithms. Overall management strategies include appropriate severity assessment of disease and comorbidities, multimodal therapy with systemic and local treatments, and evidence-based progression along the therapeutic ladder in the event of inadequate response. Sequential monotherapy with antibiotics and/or single agent therapy is discouraged and aggressive treatment of moderate to severe disease to capture the window of opportunity is highly emphasised. Specific considerations in the setting of disease comorbidities, pregnancy and breastfeeding are also addressed. Overall, the complex nature of HS requires a complex and multimodal therapeutic response with medical, physical and surgical therapies to achieve best patient outcomes.

EUROVISCO Consensus Guidelines for the Use of Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis Based on Patient Characteristics.

Viscosupplementation with hyaluronic acid (HA) is a commonly used intra-articular treatment for osteoarthritis (OA). We performed a Delphi consensus process to formulate guidelines for the use of intra-articular hyaluronic acid (IAHA) knee injection according to the patient's characteristics. The EUROVISCO group consists of 12 members who had expertise in clinical and/or research in the field of OA and IAHA treatment. This group drafted issues through an iterative process and subsequently voted according to a Delphi process on their level of agreement (LoA) on these recommendations. The scores were pooled to generate a median agreement score for each recommendation. The strength of the recommendation (SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. The level of evidence was given for each recommendation. A total of 34 statements were evaluated by the expert group. A unanimous or high LoA was obtained in 16. IAHA can be considered irrespective of the age in patients with symptomatic knee OA. It can be used in patients with diabetes and/or moderate to severe obesity. It can also be used in knee OA patients with a history of gout, meniscocalcinosis and with mild-to-moderate varus/valgus malalignment. The group recommended against the use of VS in pregnant women and in OA flare. In summary, the working group provided strong recommendations for the use of IAHA injection that will facilitate individualized treatment decision algorithms in the management of knee OA.

Enhancing foreign exchange reserve security for central banks using Blockchain, FHE, and AWS

In order to maintain the value of the national currency and control foreign debt, central banks are vital to the management of a nation’s foreign exchange reserves. These reserves, however, are vulnerable to a variety of hazards, including as money laundering, fraud, theft, and cyberattacks. These are issues that traditional financial systems frequently face because of their vulnerabilities and inefficiency. Using modern innovations in a blockchain-based solution can help tackle these serious issues. To protect data privacy, the Microsoft SEAL library is utilized for homomorphic encryption (FHE). For the development of smart contracts, Solidity is employed within the Ethereum blockchain ecosystem. Additionally, Amazon Web Services (AWS) is leveraged to provide a scalable and powerful infrastructure to support our solution. To guarantee safe and effective transaction validation, our method incorporates a hybrid consensus process that combines Proof of Authority (PoA) with Byzantine Fault Tolerance (BFT). The administration of foreign exchange reserves by central banks is made more secure, transparent, and operationally efficient by this all-inclusive approach.

Unclear Trajectory and Uncertain Benefit: Creating a Lexicon for Clinical Uncertainty in Patients with Critical or Advanced Illness Using a Delphi Consensus Process.

