Consensus In Round Research Articles

Consensus on the Structure and Content of Birth Plans: A Modified Delphi Study.

Few pregnant women in France wrote birth plans as in many other countries. The literature stresses the heterogeneity of birth plan content, which limits the utility of assessing the effects of birth plans on women's experience of childbirth. This study aimed to obtain a French national consensus on the structure and content of birth plans. A multidisciplinary steering committee was established. An electronic modified Delphi study was conducted to develop a structure and content for birth plans between November 2022 and June 2023. During three Delphi consensus rounds, panellists, including perinatal health care professionals and user representatives, were asked to rate individually and independently each proposed section and subsection formulation of the birth plan for its appropriateness. An external board assessed the understandability of the final birth plan's preamble and content. The steering committee proposed 103 formulations corresponding to items to be covered in a birth plan, categorized into 8 sections and 30 subsections, for evaluation in the Delphi rounds. The first round was completed by 42 panellists (mainly midwives), the second by 39, and the third by 36. Finally, the steering committee approved the final components of the structured birth plan in 8 sections and 19 subsections, after its reviewing by the 21 members of the external board. A French national Delphi process, after three rounds and validation by an external board, made it possible to reach a consensus on the structure and content of a birth plan in 8 sections and 19 subsections. User representatives were included as experts in the Delphi rounds, and in the external board to approve the final version of the structured birth plan.

They Will Come, You Must Build It: A Modified Delphi Process Applied to Preparing Acute Care Facilities Infrastructure for High-Consequence Infectious Diseases.

Patients with suspected or confirmed high-consequence infectious diseases (HCIDs) may present for care at any acute care facility. However, there are limited data to inform recommendations for the design, maintenance, and operation of isolation spaces for patients with suspected or confirmed HCIDs. To address this gap, we developed consensus statements by convening a group of 29 subject matter experts to participate in a modified Delphi process facilitated by a validated tool (the RAND-developed ExpertLens system). The subject matter experts participated in 3 consensus rounds, providing feedback and rating the appropriateness of 36 draft consensus statements. These draft statements were then revised based on their feedback. As a result, we developed 36 consensus statements addressing 5 domains: (1) patient room physical space, (2) doors and windows, (3) air handling, (4) electrical and plumbing, and (5) soiled utility rooms and waste management. These statements could inform the approaches of frontline acute care facilities when building new spaces or modifying existing spaces to enable appropriate HCID patient isolation and care.

ISHLT consensus statement on the perioperative use of ECLS in lung transplantation: Part II: Intraoperative considerations.

The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients.To address thischallenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung TransplantationStandards and Guidelines Committee.International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods.Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 39 recommendations regarding intraoperative considerations for ECLS in lung transplantation met consensus criteria.These recommendations focus on the planning, implementation, management, and monitoring of ECLS throughout the entire intraoperative period.

Review article: Recommendations for detection, assessment and management of suspected drug‐induced liver injury during clinical trials in oncology patients

SummaryBackgroundDrug‐induced liver injury (DILI) is a major concern for oncology drugs in clinical practice and under development. Monitoring cancer patients for hepatotoxicity is challenging as these patients may have abnormal liver tests pre‐treatment or on‐study for many reasons including liver injury due to past oncology treatments, hepatic metastases, medical co‐morbidities such as heart failure, and concomitant medications. At present, there are no regulatory guidelines or position papers that systematically address best practices pertaining to DILI detection, assessment and management in oncology patients.AimsThe goals of this review are (1) to examine and interpret the available evidence and (2) to make recommendations for detection, monitoring, adjudication, and management of suspected hepatocellular DILI during oncology clinical trials.MethodsThis manuscript was developed by the IQ Consortium (International Consortium for Innovation and Quality in pharmaceutical development) DILI Initiative that consists of members from 17 pharmaceutical companies, in collaboration with academic and regulatory DILI experts. The manuscript is based on extensive literature review, expert interpretation of the literature, and several rounds of consensus discussions.ResultsThis review highlights recommendations for patient eligibility for clinical trials with or without primary/metastatic liver involvement, as well as changes in liver tests that should trigger increased monitoring and/or discontinuation of study drug. Guidance regarding causality assessment for suspected DILI events, rechallenge and dose‐modification is provided.ConclusionsThis review brings together evidence‐based recommendations and expert opinion to provide the first dedicated consensus for best practices in detection, assessment, and management of DILI in oncology clinical trials.

