Rounds Of Voting Research Articles

The development of a regional referral pathway for locally recurrent rectal cancer: A Delphi consensus study

BackgroundThe management of patients with locally recurrent rectal cancer (LRRC) is often complex and requires multidisciplinary input whereas only few patients are referred to a specialist centre. The aim of this study was to design a regional referral pathway for LRRC, in Nouvelle Aquitaine (South-West, France). MethodsIn 2016, we conducted with a Study Steering Committee (SC) a three phase mixed-methods study including identification of key factors, identification of key stakeholders and Delphi voting consensus. During three rounds of Delphi voting, a consensus was defined as favorable, if at least 80% of participating experts rate the factor, below or equal to 3/10 using a Likert scale, or consider it as “useful” using a binary scale (third round only). Finally, the SC drafted guidelines. ResultsAmong the 423 physicians involved in 29 regional digestive Multi-Disciplinary Team (MDT) meeting, 59 participants (from 26 MDT meeting) completed all three rounds of Delphi voting. Thirteen out of twenty initially selected factors reached a favorable consensus. All patients with a LRRC need to be included into a referral pathway. Patients with a central pelvic recurrence offered curative treatment in their local hospital and patients with unresectable metastatic disease were excluded of the referral. Key performance indicators were also agreed including the time to referral and completion of pelvic MRI-, CT-, PET-scan prior to MDT referral. ConclusionThe development of this referral pathway represents an innovative health service, which will improve the management of patients with LRRC in France.

Management of adult-onset Still\u2019s disease with interleukin-1 inhibitors: evidence- and consensus-based statements by a panel of Italian experts

BackgroundAdult-onset Still’s disease (AOSD) is a rare inflammatory condition characterized by fever, rash, and arthritis. Because of its rarity, clinical trials are inherently small and often uncontrolled. Our objective was to develop recommendations for the use of interleukin (IL)-1 inhibitors in the management of patients with AOSD, based on the best evidence and expert opinion.MethodsA panel of 10 experts (9 rheumatologists and 1 pediatrician) was established. The first step was dedicated to a comprehensive literature review and development of statements. Two separate literature searches were performed on the MEDLINE (Pubmed), EMBASE, and BIOSIS databases through April 2018 to identify (1) differences and similarities between AOSD and pediatric Still’s disease (systemic juvenile idiopathic arthritis [SJIA]) and (2) the efficacy and safety of IL-1 inhibitors in AOSD treatment. In the second step, the statements were submitted in a Delphi process to a panel of 67 rheumatologists. Consensus threshold was set at 66%: positive, > 66% of voters selected scores 3 to 5; negative, > 66% of voters selected scores 1 or 2. In the third step, the voting results were analyzed, and the statements were finalized.ResultsEleven statements were developed. Forty-six of 67 rheumatologists (72%) participated in the Delphi process. A positive consensus was reached after the first round of voting and was full (> 95%) on the majority of statements. A large consensus was achieved in considering AOSD and SJIA as the same disease. The use of anti-IL-1 therapies in refractory patients was considered quite safe and effective both as the first and as a subsequent line of biologic treatment, especially in systemic patients. Because of the lack of head-to-head comparisons, a different profile of efficacy among IL-1 inhibitors could not be established. There was a large consensus that failure of the first IL-1 inhibitor does not preclude response to another one. The lack of studies comparing early versus late treatment did not allow to draw conclusions; however, data from SJIA suggest a better response in early treatment.ConclusionsThe Delphi method was used to develop recommendations that we hope will help clinicians in the management of patients with AOSD refractory to conventional therapies.

Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding Severity.

