Despite the availability of various methods for assessing medication adherence, limited guidance exists regarding the most appropriate tool, particularly for measuring glaucoma medication adherence. To achieve expert consensus on the appropriate tool for measuring glaucoma medication adherence using the Delphi technique. A two-round Delphi study was conducted with a panel of experts from diverse fields, assessing three validated adherence measurement tools. Consensus was determined using Kendall's Coefficient of Concordance. The extent of agreement and inter-rater reliability were evaluated using the scale-level content validity index (SCVI) and intraclass correlation coefficients (ICC), analysed in SPSS version 25. Sixteen experts (mean age 53.8±7.1 years; mean professional experience: 21.9±6.8 years) participated. Consensus levels of 81.0% and 89.0% were achieved in the first and second rounds, respectively. Agreement on non-adherence characteristics was high (SCVI and ICC values>0.75). The most appropriate tool for measuring non-adherence to glaucoma medication was the Glaucoma Treatment Compliance Assessment Tool-Short form (GTCAT-S) with an SCVI of 0.91 and ICC of 0.94 (95% CI: 0.78-0.99; p=0.001). The GTCAT-S was identified as the most suitable tool for measuring non-adherence to glaucoma medication. It demonstrated a high SCVI and excellent inter-rater reliability, indicating strong consensus among experts and robust measurement consistency.

The main tools for making clinical decisions based on efficient use of resources are economic evaluation studies that allow the assessment of both the costs and benefits of different therapeutics, with appropriate guidelines for preparing reports. This study aimed to develop a checklist of consumable cost elements to be considered in estimates for micro-costing studies in peritoneal dialysis (PD). Four stages were conducted, followed by data analysis and interpretation. Three stages were carried out to develop the direct cost elements questionnaire: 1st - designing the first version of the checklist; 2nd - evaluating and expanding it using the Delphi method; 3rd - conducting two expert panels; and 4th - applying the questionnaire to professionals from 18 Latin American countries. Inclusion criteria: professionals with at least one year of clinical and/or administrative experience in PD. A discrete probability distribution adjustment was performed. Distribution lots were considered according to the category of cost elements for each country. The maximum likelihood estimation method was applied, and the statistical classification of the adjustments was assessed using the Akaike Information Criterion. A total of 596 questionnaires, comprising seven dimensions and 41 elements, were validated. From the results of each batch, it was possible to segment the elements into three choice options, with the probability of evaluating an element as very important, thus allowing for the classification of the cost elements. The checklist favors more equitable economic dimensioning in comparative studies, making it possible to compare economic values in PD across countries, while considering the appropriate cost elements.

Pharmacist role expansion, including pharmacist prescribing, is increasing globally. Assessing the impact of such role expansion is vital to understand whether it achieves its intended goals. To identify key outcomes to evaluate pharmacist prescribing within Ireland's planned Common Conditions Service (CCS) and independent pharmacist prescribing contexts, and determine their measurability using existing health data sources. In a three-round Delphi study, an expert panel (including patients) rated the importance of outcomes, pre-identified via a rapid overview of reviews, using Likert scales.Outcomes reaching consensus for inclusion (rated by ≥75% as critically important) or exclusion (<25%) after the second round were not re-rated. In the third round, remaining outcomes were re-rated and experts also rated the feasibility of measuring each outcome using existing health data sources. Thirty experts completed all rounds. For CCS, seven outcomes reached consensus as critically important: "Patient experience and satisfaction", "Access to care", "Guideline concordance", "Symptom improvement, or clinical cure", "Re-consultation with other healthcare providers", "Cost of care to the healthcare system", and "Referral to other healthcare providers". For other independent prescribing contexts, ten outcomes were critically important, including "Mortality", "Clinical effectiveness", "Adverse events", and "Cost of care to patients". Important CCS outcomes varied in their measurability using existing data, with 'Prescribing rate' (76% agreement) and 'Cost to patients' (64%) and 'Cost to patients' (64%) were most feasible. This study identified priority outcomes for evaluating the impact of pharmacist prescribing and their measurability, encompassing clinical, safety, economic, and patient perspectives.

