Consensus Process Research Articles

2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations.

To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines. This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR. Transdisciplinary, international collaboration in academia, referral practice, and general practice. For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science. Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.

IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Validated German PROMs for People with Major Amputation of the Lower Extremity - A Narrative Review Based on the Final Report of the LEAD and COMPASS Initiative of the ISPO

Patient-reported outcome measures (PROMs) play an important role in the rehabilitation of people with major limb amputations. Patient-completed questionnaires help collect specific constructs on this patient population. The COMPASS and LEAD initiatives, carried out by the International Society for Prosthetics and Orthotics (ISPO), underscore the importance of regularly collecting high-quality PROMs. These are essential for the evaluation of rehabilitation needs, progress, and success. In the final report of ISPO's major international initiative, PROMs recommendations of the expert panel are tabulated. In Table 3.2 of the report, ISPO lists n=12 PROMs that were included in the narrow consensus process were considered to be of acceptable quality, and therefore recommended. The aim of this systematic review was to specifically search for these recommended PROMS regarding their availability in a German and validated version in order to identify potential gaps. All PROMs that were available in a German and validated version were then examined further with regard to the quality of the validation study, using the checklist of COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Through a systematic literature search, six validated German-language versions were found. Only four of these met the quality standards of the COSMIN checklist sufficiently. Overall, this review shows serious gaps in the availability in the German language of validated versions of PROMs used internationally and recommended as standard by the ISPO. This gap needs to be closed by guideline-oriented translation and subsequent validation studies in order to be able to offer and collect the PROMS recommended by the ISPO also for German-speaking patient populations.

Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study.

Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as "not important" or "not important at all" and >60% "important" or "very important." In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains-background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges.

CaReL Guideline: A Consensus-Based Guideline on Case Reports and Literature Review (CaReL)

Introduction Clinical case reports enrich medical literature by presenting rare medical issues. However, case reports that do not adhere to a standard template often lack rigor and limit their usefulness in clinical guidance. Several guidelines for reporting case reports have been structured, while further improvements are still required. The current guideline (CaReL) aims to enhance the comprehensiveness of case reports by integrating a detailed literature review. Methods In total, 56 researchers were selected based on specific publication criteria for structuring the guidelines. The guideline development was based on a two-step consensus process, including a literature review and survey distribution. Responses underwent scrutiny to ensure reliability and validity. Content validity was assessed, with revisions made to achieve a content validity index exceeding 0.78. The guideline's feasibility and effectiveness were evaluated by pilot testing, with feedback incorporated for finalization, ensuring the robustness and practicality of the guideline. Results The CaReL guidelines can improve the quality of case reports through a comprehensive checklist with an increased emphasis on literature review. In addition to traditional sections with their subsections discussed in previous guidelines, the checklist also focuses on literature review in the abstract and discussion. Conclusion The CaReL guidelines offer a comprehensive structure for documenting case reports. They highlight the importance of incorporating a literature review to better introduce medical issues to readers and scholars and embedding reported cases into the current scientific state of the art. Implementing these guidelines can promote knowledge sharing and improve patient care

A Core Outcome Set for Research Evaluating Interventions to Enable Communication in Patients With an Artificial Airway: An International Delphi Consensus Study (Comm-COS).

Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population. 1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages. Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting. Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field. None. We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention. This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.

Grey multi-criteria group consensus decision-making based on cobweb model

PurposeConsidering the bounded confidence of decision-makers (DMs), a new grey multi-criteria group consensus decision-making (GMCGCDM) model is established by using interval grey number (IGN), cobweb model, social network analysis (SNA) and consensus reaching process (CPR).Design/methodology/approachFirstly, the model analyzes the social relationship of DM under social networks and proposes a calculation method for DMs’ weights based on SNA. Secondly, the model defines a cobweb model to consider the preferences of decision-making alternatives in the decision-making process. The consensus degree is calculated by the area surrounded by the connections between each index value of DMs and the group. Then, the model coordinates the different opinions of various DMs to reduce the degree of bias of each DM and designs a consensus feedback mechanism based on bounded confidence to guide DMs to reach consensus.FindingsThe advantage of the proposed method is to highlight the practical application, taking the selection of low-carbon suppliers in the context of dual carbon as an example. Comparison analysis is performed to reveal the interpretability and applicability of the method.Originality/valueThe main contribution of this paper is to propose a new GMCGCDM model, which can not only expand the calculation method of DM’s weight and consensus degree but also reduce the time and cost of decision-making.