Although bleeding frequently occurs in critical illness, no published definition to date describes the severity of bleeding accurately in critically ill children. We sought to develop diagnostic criteria for bleeding severity in critically ill children. Delphi consensus process of multidisciplinary experts in bleeding/hemostasis in critically ill children, followed by prospective cohort study to test internal validity. PICU. Children at risk of bleeding in PICUs. None. Twenty-four physicians worldwide (10 on a steering committee and 14 on an expert committee) from disciplines related to bleeding participated in development of a definition for clinically relevant bleeding. A provisional definition was created from 35 descriptors of bleeding. Using a modified online Delphi process and conference calls, the final definition resulted after seven rounds of voting. The Bleeding Assessment Scale in Critically Ill Children definition categorizes bleeding into severe, moderate, and minimal, using organ dysfunction, proportional changes in vital signs, anemia, and quantifiable bleeding. The criteria do not include treatments such as red cell transfusion or surgical interventions performed in response to the bleed. The definition was prospectively applied to 40 critically ill children with 46 distinct bleeding episodes. The kappa statistic between the two observers was 0.74 (95% CI, 0.57-0.91) representing substantial inter-rater reliability. The Bleeding Assessment Scale in Critically Ill Children definition of clinically relevant bleeding severity is the first physician-driven definition applicable for bleeding in critically ill children derived via international expert consensus. The Bleeding Assessment Scale in Critically Ill Children definition includes clear criteria for bleeding severity in critically ill children. We anticipate that it will facilitate clinical communication among pediatric intensivists pertaining to bleeding and serve in the design of future epidemiologic studies if it is validated with patient outcomes.

Exploring the fundamental aspects of the Enhanced Recovery After Surgery nurse's role.

To investigate the common aspects of the role of the ERAS nurse, and similar roles. A modified Delphi technique was used to explore the opinions of ERAS nurses, facilitators and their colleagues in the UK. A series of consensus statements on the role of the ERAS nurse were produced that were voted on and agreed via an online survey, then subsequently voted on at the seventh ERAS UK conference. Six consensus statements were proposed and agreed in the second round of voting. In the final round of voting, consensus was reached on four of the six statements related to data collection, patient education, staff education and patient support throughout the pathway. The two statements that did not reach consensus were related to leadership and project management. It is hoped that by producing these consensus statements, the role of the ERAS nurse will be better understood by all members of multidisciplinary ERAS teams, particularly managers and decision-makers, and can be supported in the future.

Lymphadenectomy during Potentially Curative Pulmonary Metastasectomy - Recommendations of an Expert Consensus Panel using the Delphi Process

The aim of the consensus approach was to improve the quality of care by agreement on definitions and standards, in order to harmonise lymphadenectomy during lung metastasectomy. The Delphi process consisted of two rounds of anonymous voting before discussion at a consensus meeting to reach final consensus within a group of experts. Consensus was assumed when > 75% of the panel agreed. Of 76 invited experts (board certified thoracic surgeons leading high-volume thoracic departments), 49 and 47 participated in the first and second round questionnaire, respectively. 43 experts attended the consensus meeting and reached consensus on the following: surgical approach for solitary subpleurally located lung metastasis is videothoracoscopy compared to anterolateral thoracotomy for multiple lung metastases. Lymphadenectomy is performed irrespective of the surgical approach. Systematic lymphadenectomy or sampling are core elements of pulmonary metastasectomy for colorectal, renal and non-seminomatous testicular cancer. The size of pulmonary metastasis does not influence lymphadenectomy per se. Pulmonary metastasectomy is not abolished in case of intraoperatively detected lymph node metastases. An expert group agreed on recommendations for lymphadenectomy during pulmonary metastasectomy using the Delphi process.

The Brazilian Portuguese Version of the DISCERN Instrument: Translation Procedures and Psychometric Properties

ObjectivesTo report on the translation procedures and psychometric properties of the DISCERN tool in Brazilian Portuguese. MethodsThree people translated the DISCERN from English into Brazilian Portuguese. A committee of experts and community representatives evaluated the quality of the 3 versions in 2 online voting rounds. Two native speakers back-translated the questionnaire into English. We compared these versions to the original DISCERN and made small adjustments. The final Brazilian Portuguese version of DISCERN was tested twice by journalism students to evaluate the quality of a text about smoking cessation treatments. We evaluated participants’ health literacy with the Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHL-PA) tool, assessed the internal consistency of the translated questionnaire with the Cronbach test, and measured its reproducibility with the intraclass correlation coefficient (ICC). We then investigated the relationship between DISCERN and SAHL-PA scores and demographic variables. ResultsThe participants (n = 126) had no difficulty in using the questionnaire. Cronbach's alpha was 0.865 (95% confidence interval [CI], 0.826-0.898), and the ICC between the 2 evaluations was 0.845 (CI 0.717-0.912). The mean health literacy of the participants was adequate. There was no correlation between the DISCERN score and the SAHL-PA score, age, or sex (P > .05). ConclusionsThe Brazilian Portuguese version of the DISCERN questionnaire has excellent internal consistency and good reproducibility. The evaluators’ ages, sex, and health literacy did not interfere with the score resulting from the evaluation of the quality of the text.