Neurofibromatosis type1 adult surveillance form for Austria.

Neurofibromatosis type1 (NF1) is arare autosomal dominant tumor predisposition syndrome with abirth prevalence of approximately 1in 2000-3000 individuals. Management of both benign and malignant tumors arising in individuals with NF1 is demanding and tumors may be difficult to treat. Both standardized and individual surveillance programs are therefore highly important to prevent morbidity and mortality in patients with NF1. The guidelines for the clinical management of NF1 recently proposed by the European Reference Network for Genetic Tumor Risk Syndromes provide the cornerstone of the present surveillance form and were discussed through three rounds of voting and afinal consensus meeting involving experts from five Austrian and one German clinical NF1 centers for adults and one patient organization representative. Subsequently, 31items within 4categories were integrated into the proposed surveillance form for Austria. All recommendations, unless otherwise specified, pertain to primarily asymptomatic patients in routine follow-up. At healthcare transition from pediatric to adult surveillance or the initial visit in adulthood, we suggest athorough clinical, laboratory and radiological examination to obtain abaseline for future diagnostics. To comply with the general screening recommendations in Austria, we suggest extending the frequency of clinical visits from annual to biennial at 50years of age. In cases of clinical dynamics, early follow-up is recommended to facilitate early detection of potential complications. Particular emphasis should be placed on preventive patient education.

The trust incentive mechanism by trust propagation to optimize consensus in social network group decision making

Trust relationship in social network group decision making (SN-GDM) is one of the key factors to promote group consensus. This trust relationship reflects the importance of experts, and the consensus feedback opinion induced by the trust relationship is easier to be accepted by the group. But this trust relationship is often assumed to be static, and therefore the dynamic effect of incentive behavior among experts on trust relationship is not considered. To do that, the purpose of this paper is to develop a trust incentive mechanism to effectively promote group consensus. First, the new discount based Uninorm trust propagation operator with 2-tuple linguistic is presented, which transforms an incomplete trust relationship into a complete trust relationship. And then, the trust incentive mechanism with opinions similarity between experts is constructed, which reflects not only the incentive process among experts, but also the dynamic change of the social trust relationship. Further, the trust incentive mechanism driven consensus optimization model is established to generate experts’ recommendation advices, which not only effectively reduce the total adjustment cost of experts to promote consensus, but also makes the experts continue to motivate the discussion after revising their opinions, leading to dynamic changes in the social trust relationship in the next consensus round. Finally, an example of agricultural UAV brand selection in “Metaverse” intelligent shopping is provided to illustrate the proposed method, and the results show that with the increase of incentive factor, the total adjustment cost decreases, and the best UAV brand also changes alternately and tends to be stable. In addition, comparing with the method without trust incentive, the interaction cost of the proposed method is 13.46% lower, and then our proposed method has certain flexibility and advantages.

Lightweight adaptive Byzantine fault tolerant consensus algorithm for distributed energy trading

With the rapid development of smart grid, constructing distributed energy trading market (DETM) based on blockchain to coordinate distributed energy resources (DER) has become a future direction. However, existing consensus algorithms of blockchain face many challenges in large-scale energy trading scenarios, such as high resource overhead, slow transaction procedure. To solve the above crucial problems for wide deployment of distributed energy trading, this study proposes a novel consensus algorithm named Lightweight adaptive Byzantine fault tolerant consensus (LA-BFT), and a reputation calculation method based on behavioral characteristics for selection of consensus nodes. The LA-BFT consists of two parts: (i) weak consensus for normal cases. By introducing threshold signature mechanism, weak consensus simplifies the consensus process to achieve linear communication complexity O(n). (ii) byzantine node detection scheme is enable for malicious cases. With consensus committee, the detection scheme can detect the potential byzantine nodes by cross-validation, which ensures transaction safety. The reputation calculation method is presented to cooperate with LA-BFT to elect leaders and candidates for consensus procedure. Once a round of consensus is completed, the reputation of each node needs to be updated, only nodes with high reputation are eligible to become leaders or committee nodes in the next round. With the reputation calculation method, honest nodes and byzantine nodes can be effectively identified, ensuring the security of the consensus process. Numerical results indicate that LA-BFT exhibits superior performance on communication overhead and bandwidth occupancy in large-scale concurrent energy trading scenarios. When the number of nodes is 50, under normal scenarios, LA-BFT’s communication overhead is notably lower, constituting a mere 6.02% of PBFT and 24.26% of SHBFT, while bandwidth occupancy amounts to merely 5.55% of PBFT and 9.76% of SHBFT.