Clinical uncertainty is associated with increased resource utilization, worsened health-related quality of life for patients, and provider burnout, particularly during critical illness. Existing data are limited, because determining uncertainty from notes typically requires manual, qualitative review. We sought to develop a consensus list of descriptors of clinical uncertainty and then, using a thematic analysis approach, describe how respondents consider their use in intensive care unit (ICU) notes, such that future work can extract uncertainty data at scale. We conducted a Delphi consensus study with physicians across multiple institutions nationally who care for critically ill patients or patients with advanced illnesses. Participants were given a definition for clinical uncertainty and collaborated through multiple rounds to determine which words represent uncertainty in clinician notes. We also administered surveys that included open-ended questions to participants about clinical uncertainty. Following derivation of a consensus list, we analyzed participant responses using thematic analysis to understand the role of uncertainty in clinical documentation. Nineteen physicians participated in at least 2 of the Delphi rounds. Consensus was achieved for 44 words or phrases over 5 rounds of the Delphi process. Clinicians described comfort with using uncertainty terms and used them in a variety of ways: documenting and processing the diagnostic thinking process, enlisting help, identifying incomplete information, and practicing transparency to reflect uncertainty that was present. Using a consensus process, we created an uncertainty lexicon that can be used for uncertainty data extraction from the medical record. We demonstrate that physicians, particularly in the ICU, are comfortable with uncertainty and document uncertainty terms frequently to convey the complexity and ambiguity that is pervasive in critical illness. Question: What words do physicians caring for critically ill patients use to document clinical uncertainty, and why?Findings: A consensus list of 44 words or phrases was identified by a group of experts. Physicians expressed comfort with using these words in the electronic health record.Meaning: Physicians are comfortable with uncertainty words and document them frequently to convey the complexity and ambiguity that is pervasive in critical illness.

When, where and how should we assess professionalism in undergraduate medical education? Practical tips from an international conference roundtable discussion

The assessment of professionalism in healthcare disciplines is a challenging and nuanced topic in medical education. The literature, although continually emerging, remains in its infancy in regards to the role of the assessment of professionalism, appropriate timing for assessment, methods to assess professionalism and the benefits and implications of assessment of professionalism. With emergence of healthcare professionalism in both undergraduate and postgraduate curricula and increasing awareness of professionalism’s pertinent role in developing as a healthcare practitioner, the concept of assessing this topic is being discussed regularly in international fora, but as yet there is no consensus decision in how best to proceed. The authors have over a decade of experience researching, promoting and delivering healthcare professionalism education. They presented a roundtable discussion to an international panel of medical educators at an international conference. The attendees represented multiple healthcare disciplines. Breakout rooms and pre-determined introductory questions were used to explore the international consensus on current thinking about assessment in healthcare professionalism. This paper presents these findings as practical tips for educators who are considering introducing or extending their assessment of undergraduate professionalism, all of which were taken from the main themes of the discussion. The aim of the paper is to support educators to think about their stance on this often divisive issue, consider their approaches and focus future research to clarify the remaining unknowns.

Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19.

Addressing criticism that the agency's Covid-19 response was lacking, the US Centers for Disease Control and Prevention (CDC) has proposed internal agency reforms intended to improve its performance during the next pandemic. They are aimed at improving surveillance and analytic capacity and agency communications. This essay, via a counterfactual analysis of the CDC's proposed reforms, asks how, if completed in advance of Covid-19, they might have changed outcomes in four cases of guidance controversy during the pandemic. CDC planned reforms, though they have merit, are predicated on the ability to come to "scientific closure" in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise threaten the agency's reform goals.

BN SO16 - Gastro-gastric intussusception without any lead point – a case report and review of literature

Abstract Background Gastrogastric intussusception in a rare condition in adults. The underlying aetiologies include pathological lead points, anatomical abnormalities, previous foregut surgery or foreign body. The management of symptomatic gastrogastric intussusception in the absence of these aetiologies remains poorly defined and is highlighted by the paucity of evidence available for guidance. We present a case of idiopathic gastrogastric intussusception and a review of the literature. Method A 34-year-old male patient with a background of thrombocytopenia-absent radius (TAR) syndrome presented with recurrent episodes of upper abdominal pain and vomiting. Investigations with a CT abdomen revealed proximal gastrogastric intussusception. Subsequent endoscopy showed oedematous mucosa along the lesser curve and no pathological lead points or anatomical abnormalities. Histological findings were normal. Results The patient remained symptomatic despite a normal subsequent CT abdomen. A consensus decision was reached, and the patient was counselled for a laparoscopic gastropexy. Laparoscopic findings showed a central area of scar tissue circumferentially along the mid-body of the stomach highlighting the chronicity of the condition. No hiatal abnormalities were identified. A gastropexy was performed in two layers along the greater curvature of the stomach with non-absorbable interrupted sutures. The postoperative course was unremarkable. The patient remained asymptomatic on 6-week clinic follow up. Conclusion No previous case reports of idiopathic gastrogastric intussusception were identified on our literature search. It is our impression that this is the first such case-report to illustrate the diagnostic challenges of this rare, intermittently symptomatic condition and the successful management of it.