Aktywizm dający przyjemność: działanie na zasadzie wspólnej zgody, lokalne zakorzenienie i oddolne polityki integracyjne

This article discusses the operation of a grassroots pro-refugee initiative that has been active since the 2015 migration crisis. The author answers questions about why the grassroots initiative, which has no formal structures or external funding, has lasted so long, and analyzes its structure and mechanisms for effective interaction and cooperation with the local environment. The initiative is embedded in an existing local network, while drawing inspiration from the transnational activist movement. The author uses Adrienne Maree Brown’s notion of “pleasure activism,” David Graeber’s ethnographic descriptions of “anarchist groups operating by a consensus,” and ethnographic research of the initiative, which he conducted from September 2021 to July 2022. Key-words: pleasure activism, co-operation, local rootedness, friendship, consensual decision-making, refugees, grassroots pro-refugee collectives

Study of data replication process using Raft replication algorithm to maintain consistency in server cluster

The article considers the issues of ensuring availability and fault tolerance of a server cluster. The analysis of methods and technologies for increasing system reliability and improving performance, such as data replication, automatic switching between servers and fast recovery after failures, is carried out. It is indicated that the key element in modern distributed systems is replication-based clustering. The types of replication are analyzed. It is shown that during the operation of the system, there is a choice between the stability of the received data and the speed or scaling limitation. It is shown that the Raft algorithm is one of the reliable mechanisms with a high level of availability for achieving consensus and data management. An analysis of the literature on the use of the Raft consensus algorithm is carried out. The replication process using the Raft algorithm is analyzed. It is substantiated that it is possible to ensure strong consistency and high availability of the cluster using the management and control mechanism on the Kubernetes platform while maintaining cluster configuration synchronization. The Raft consensus process is studied using the M/M/s QS model. The exponential distribution of time between client requests and servicing with a certain number of servers is considered. The program code for the mathematical model in Python has been developed. Modeling has been performed in the Visual code environment in Python. The following parameters have been studied: the number of servers that operate at a certain average speed, the expected time of a client request in the system, and the probability of message delay. It has been proven that as the arrival speed increases, the expected time of a client request increases. The analysis provides an understanding of how the Raft algorithm works in different contexts and is applicable to optimizing system design processes.

Theoretical design of blockchain-based traceability for organic egg supply chains according to regulation (EU) 2018/848.

The use of blockchain technology to establish food traceability chains has the potential to provide transparent information of food stuffs along the entire supply chain and also aid in the documentation or even execution of official food control processes. Particularly in instances where analytical methodologies cannot provide definitive data for food control questions under study, the certificate-based approach of a traceability chain may offer a way of regulatory control for state authorities. Given the rising importance of organic produce and the high share of eggs among the organic produce in the European Union as well as the new EU regulation on organic products and labelling that came into force in 2022, we analyze here how the control of egg production type and marketing standards can be represented within a blockchain-based traceability chain such as to maximize the traceability in compliance with the current relevant EU regulations. Intended for the use by the official food control authorities, a traceability chain for organically produced eggs in the EU would need to be implemented as a permissioned blockchain, since only select entities are allowed to participate. By combining a proof of authority consensus mechanism with issuance of soulbound tokens, we effectively suggest a 'proof of soulbound authority' consensus process. The soulbound tokens are issued throughout the administrative chain from the European Commission down to the official food control authorities in individual member states that ultimately certify the control bodies for organic produce. Despite the general limitation of not providing unambiguous proof of the organic status of individual products, the concept discussed here offers advantages with respect to allocation of authority at EU level and therefore might have positive effects beyond the traceability chain.