Practical social media recommendations for dementia prevention researchers.

Practical social media recommendations are needed to facilitate greater engagement in dementia prevention research. Alongside relevant experts, our aim was to develop a set of consensus recommendations that reflect the values and priorities of prospective participants to guide social media use. We conducted a three-round, modified Delphi consisting of three online surveys and three conferences calls. The diverse, international Delphi panel comprised 16 experts with lived (n = 10) and professional (n = 6) experiences. Consensus was defined a priori as ≥ 70% agreement. Twenty-six items achieved consensus. Two items reached consensus in round 1: ethical considerations of closed social media groups (88%) and of social media users sharing prevention content with connections who are not on social media (79%). Nine items reached consensus in round 2, related to misinformation (79%), stigma (93%), and other key aspects of social media communication. After revisions, 15 items reached consensus in the final round. These items included: identifying when researchers ought to engage, managing closed social media groups, rankings of short form content, prioritizing lay summaries and multimedia resources, and rankings of preferred language. One item about the language of prevention for audiences living with dementia did not reach consensus. Final consensus items formed the new set of recommendations, which we organized into seven social media use cases. These use cases include setting up a social media page or community, handling online misinformation, actively challenging stigma, handling difficult online interactions, introducing new research to the public, help with study recruitment, and the language of prevention when writing posts. These consensus recommendations can help dementia prevention researchers harness social media use for the purposes of public engagement and uphold the norms and values specific to the dementia research and broader communities. We created social media recommendations with research and community experts.Recommendations cover key ethical considerations for dementia prevention research.Areas include misinformation, stigma, information updates, and preferred language.Full consensus recommendations are organized into seven social media use cases.

Research Priorities in the Mechanical Diagnosis and Therapy Among Diploma Therapists: An International Delphi Study.

Introduction Mechanical diagnosis and therapy (MDT) is the most researched approach in musculoskeletal physical therapy and involves classifying patients into sub-groups based on their response to loading strategies. MDT diploma therapists (Dip-MDTs) fully recognize the value of MDT in musculoskeletal physical therapy. MDT is updating its system based on the latest research, but the system has not yet been fully established. Therefore, more research is required to increase the comprehensibility of the system. Thus, we aimed to identify future research priorities of MDT. Methods We conducted a modified Delphi study with three rounds. The Research Advisory Committee(RAC) members (n=7) of the McKenzie Institute International were invited to participate in the initial idea generation round. In the subsequent two consensus rounds, Dip-MDTs (n=299) were asked to indicate their level of agreement with the results of the idea generation round using a five-point Likert scale.The criteria for consensus weremean score ≥4.0, coefficient of variation ≤30%, percent agreement ≥75%, and quartile deviation ≤1. A post-hoc analysis of the consensus was conducted when the number of participants from a certain country exceeded one-third of the total number of participants. Results The participation rates for each round were 57.1%, 52.2%, and 49.8%. The USA accounted for 43.6% and 44.3% of all participants at the two consensus rounds, respectively. Finally, nine items reached consensus in the second consensus round. After the post-hoc analysis, eight items reached consensus: (1) cost-effectiveness, (2) cervical and thoracic spine, (3) extremity classifications, (4) filtered randomized controlled trials (RCTs), (5) spinal source classification, (6) centralization and directional preferences, (7) predictive factors for recurrence, and (8) patient education. Conclusion In this study, we identified the research priorities of MDT that would enhance the completion of the MDT system.

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi study

Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. No funding was received.

CE-PBFT: An Optimized PBFT Consensus Algorithm for Microgrid Power Trading

Currently, in the blockchain-based distributed microgrid trading system, there are some problems, such as low throughput, high delay, and a high communication overhead. To this end, an improved Practical Byzantine Fault Tolerance (PBFT) algorithm (CE-PBFT) suitable for microgrid power trading is proposed. First, a node credit value calculation model is introduced, and nodes are divided into consensus, supervisory, and propagation nodes according to their credit values, forming a hierarchical network structure to ensure the efficiency and reliability of consensus. Secondly, the consensus process is optimized by adopting a segmented consensus mechanism. This approach calculates the consensus rounds for nodes and selects the methods for node-type switching and consensus based on these calculations, reaching dynamic changes in node states and credit values, effectively reducing the communication overhead of node consensus. Finally, the experiments show that compared with the IMPBFT and PBFT algorithms, the CE-PBFT algorithm has better performance in throughput, delay, and communication overhead, with a 22% higher average throughput and 15% lower average delay than the IMPBFT algorithm and a 118% higher average throughput and 87% lower average delay than the PBFT algorithm.