Integrating PIK3CA Testing into Clinical Practice for Advanced HR+/HER2- Breast Cancer: An Expert Consensus.

Background: Systems-based healthcare safety investigation is an important initiative to improve patient safety worldwide. It requires the use of credible methods and approaches by competent investigators. There is currently no empirically developed competency framework for the healthcare safety investigator role. We developed a competency framework for healthcare safety investigators using an empirical research approach. Method: We used a two-round modified Delphi technique electronically. Two web-based surveys were sent to a panel of experts in healthcare safety investigations in England. The panel rated the relevance of a proposed set of competencies and provided qualitative comments. Strength of agreement was assessed using the interquartile range (IQR), the median and percentage agreement. Participants’ comments were reviewed, with reference to the contemporary healthcare safety literature and practice. Results: A total of 28 participants completed the round-one survey. In round two, 24 of the 28 participants completed the survey. At the end of the round-two survey, 38 competencies and 82 corresponding descriptors were agreed as relevant with high agreement levels (IQR ≤ 1.25, median ≥ 4, percentage agreement ≥ 70%). These were organised in four domains: 1. Personal qualities, 2. Investigation knowledge and skill application, 3. Effective and compassionate engagement, and 4. Manages investigation lifecycle. Conclusion: To our knowledge, this is the first empirically derived competency framework specifically focused on the healthcare safety investigator role. The high levels of agreement among participants give credibility to the findings. This competency framework provides an evidence base to inform the scope and requirements of the healthcare safety investigator workforce.

Infection-related glomerulonephritis (IRGN) is the leading cause of acute glomerulonephritis (GN) in children worldwide, particularly in low- and middle-income countries. To provide evidence-based care, the Glomerular Disease Workgroup of the Asian Pediatric Nephrology Association (AsPNA) convened a panel of experts to develop recommendations on diagnosis, evaluation and management of pediatric IRGN. Following a comprehensive literature search, available evidence was graded using the AAP-GRADE approach, and recommendations finalized through Delphi consensus. The panel recommends diagnosing acute GN in children presenting with hematuria and proteinuria, if accompanied with edema, oliguria, or hypertension. Postinfectious GN is suspected in patients with acute GN with recent streptococcal or staphylococcal infection and transient hypocomplementemia. The evaluation includes urinalysis, kidney function tests, serum albumin, complement C3, blood counts and kidney ultrasonography. Kidney biopsy is required for patients with atypical features, nephrotic syndrome, persistently low C3 beyond 12weeks, and/or rapidly progressive GN. Therapy is chiefly supportive, including fluid and salt restriction in patients with edema or hypertension, diuretics for volume overload, and calcium channel blockers for stage 2 hypertension. Patients with significant edema, severe hypertension, or acute kidney injury require inpatient monitoring. Patients with staphylococcus-associated GN infective endocarditis associated GN and shunt nephritis require therapy with antibiotics. Immunosuppressive therapy is suggested in patients with crescentic IRGN or rapidly progressive course. All patients with IRGN, particularly those with crescentic GN or rapidly progressive GN, require long-term monitoring of serum creatinine, urinalysis and blood pressure. These guidelines intend to provide a structured, evidence-informed approach for the management of patients with IRGN.

This work aimed to translate the Perinatal Anxiety Screening Scale into Chinese and test its validity and reliability. Anxiety symptoms are common in the perinatal period and negatively affect maternal and fetal outcomes. However, a sensitive anxiety screening tool specific to perinatal women, including a broad range of problematic anxiety symptoms, is not available in the Chinese language. Based on the translation, adaptation and validation of instruments or scale guideline, the Chinese version of the Perinatal Anxiety Screening Scale was developed by translation, synthesis, back-translation, pilot testing and psychometric testing. By convenience sampling, 350 perinatal women participated in this study from a tertiary hospital in Guangzhou, China. The Chinese version of the Perinatal Anxiety Screening Scale comprised four dimensions with 31 items and demonstrated good internal consistency (Cronbach's α: 0.94) and acceptable test-retest reliability within a two-week interval (intraclass correlation coefficient: 0.81). An expert panel evaluated that the average Scale-Content Validity Index (S-CVI/Ave) was 0.96, and the Item Content Validity Index (I-CVI) ranged from 0.89 to 1.00. As expected, the PASS significantly correlated with the Pregnancy-specific Anxiety Questionnaire and Self-Rating Anxiety Scale (r = 0.74, p < 0.001; r = 0.67, p < 0.001). In exploratory factor analysis, the cumulative contribution rate of the four common factors was 66.19%. The PASS-C was rigorously developed following the translation, adaptation and validation guidelines. The PASS-C was evaluated to have good reliability and validity. Additionally, it was verified to be easy and fast to assess the severity of anxiety symptoms in perinatal women for clinicians in China. We therefore advise that the PASS-C be introduced into clinical practice as a rapid screening instrument of anxiety disorders in antenatal and postnatal women. This enables nurses or clinicians to initiate timely, evidence-based interventions, such as psychological support or referrals to mental health specialists, thereby improving maternal and infant outcomes.