Identifying neonatal transport research priorities: a modified Delphi consensus

ObjectivesWith increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport...

Development of the neonatal pain response variable set: a mixed methods consensus process

While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. This study aims to reach a consensus on optimal and comprehensive variables for neonatal pain assessment, leading to the development of a multidimensional neonatal pain response variable set. This study consisted of three phases: (1) A literature review was conducted to identify influencing factors and assessment indicators of neonatal pain response. (2) Panel meetings involving neonatal healthcare professionals evaluated and screened factors and indicators to develop an initial draft of the variable set. (3) Through two rounds of Delphi study achieved consensus, and determined the neonatal pain response variable set. Through a literature review and a panel meeting, the identified factors and indicators were categorized into contextual, physiological, and behavioral variables, forming an initial draft of the variable set. Sixteen professionals participated in two rounds of the Delphi study, with response rates exceeding 70%, and authority coefficients surpassing 0.7 in both rounds. The final iteration of the variable set includes 9 contextual variables, 2 physiological variables, and 5 behavioral variables. Conclusion: Neonatal pain response variable set developed in this study is scientific, comprehensive, and multidimensional, aligning with the characteristics of neonatal pain response and clinically applicable. The inclusion of contextual variables enhances the ability to confront the complexity of clinical environments and individual differences. It can provide a practical and theoretical basis for clinical research on neonatal pain assessment.What is Known:• Neonatal pain assessment relies on scales used by healthcare professionals currently. But there is no “gold standard” for neonatal pain assessment.• While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. Most of scales overlook the clinical environment complexity individual differences in pain responses, diminishing the accuracy and applicability.What is New:• In addition to the commonly used physiological and behavioral variables in the scales, we have incorporated contextual variables to better address the complexity of clinical environments and individual differences in pain responses.• Through an evidence-based approach, developed a neonatal pain response variable set comprising 9 contextual variables, 2 physiological variables, and 5 behavioral variables.

A utility-based three-way group decision consensus model with overlapping subgroups

This paper introduces a relative utility function-based consensus method for three-way group decision (TWGD) in a social network scenario where overlapping subgroups and non-overlapping subgroups co-exist. Firstly, we construct a three-way decision (TWD) model rooted in utility theory, which proposes a novel objective calculation method for the relative utility functions based on evaluation values. The relative utility matrices of decision makers (DMs) are derived on this basis. Secondly, a utility and trust-driven overlapping clustering algorithm is designed to maximize the overall trust level and the difference between subgroup clustering centers, aiming to divide the group into several manageable subgroups. In addition, we identify contrarian DMs, triggering a delegation-exit mechanism, and determine the weights of subgroups and DMs. Thirdly, a three-way group consensus decision model is formulated to provide targeted adjustment strategies for different types of DMs. To improve group consensus, we address the influence of key DMs on the opinions of overlapping subgroups with a minimum adjustment consensus model. Finally, we demonstrate the feasibility and scientificity of the proposed method through the illustrative example, sensitivity analysis, and comparative analysis.

Dyskinetic crisis in GNAO1-related disorders: clinical perspectives and management strategies.