Guidance on assessing efficacy and harms in traditional Chinese medicine dietotherapy: Introducing the Dietotherapy Intention, Evaluation, and Harm Tracking (DIET) pathway

IntroductionTraditional Chinese medicine (TCM) dietotherapy, based on the principle of “medicine and food homology”, is widely used across diverse healthcare domains. However, the dual attributes of “medicine” and “food” possessed by medicinal and edible herbs make it challenging to assess the efficacy and harms of TCM dietotherapy using currently available methodological systems. This limits the advancement of health services and regulations in this field. This study introduces the Dietotherapy Intention, Evaluation, and Harm Tracking (DIET) pathway, a staged approach for assessing the efficacy and harms of TCM dietotherapy. ResultsThe DIET pathway was developed through comprehensive analysis and two rounds of Delphi expert consensus. Based on the distinct characteristics and management requirements of TCM dietotherapy, the DIET pathway divides the assessment process into three stages: Stage 1 (Intention) aims to establish intended efficacy goals, Stage 2 (Evaluation) aims to validate efficacy and harms, and Stage 3 (Harm Tracking) aims to assess harms in special scenarios. Elaborate methodological guidelines are provided for each stage. ConclusionThe DIET pathway has created a methodological environment that enables systematic and efficient assessment of the efficacy and harms of TCM dietotherapy regimens, which will facilitate the application and management of TCM dietotherapy.

Developing a Vape Shop-Based Smoking Cessation Intervention: A Delphi Study.

Providing access to a vape shop-based smoking cessation intervention may simultaneously increase e-cigarette use and increase the effectiveness of e-cigarettes for smoking cessation. The aim of this study was to identify the most important elements of vape shop-based smoking intervention to stakeholders who would be involved in delivering or accessing such an intervention. We conducted a three-round Delphi study of vape shop staff (n = 40), stop smoking professionals and tobacco control leads (n = 30), and smokers, vapers, and dual users (n = 30) in the United Kingdom in May-August 2021. In each round participants were asked whether they agreed or disagreed with statements related to vape shop-based interventions. Forty-six of 95 statements reached consensus in round 1, 29 out of 49 in round 2, and 8 out of 20 in round 3. There was support for a vape shop-based intervention across stakeholder groups (96%). There was consensus that the service should comprise both product (98%) and behavioral support (97%), and that quitting vaping should not be a goal of the service (79%). Although there was consensus that there should be some free product provision, there was less consensus as to what this should involve. Views were mostly consistent across stakeholder groups. There was broad consensus on how to deliver a vape shop-based smoking cessation intervention, providing a strong basis for future intervention development and implementation. Challenges around misuse of the service and misperceptions about vaping would need to be addressed for such an intervention to be feasible and effective. Many smokers who make a quit attempt using e-cigarettes purchase their vaping products in vape shops. Delivering vape-shop-based smoking cessation interventions could help to maximize the effectiveness of e-cigarettes for quitting smoking. This study used a Delphi approach to identify the most important elements of a vape shop-based intervention among stakeholders. The findings could be used to help develop future interventions.

Research and practice priorities in pilonidal sinus disease: a consensus from the PITSTOP study.

Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field. Patients and surgeons were invited to participate. A 'So what, now what' exercise was conducted, informed by data from PITSTOP. This generated statements for research and practice priorities. A three-round online Delphi study was conducted, ranking statements based on policy and research separately. Statements were rated 1 (not important) to 9 (important). Statements that were rated 7-9 by more than 70% of participants were entered into the consensus meeting. Personalized voting feedback was shown between rounds. A face-to-face meeting was held to discuss statements, and participants were asked to rank statements using a weighted choice vote. Twenty-two people participated in the focus group, generating 14 research and 19 policy statements. Statements were voted on by 56 participants in round 1, 53 in round 2 and 51 in round 3. A total of 15 policy statements and 19 research statements were discussed in the consensus round. Key policy statements addressed treatment strategies and intensity, surgeon training opportunities, need for classification and the impact of treatment on return to work. Research recommendations included design of future trials, methodology considerations and research questions. This study has identified research and policy priorities in pilonidal sinus disease which are relevant to patients and clinicians. These should inform practice and future research.