AI-generated agents with expert personas in biotechnology: Delphi evaluation of emerging technologies and future trajectories

Stillbirths impact over two million parents globally every year. Despite current knowledge, technology, and investigations, many stillbirths remain unexplained and are not fully investigated. An important step forward in addressing this gap is determining which investigations produce the highest utility in identifying the cause of death (COD). The objective of this study is to identify and define the usefulness or utility of investigations in determining COD among a cohort of stillbirths. Prospective cohort study from 2013 to 2018 comprising 695 stillbirths. An expert panel blinded to COD assessed the clinical utility of investigations using a purpose-built tool. A stepwise approach was applied, categorising investigations into three groups: clinical and laboratory investigations; placental pathology; and autopsy examination. Clinical utility of the investigations was defined as the proportion of cases in which each test contributed to the identification of the COD. Placental pathology had the highest clinical utility (87%), followed by comprehensive maternal history (82%), genetic analysis (75%), maternal blood investigations for infection (64%), fetal-maternal haemorrhage (FMH) (57%), and fetal autopsy (47%). Placental pathology and genetic analysis were useful across all clinical scenarios, while autopsy was most beneficial when the clinical scenario was unknown. A COD was established in 528 cases (76%), with 310 cases (47%) identified post-placental examination. The investigations with the highest clinical utility were placental pathology, comprehensive maternal history, genetic analysis, maternal blood investigations, FMH, and fetal autopsy. This study supports a core set of investigations, supplemented by selective tests based on the clinical scenario.

Community pharmacy practice has evolved from dispensing and medication counseling towards clinical pharmacy services such as medication reviews to ensure rational pharmacotherapy. These functions require better access to patient data than are currently available in community pharmacies. This study aimed to identify and prioritize patient data that should be available in Finnish community pharmacies for 1) statutory dispensing, including medication counseling, and 2) clinical pharmacy services promoting rational pharmacotherapy. This study applied a three-round Delphi survey with an expert panel of 20 clinical pharmacists. A consensus was formed using a preliminary list of patient data (39 items) important for managing major long-term diseases and related pharmacotherapies in outpatient care. The list was based on literature and research group's expertise. A consensus ≥80% was required. The responses were analyzed quantitatively and qualitatively. Most panelists (n=15/19) perceived the current patient data available in community pharmacies insufficient. More patient data should be available, especially for providing clinical pharmacy services, but also for dispensing and related medication counseling (34 vs. 11 items reached a consensus, respectively). For both purposes, patient data on diagnoses, kidney function, and blood pressure were rated most important to be available. Panelists expressed some concerns about community pharmacists' resources and competence to use the data. Consensus was reached for a relatively large set of patient data items to be available in community pharmacies, especially for providing clinical pharmacy services.