Limitations of trust and legitimacy in blockchain: exploring the effectiveness of decentralisation, immutability and consensus mechanisms in blockchain governance

PurposeThis paper examines to what extent blockchain creates legitimacy and trust in different modes of public governance. It posits that while blockchain aims for political legitimacy through decentralising, immutable and consensus-based mechanisms, the execution of these mechanisms is limited in legitimating governance, which has knock-on effects on trust. It provides an original contribution by recontextualising and reframing blockchain as a governance mechanism that should, and must, perform a legitimating function in order to engender trust.Design/methodology/approachThe research adopts a comprehensive framework for understanding the legitimacy of blockchain governance, positioning it in terms of co-governance, self-governance and hierarchical governance modes. It systematically analyses blockchain whitepapers, legislation, government documents and other sources in three paradigmatic case studies where blockchain governance failed. These cases are then used to assess blockchain according to three key characteristics of decentralisation, immutability and consensus.FindingsThe research finds that blockchain’s use in governance settings still relies on legitimacy conferred from other sources – namely state – in order to generate trust. Significant limitations in its de facto political decentralisation, immutability and consensus protocols can create failures in co-governance, self-governance and hierarchical-governance applications, thus limiting the legitimation function of blockchain in facilitating political trust.Originality/valueThese findings are significant in highlighting blockchain’s limitations as a decentralised, immutable and consensus-driven legitimating tool, which has knock-on effects on trust in technology and governance more broadly. It also has broader implications in more clearly highlighting the interconnectedness of political trust and legitimacy in governance processes.

NCOG-17. THE COMBAT PROJECT - CORE POST OPERATIVE MORBIDITY SET FOR PAEDIATRIC BRAIN TUMOURS

Abstract BACKGROUND Brain tumours are associated with high morbidity both from the tumour and the medical and surgical interventions used to treat them. Post operative morbidity reporting following surgery for paediatric brain tumours is poor due to the lack of a common language when reporting harms. One solution is to develop a core outcome set to stipulate the minimum post operative adverse outcomes that should be reported. The COMBAT (Core Post Operative Morbidity Set for Paediatric Brain Tumours) Project will develop a core outcome set that can be applied to post operative paediatric brain tumour patients to harmonise how adverse outcomes are measured and reported, enabling comparison between different trials, studies and clinical services. We aim to generate interest in The COMBAT Project and invite participation in the project from healthcare professionals and researchers experienced in paediatric neuro-oncology for the consensus process. METHODS AND ANALYSIS We will engage with national and international stakeholders including patients and their carers, healthcare professionals and researchers. A systematic review will identify harms reported in post operative paediatric brain tumour patients and how they are measured. Qualitative interviews with patients and carers will identify any harms of importance to them. A Delphi survey will be created from the harms identified. A consensus meeting will be held to finalise the core outcome set. The final core outcome set will be published and disseminated to encourage uptake. DISCUSSION There is a clear need for a common language to harmonise measurement and reporting of harms following surgery for paediatric brain tumour patients. This project will define post operative adverse outcomes that are of critical importance to key stakeholders. It will be used to standardise surgical morbidity outcome measurement and reporting in trials, studies and clinical practice and will inform future research in this field.