GNAO1-related disorders (GNAO1-RD) encompass a diverse spectrum of neurodevelopmental and movement disorders arising from variants in the GNAO1 gene. Dyskinetic crises, marked by sudden and intense exacerbations of abnormal involuntary movements, present a significant challenge in GNAO1-RD. This study aimed to establish a standardized framework for understanding dyskinetic crises, addressing crucial aspects such as definition, triggers, diagnostic criteria, complications, and management strategies. A Delphi consensus process was conducted involving international experts in GNAO1-RD. The panel of thirteen experts participated in three voting rounds, discussing 90 statements generated through a literature review and clinical expertise. Consensus was achieved on 31 statements, defining dyskinetic crises as abrupt, paroxysmal episodes involving distinct abnormal movements in multiple body regions, triggered by emotional stress or infections. Dyskinetic crises may lead to functional impairment and complications, emphasizing the need for prompt recognition. While individualized pharmacological recommendations were not provided, benzodiazepines and clonidine were suggested for acute crisis management. Chronic treatment options included tetrabenazine, benzodiazepines, gabapentin, and clonidine. Deep brain stimulation should be considered early in the treatment of refractory or prolonged dyskinetic crisis. This consensus provides a foundation for understanding and managing dyskinetic crises in GNAO1-RD for clinicians, caregivers, and researchers. The study emphasizes the importance of targeted parental and caregiver education, which enables early recognition and intervention, thereby potentially minimizing both short- and long-term complications. Future research should concentrate on differentiating dyskinetic crises from other neurological events and investigating potential risk factors that influence their occurrence and nature. The proposed standardized framework improves clinical management, stakeholder communication, and future GNAO1-RD research.

Blockchain-based secure optimized traceable scheme for smart and sustainable food supply chain

A large number of nodes, and significant system overhead are among the challenges. To tackle these problems, a new PBFT technique known as trace-PBFT (t-PBFT) is being contemplated for adoption in the food supply chain. The PBFT algorithm, short for Practical Byzantine Fault Tolerance, serves as the fundamental algorithm. The linkages throughout the supply chain may be categorized into three primary groups. As a response to the continuing discussion over the amount of data, the status of each node is continuously updated in real time. This metric is utilized to evaluate the dependability of the principal node and to analyze the overall performance of the nodes. To minimize the amount of data transmitted between nodes, we optimized the consensus process of the first algorithm. The distinct attributes of offering collaborative food technology were considered throughout this procedure. Experimental evidence indicates that the t-PBFT approach outperforms the PBFT algorithm in terms of throughput, request delay, and information overhead. An architectural paradigm is proposed by integrating the t-PBFT algorithm with a federated network. This model was developed in response to the distinct demands of the food supply chain. This model effectively captures data at each stage of the food supply chain to ensure information tracking while preserving the safety of the food technology flow process.

Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery

Abstract Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.

‘Risk on steroids’: Investing in the hydrogen economy

A global energy transition requires alternatives to fossil fuels in energy-intensive industries and transport sectors, which are particularly reliant on the unique material properties of fossil fuels as fuel and as feedstock. Renewable energy transitions, therefore, demand large-scale investments in green hydrogen to produce substitutes as a means of indirect electrification. In the context of European climate governance, a political consensus has emerged to support the establishment of such production networks to lower emissions and create renewable-based fuels and feedstock. Yet, despite seemingly strong momentum, investment decisions are far behind global net zero scenarios. Through interviews with key actors, participant observation and document analysis, we explore investments in this type of production capacity, focusing on the challenges associated with financing such investments. We argue that risk expectations and uncertainties around profitability are holding back energy companies and institutional investors from investing in hydrogen and hydrogen derivatives. While investors and creditors await public derisking, fossil fuel incumbents maintain favourable financing conditions vis-à-vis renewable energy developers. These findings suggest clear limits to derisking and highlight the relevance of disciplinary measures to compel incumbents to scale up alternatives to fossil fuels.

Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist: An International Consensus Statement on Optic Nerve Sheath Diameter Imaging and Measurement.