The aim of this study was to describe the methodological development of appropriate use criteria for arterial catheter use in adult intensive care units using the RAND Corporation/University of California, Los Angeles (RAND/UCLA) Appropriateness Method. This methods paper reports the prespecified development phase of an appropriateness study. The RAND/UCLA Appropriateness Method was applied in sequential phases, including defining scope and key terms, synthesising evidence through a literature review and national survey, developing clinical indications, and rating indications across two rounds by an interdisciplinary expert panel. Panel members had expertise in arterial catheter insertion and management across intensive care, anaesthesiology, emergency medicine, infectious diseases, critical care nursing, and clinical and tertiary intensive care education. Clinical indications were iteratively developed based on common clinical scenarios, anticipated uses, practice guidelines, and available evidence on efficacy and safety. Each indication was rated on a 9-point scale (1 = harms outweigh benefits; 9 = benefits outweigh harms) and classified as appropriate (median: 7-9 without disagreement), uncertain/neutral (median: 4-6 or any median with disagreement), or inappropriate (median: 1-3 without disagreement). Disagreement was assessed using the Interpercentile Range Adjusted for Symmetry method. The RAND/UCLA Appropriateness Method provides a structured, transparent, and reproducible approach for developing appropriate use criteria for arterial catheters in adult intensive care. The final appropriateness ratings and clinical recommendations derived from this process are reported separately.

Developing a hierarchical cognitive second language (L2) reading model using multi-dimensional fuzzy Delphi method and interpretive structural modeling.

Multiple studies have identified limitations in the nodal (N) category definitions of the eighth-edition tumor-node-metastasis classifi cation (TNM8) for major salivary gland carcinoma (SGC). Minor SGCs have traditionally been staged according to site of origin despite distinct biology and patterns of spread, and the feasibility of a unified staging system for both major and minor SGCs had not been systematically evaluated. These shortcomings prompted a comprehensive reassessment of SGC staging. A multidisciplinary international expert panel, in collaboration with the American Joint Committee on Cancer (AJCC) Head and Neck Core Group, developed and validated a refined TNM classification for SGC. The proposed system was subsequently adopted by both the AJCC and the Union for International Cancer Control (UICC). The ninth edition (TNM9) introduces the first unified SGC-specific staging system applicable to both major and minor SGCs. Key revisions include: (1) exclusion of extremely rare or non-salivary-origin histologies (e.g., squamous cell carcinoma, neuroendocrine carcinoma, and basosquamous carcinoma); (2) integration of major and minor SGCs into a single staging framework, with clarification of T3-T4 definitions to ensure applicability across both groups; (3) simplified N categorization based on lymph node count and extranodal extension (ENE): N0 (no nodal disease), N1 (1-3 nodes without ENE), and N2 (3 nodes or any ENE); and (4) restriction of stage IV exclusively to M1 disease, allowing future refinement of metastatic subcategories. Clinical TNM (cTNM) applies the same criteria as pathologic TNM (pTNM), incorporating radiologic assessment of abnormal lymph node count and imaging-detected ENE (iENE). By establishing a unified, biologically relevant staging system with improved prognostic discrimination, TNM9 enhances clinical applicability and promotes more consistent management of both major and minor salivary gland carcinomas.

Development and validation of the Clinical Nursing Knowledge Questionnaire-15 (CNKQ-15) for assessing contraceptive knowledge among nurses.

As paediatric day surgery becomes increasingly common, postoperative care is transferred to the home setting where parents play a central role in assessing and managing their child's postoperative pain. No validated Swedish instrument currently exists to support parents in evaluating their child's pain at home. To assess the reliability and validity of the Swedish translation of the PPPM-S in children aged 2-12 years during the first two postoperative days. The instrument was earlier translated from English into Swedish in accordance with the WHO Guidelines for translation and adaptation of an instrument. A backward-forward translation was done with a bilingual expert panel, and cognitive interviews were done in the target population. This study was conducted at three Swedish hospitals between 2022 and 2025 involving 80 parents of children aged 2-12 years who underwent day surgery. Parents completed the PPPM-S on postoperative days 1 and 2. To evaluate the accuracy of the instrument, the results were compared with scores from an established pain rating scale, the Coloured Analogue Scale (CAS). PPPM-S demonstrated good psychometric properties: good internal consistency (Cronbach's alpha 0.842-0.851) and satisfactory criterion validity demonstrated by strong correlations with CAS (Spearman's rho = 0.683-0.630, p < 0.01). ROC analysis identified 5/15 as an optimal cut-off, with acceptable sensitivity and specificity. Parents reported high levels of satisfaction and found it easy to use at home. The PPPM-S is a valid and practical tool for assessing children's postoperative pain at home. It can help parents better understand and evaluate their child's pain, potentially improving postoperative care in the home setting.