QOL-20. NATIONAL BRAIN TUMOR SOCIETY BRAIN TUMOR QUALITY OF LIFE RESEARCH AGENDA

Abstract BACKGROUND QoL is a critical aspect of health care outcomes, particularly in the context of brain tumor treatment and survivorship. There are evidence gaps in optimal strategies for improving QoL among brain tumor patients and care partners. Understanding the multifaceted dimensions of QoL and identifying key areas for brain tumor QoL research can significantly enhance patient care and support. Engaging the brain tumor community in defining QoL outcomes and determining research priorities can help orient research resources to community needs and perspectives. OBJECTIVE To summarize the process and outcomes of an NBTS-led collaborative effort to co-design a comprehensive research agenda on QoL for brain tumor patients and care partners, as outlined in the “Brain Tumor QoL Research Agenda.” METHODS The agenda was developed through a collaborative effort involving experts in neuro-oncology, patients, care partners, patient advocacy groups, and healthcare professionals over a two-year period. A review of existing literature, patient experiences, and expert opinions informed the identification of key research priorities. A multistakeholder advisory group held monthly meetings where brain tumor QoL was defined. In 2023, we conducted two “Research Roundtables” for adults and pediatric/AYA. The World Cafe method captured data and a survey consensus process to validate findings. RESULTS The QoL research agenda delineates a multifaceted framework encompassing domains crucial for understanding and improving QoL in brain tumor patients. Key focus areas include symptom management, psychosocial support, care burden, treatment decision-making, survivorship issues, and health care delivery models. An RFP was released by NBTS with input from stakeholder advisors in April 2024. CONCLUSION The Brain Tumor QoL Research Agenda created a roadmap for advancing research efforts aimed at enhancing the QoL of individuals affected by brain tumors. By addressing the identified research priorities, healthcare stakeholders can work towards implementing effective interventions and policies to optimize patient outcomes and well-being. This program was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (EACB-23261).

Understanding ‘quality’ in adult traumatic brain injury rehabilitation from the perspectives of different stakeholders: a participatory mixed methods study

ABSTRACT Primary objective The purpose of this study was to explore how ‘quality’ is understood for traumatic brain injury (TBI) rehabilitation from the perspectives of the rehabilitation recipients, their families and the providing clinicians. Research design A participatory study using a mixed-methods, triangulation design. Methods The study involved 1. a systematic literature search; 2. Individual semi-structured interviews with people with TBI and/or their caregivers and TBI rehabilitation clinicians, and 3. an online consensus process. Outcomes and results 22 participants (7 people with TBI, 8 caregivers, 7 clinicians) participated in individual interviews. Their transcribed data were coded into broad categories via in-depth reflexive, thematic analysis; these categories were then mapped to 13 quality domains extracted from the literature. The emergent themes were then presented to the individuals, via an electronic consensus tool in two rounds. This resulted in 12 prioritized domains of quality that encompass service features, staff qualities and effectiveness. Conclusion These evidence-informed and consensus-agreed indicators for quality may help guide both the provision and evaluation of TBI rehabilitation, that is valued and meaningful.

Development and Validation of the Midwifery Interventions Classification for a Salutogenic Approach to Maternity Care: A Delphi Study.

Background/Objectives: This study aims to develop and validate a Midwifery Interventions Classification (MIC), which is an evidence-based, standardized taxonomy and classification of core midwifery interventions based on a salutogenic perspective for maternity care. Methods: This study described the consensus process up to the results regarding the validation of the MIC through a two-round Delphi survey involving three panels of stakeholders: Midwives, Healthcare Researchers, and Maternity Service Users. Results: The resulting MIC comprises 135 core midwifery interventions classified into Direct Midwifery care (n = 80 interventions), Indirect Midwifery Care (n = 43 interventions), and Community Midwifery Care (n = 12 interventions), reaching an overall consensus rate among experts equal to 87%. These interventions were, therefore, adapted specifically for the Italian midwifery care context, with potential for international transferability, implementation, and scalability. Conclusions: The MIC is pivotal to boosting quality improvement, education, and comparable data collection for research, sustaining midwives' role in promoting optimal health for women, newborns, and families at large.

An optimized and efficient multiuser data sharing using the selection scheme design secure approach and federated learning in cloud environment

An optimized and efficient multiuser data sharing using the selection scheme design secure approach and federated learning in cloud environment