PnV: An Efficient Parallel Consensus Protocol Integrating Proof and Voting

Consensus protocols, as crucial components of blockchain technology, play a vital role in ensuring data consistency among distributed nodes. However, the existing voting-based and proof-based consensus protocols encounter scalability issues within the blockchain system. Moreover, most consensus protocols are serialized, which further limits their scalability potential. To address this limitation, parallelization methods have been employed in both types of consensus protocols. Surprisingly, however, novel fusion consensus protocols demonstrate superior scalability compared with these two types but lack the utilization of parallelization techniques. In this paper, we present PnV, an efficient parallel fusion protocol integrating proof-based and voting-based consensus features. It enhances the data structure, consensus process, transaction allocation, and timeout handling mechanisms to enable concurrent block generation by multiple nodes within a consensus round. Experimental results demonstrate that PnV exhibits superior efficiency, excellent scalability, and acceptable delay compared with Proof of Vote (PoV) and BFT-SMART. Moreover, at the system level, the performance of the PnV-based blockchain system optimally surpasses that of the FISCO BCOS platform. Our proposed protocol contributes to advancing blockchain technology by providing a more efficient and practical solution for achieving decentralized consensus in distributed systems.

Inflammatory bowel disease patients’ perspectives of non-medical needs

BackgroundInflammatory bowel disease (IBD) imposes a huge burden on the healthcare systems and greatly declines the patient’s quality of life. However, there is a paucity of detailed data regarding information and supportive needs as well as sources and methods of obtaining information to control different aspects of the disease from the perspectives of the patients themselves. This study aimed to establish the IBD patients’ preferences of informational and supportive needs through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).MethodsIBD patients were recruited from different centers. Considering inclusion and exclusion criteria, 521 participants were filled a predefined questionnaire. This questionnaire was prepared through literature review of the recent well-known guidelines on the needs of IBD patients, which was further approved by the experts of IBD area in three rounds of Delphi consensus. It includes 56 items in four sections of informational needs (25), supportive needs (15), sources of information (7), and methods of obtaining information (9).ResultsIn particular, EFA was used to apply data reduction and structure detection. Given that this study tries to identify patterns, structures as well as inter-relationships and classification of the variables, EFA was utilized to simplify presentation of the variables in a way that large amounts of observations transform into fewer ones. Accordingly, the EFA identified five factors out of 25 items in the information needs section, three factors out of 15 items in the supportive needs section, two factors out of 7 items in the information sources section, and two factors out of 9 items in the information presentation methods. Through the CFA, all 4 models were supported by Root Mean Squared Error of Approximation (RMSEA); Incremental Fit Index (IFI); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); and SRMR. These values were within acceptable ranges, indicating that the twelve factors achieved from EFA were validated.ConclusionsThis study introduced a reliable 12-factor model as an efficient tool to comprehensively identify preferences of IBD patients in informational and supportive needs along with sources and methods of obtaining information. An in-depth understanding of the needs of IBD patients facilitates informing and supporting health service provision. It also assists patients in a fundamental way to improve adaptation and increase the quality of life. We suggest that health care providers consider the use of this tool in clinical settings in order to precisely assess its efficacy.

International multi-stakeholder consensus statement on clinical trial integrity

ObjectiveTo prepare a set of statements for randomised clinical trials (RCT) integrity through an international multi-stakeholder consensus.MethodsThe consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymized two-round modified Delphi survey with consensus threshold based on the average percentage of majority opinions; and a final consensus development meeting. Prospective registrations: (https://osf.io/bhncy, https://osf.io/3ursn).ResultsThere were 30 stakeholders representing 15 countries from five continents including trialists, ethicists, methodologists, statisticians, consumer representatives, industry representatives, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with eight additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n = 6), design and approval (n = 11), conduct and monitoring (n = 19), reporting of protocols and findings (n = 20), post-publication concerns (n = 12) and future research and development (n = 13).ConclusionImplementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.