To standardize optic nerve sheath diameter (ONSD) point-of-care ultrasonography (POCUS) and improve its research and clinical utility by developing the ONSD POCUS Quality Criteria Checklist (ONSD POCUS QCC). Three rounds of modified Delphi consensus process and three rounds of asynchronous discussions. Online surveys and anonymous asynchronous discussion. Expert panelists were identified according to their expertise in ONSD research, publication records, education, and clinical use. A total of 52 panelists participated in the Delphi process. None. Three Delphi rounds and three asynchronous discussion rounds generated consensus on quality criteria (QC). This started with 29 QC in addition to other QC proposed by expert panelists. The QC items were categorized into probe selection, safety, body position, imaging, measurement, and research considerations. At the conclusion of the study, 28 QC reached consensus to include in the final ONSD POCUS QCC. These QC were then reorganized, edited, and consolidated into 23 QC that were reviewed and approved by the panelists. ONSD POCUS QCC standardizes ONSD ultrasound imaging and measurement based on international consensus. This can establish ONSD ultrasound in clinical research and improve its utility in clinical practice.

Clinical impact of using [18F]AlF-NOTA-octreotide PET/CT instead of [68Ga]Ga-DOTA-SSA PET/CT: Secondary endpoint analysis of a multicenter, prospective trial.

[18F]AlF-NOTA-octreotide ([18F]AlF-OC) is a promising alternative for [68Ga]Ga-DOTA-somatostatin analogs (SSAs) in positron emission tomography (PET) imaging of the somatostatin receptor (SSTR). Our aim is to assess changes in TNM staging and differences in patient management between [18F]AlF-OC PET/CT and [68Ga]Ga-DOTA-SSA PET/CT in the work-up of neuroendocrine tumor (NET) patients. Patients who underwent both [18F]AlF-OC and [68Ga]Ga-DOTA-TATE or [68Ga]Ga-DOTA-NOC PET/CT in our multicenter study (Pauwels et al., J Nucl Med.2023;63:632-638) with a NET were included for analysis. TNM staging was determined and compared for both tracers. For each patient, the blinded [68Ga]Ga-DOTA-SSA or [18F]AlF-OC PET/CT images were presented in random order at a multidisciplinary team board. The images were presented together with clinical information and compared with previous SSTR and [18F]FDG PET/CT imaging. After a consensus decision for patient management was recorded, the board was presented with the PET/CT images from the other SSTR tracer and a decision was made for the second tracer. Differences in management were classified as major if it entailed an intermodality change and minor if it led to an intramodality change. Compared with [68Ga]Ga-DOTA-SSA, the use of [18F]AlF-OC led to a change in 16/75 patients: TNM staging changes in 10/75 patients (13.3%; downstaging in 3/10, upstaging in 7/10) and differences in clinical management were seen in 10/75 patients (13.3%), leading to a major difference in 7/10 cases and a minor change in 3/10 cases. All 10 cases with a difference in patient management between both PET tracers were caused by additional lesion detection by [18F]AlF-OC. The use of [18F]AlF-OC did not impact TNM staging or clinical management in the large majority of the patients (86.7%), further validating the potential for routine clinical use of [18F]AlF-OC PET/CT as an alternative for [68Ga]Ga-DOTA-SSA PET/CT. The trial is registered under ClinicalTrials.gov identifier NCT04552847 and EudraCT 2020-000549-15.

Partisan Politics in Finland

Abstract Traditionally, the Finnish party system has involved a high level of fragmentation yet remarkable stability, consensual decision-making, ideologically broad government coalitions, and mostly modest levels of polarization between parties or voters. These features suggest a limited effect of the party composition of government on economic policy. However, based on studies on close local elections, parliamentary speech, and party manifestos, we argue that the link between party politics and policy outcomes likely plays a role in Finland. Most analyses have examined the extent to which the characteristics of local politicians within the parties affect policy outcomes. These studies show that occupation, education, experience, competence, and residential location of local politicians strongly affect local policies, indicating that, in general, politics matters for policy. We also discuss how consensual national politics may have contributed to the recent success of the populist challenger Finns Party. As a new major player, the party has emphasized the role of sociocultural issues and especially affective polarization, which represents a considerable paradigm shift from the catch-all party policies typical of Finland for many decades. It is thus possible that the link between politics and policy will become more pronounced in the future, motivating further research.