Existing tools for assessing Long COVID are primarily designed for the general population. Few instruments adequately capture the needs and vulnerabilities of high-risk groups such as patients with chronic obstructive pulmonary disease (COPD), who have structurally vulnerable lungs. This study was designed to develop and validate the Long COVID Symptom Severity Index (LCSSI), a concise and clinically sensitive instrument designed specifically for use on patients with respiratory diseases. The study was conducted in two phases. In Phase I, item generation was based on a literature review and expert panel discussion involving six pulmonologists. In Phase II, a cross-sectional validation study was conducted in the chest medicine wards and outpatient clinics of a medical center in southern Taiwan. The psychometric properties of the LCSSI were examined. One hundred and twenty-eight patients with COPD (93% male) were enrolled, of whom 63.3% were classified under GOLD (global initiative for chronic obstructive lung disease) Group E. The most prevalent symptoms found were cough/sputum (100%), fatigue/weakness (90.6%), and dyspnea (88.3%). The LCSSI demonstrated excellent internal consistency (Cronbach's α = .88), and correlated positively with the COPD Assessment Test (p < .01) and negatively with the 15D Health-Related Quality of Life scale (p < .01). Mean LCSSI scores differed significantly across GOLD groups, with Group E showing higher mean total and core symptom scores (all p < .01), supporting construct validity. Based on this sample, the results indicate the LCSSI has acceptable internal consistency and validity, supporting its use as a reference tool for symptom assessment in patients with COPD during the late recovery phase for Long COVID.

The Utility of Artificial Intelligence Platforms for Post-Operative Mohs Micrographic Surgery Questions: A Blinded Expert Panel Evaluation.

Expert opinion by Federation of Obstetric and Gynaecological Societies of India on elagolix - Redefining the endometriosis therapy landscape.

Collaborative Codesign of "Singing-it-Safe": A Pilot Vocal Health Education Programfor Tertiary Singers Using the Delphi Method.

Despite rapid advances in genomic sequencing, most rare coding variants remain insufficiently characterized for clinical use, limiting the potential of personalized medicine. When classifying whether a variant is pathogenic, clinical labs adhere to diagnostic guidelines that integrate many forms of evidence, including case data, computational predictions, and functional screening data. While a great deal of clinical evidence has been curated for many variants, the majority still cannot be definitively classified as 'pathogenic' or 'benign', and thus persist as 'Variants of Uncertain Significance' (VUS). Variant Curation Expert Panels (VCEPs) are tasked with analyzing the available evidence for each variant to reach a classification. To make use of previously curated evidence, we processed over 2.3 million free-text variant summaries from ClinVar, employing sentence-level classification to restrict to sentences that contain different forms of evidence, and removing uninformative or similar summaries. We then used labeled text summaries to train ClinVar-BERT, a model that can discern evidence of pathogenicity or benignity within variant text summaries. We validated ClinVar-BERT model predictions for variant summaries that are classified as uncertain using variants curated by expert panels, orthogonal functional screening data, and computational predictions. ClinVar-BERT model predictions of VUS had significantly different estimates of functional impact in clinically actionable genes, including BRCA1 (p = [Formula: see text]), TP53 (p = [Formula: see text]), and PTEN (p = [Formula: see text]) with an AUROC = 0.927 when classifying whether variants are damaging or are expected to retain function. Similarly, ClinVar-BERT model predictions of VUS had significantly different AlphaMissense computational scores: BRCA1 (p = [Formula: see text]), TP53 (p = [Formula: see text]), and PTEN (p = [Formula: see text]). In genes screened for secondary findings or included on ClinGen expert panels, ClinVar-BERT prioritizes 7,644 variants for expert review, where 2 or more clinical summaries related to the same VUS were model-predicted to contain pathogenic evidence, and 7,042 variants with 2 or more summaries predicted to contain benign evidence. This would result in the average VCEP having 143 variants prioritized for review, ranging from 8 to 907 variants across VCEPs. These findings suggest that ClinVar-BERT can discern evidence from diagnostic reports, useful for prioritizing variants for re-assessment by expert curation panels.