Multi-dimensional multi-round minimum cost consensus models with iterative mechanisms involving reward and punishment measures

In order to address the issues of unfairness in consensus and subjectivity bias in data, while further expanding the traditional minimum cost consensus model (MCCM) in terms of opinion dimension and consensus round, we propose the multi-dimensional MCCM (MD-MCCM) and multi-round MCCM (MR-MCCM). Subsequently, we introduce the concepts and definitions pertaining to these two variants of consensus and formulate their respective consensus model frameworks. To benefit from the advantages of both, we integrate these two types of consensus models, thereby introducing the concept of multi-dimensional multi-round minimum cost consensus. To address the issues of unfairness and subjectivity in the consensus-reaching process, we propose two specific reward and punishment measures and devise the multi-dimensional multi-round consensus iterative mechanisms. These mechanisms facilitate an iterative update of decision-makers’ opinions, weights, and unit costs within the feedback process. Based on this foundation, we construct the multi-dimensional multi-round MCCM (MDMR-MCCM) involving Euclidean and Manhattan distance measures, and their corresponding algorithm and consensus reaching process are presented. Finally, a group decision problem concerning site selection validates the rationality and effectiveness of our models. Moreover, a comparative analysis of results obtained using different models is provided.

Establishing an updated consensus on the conceptual and operational definitions of Making Every Contact Count (MECC) across experts within research and practice: an international Delphi Study

ObjectivesThe Making Every Contact Count (MECC) initiative is broadly defined as an opportunistic approach to prevention by making use of the thousands of conversations service providers have with service users every day. However, since its conception, the application of MECC has diverged and developed considerably. Thus, the current study aimed to revise the definition according to current research and practice to better describe what is and is not included. Study designA consensus building classic Delphi methodology, completed by an expert panel. MethodsRound 1 asked open questions around the definition of MECC. Content analysis of round 1 identified statements that were rated for agreement in round 2. Statements achieving ≥80% agreement were included in a short, long, or operational definition of MECC that were rated for agreement in round 3 (the minimum number required). An agreement of ≥80% indicated consensus. ResultsForty out of 100 contacted experts completed three rounds. Experts in practice and research were recruited internationally although most were from England. From round 1, 274 statements were generated, of which 96 achieved consensus and were included within round 3. The short and long definition received consensus in round 3, the operational definition required four rounds to reach consensus. ConclusionsMECC is a person-centred approach to health behaviour change that, provided an individual possesses the relevant skills, can be delivered by anyone and anywhere. The distinguishing feature of MECC is not in its duration, target behaviour, or conditions for delivery, but rather in the approach taken and the mechanisms applied to conversations. Implications for research and practice are discussed, and the limits for applicability acknowledged.

Extending the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in Traditional Chinese Medicine (TCM): The GRADE-TCM

AimTo extend and form the “Grading of Recommendations Assessment, Development and Evaluation in Traditional Chinese Medicine” (GRADE-TCM). MethodsMethodologies were systematically reviewed and analyzed concerning evidence-based TCM guidelines worldwide. A survey questionnaire was developed based on the literature review and open-end expert interviews. Then, we performed expert consensus, discussion meeting, opinion collection, external examination, and the GRADE-TCM was formed eventually. Results265 Chinese and English TCM guidelines were included and analyzed. Five experts completed the open-end interviews. Ten methodological entries were summarized, screened and selected. One round of consensus was conducted, including a total of 22 experts and 220 valid questionnaire entries, concerning 1) selection of the GRADE, 2) GRADE-TCM upgrading criteria, 3) GRADE-TCM evaluation standard, 4) principles of consensus and recommendation, and 5) presentation of the GRADE-TCM and recommendation. Finally, consensus was reached on the above 10 entries, and the results were of high importance (with voting percentages ranging from 50 % to 81.82 % for “very important” rating) and strong reliability (with the Cr ranging from 0.93 to 0.99). Expert discussion meeting (with 40 experts), opinion collection (in two online platforms) and external examination (with 14 third-party experts) were conducted, and the GRADE-TCM was established eventually. ConclusionGRADE-TCM provides a new extended evidence-based evaluation standard for TCM guidelines. In GRADE-TCM, international evidence-based norms, characteristics of TCM intervention, and inheritance of TCM culture were combined organically and followed. This is helpful for localization of the GRADE in TCM and internationalization of TCM guidelines.