Best practice guidelines regarding diagnosis and management of patients with type II collagen disorders

PurposeSkeletal dysplasias comprise a heterogeneous group of inherited disorders of development, growth, and maintenance of the human skeleton. Because of their relative rarity and wide phenotypic variability, patients should be accurately identified, uniformly assessed, and managed by clinicians who are aware of their potential complications and possess the knowledge and resources to treat them effectively. This study presents expert guidelines developed to improve the diagnosis and management of patients with type II collagen skeletal disorders to optimize clinical outcomes. MethodsA panel of 11 multidisciplinary international experts in the field of skeletal dysplasia participated in a Delphi process, which comprised analysis of a thorough literature review with subsequent generation of 26 diagnosis and care recommendations, followed by two rounds of anonymous voting with an intervening face-to-face meeting. Those recommendations with more than 80% agreement were considered as consensual. ResultsAfter the first voting round, consensus was reached to support 12 of 26 (46%) statements. After the panel discussion, the group reached consensus on 22 of 24 revised statements (92%). ConclusionsConsensus-based, expert best practice guidelines developed as a standard of care to assist accurate diagnosis, minimize associated health risks, and improve clinical outcomes for patients with type II collagen skeletal dysplasias.

Evidence- and consensus-based recommendations for the use of pegvaliase in adults with phenylketonuria

PurposePhenylketonuria (PKU) is a rare metabolic disorder that requires life-long management to reduce phenylalanine (Phe) concentrations within the recommended range. The availability of pegvaliase (PALYNZIQ™, an enzyme that can metabolize Phe) as a new therapy necessitates the provision of guidance for its use. MethodsA Steering Committee comprising 17 health-care professionals with experience in using pegvaliase through the clinical development program drafted guidance statements during a series of face-to-face meetings. A modified Delphi methodology was used to demonstrate consensus among a wider group of health-care professionals with experience in using pegvaliase. ResultsGuidance statements were developed for four categories: (1) treatment goals and considerations prior to initiating therapy, (2) dosing considerations, (3) considerations for dietary management, and (4) best approaches to optimize medical management. A total of 34 guidance statements were included in the modified Delphi voting and consensus was reached on all after two rounds of voting. ConclusionHere we describe evidence- and consensus-based recommendations for the use of pegvaliase in adults with PKU. The manuscript was evaluated against the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and is intended for use by health-care professionals who will prescribe pegvaliase and those who will treat patients receiving pegvaliase.

Use of sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors: An Asian perspective and expert recommendations.

Diabetes mellitus in Asia accounts for more than half of the global prevalence. There is a high prevalence of cardiovascular disease (CVD) in the region among people with type 2 diabetes mellitus (T2DM) and it is often associated with multiple risk factors including hypertension, renal disease and obesity. The early onset of T2DM and the eventual long disease duration portends an increasing proportion of the population to premature CVD. In addition to lowering blood glucose, sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors exert favourable effects on multiple risk factors (including blood pressure, body weight and renal function) and provide an opportunity to reduce the risk of CVD in patients with T2DM. In this article, we consolidated the existing literature on SGLT‐2 inhibitor use in Asian patients with T2DM and established contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, published data from clinical trials in the Asian population (dapagliflozin, canagliflozin, empagliflozin, ipragliflozin, luseogliflozin and tofogliflozin), CVD outcomes trials (EMPAREG‐OUTCOME, CANVAS and DECLARE‐TIMI 58) and real‐world evidence studies (CVD‐REAL, EASEL, CVD‐REAL 2 and OBSERVE‐4D). A series of clinical recommendations on the use of SGLT‐2 inhibitors in Asian patients with T2DM was deliberated among experts with multiple rounds of review and voting. Based on the available evidence, we conclude that SGLT‐2 inhibitors represent an evidence‐based therapeutic option for the primary prevention of heart failure hospitalization and secondary prevention of CVD in patients with T2DM, and should be considered early on in the treatment algorithm for patients with multiple risk factors, or those with established CVD.

The future of general surgery training: A Canadian resident nationwide Delphi consensus statement

BackgroundSeveral models have been introduced to improve and restructure surgical training, but continued barriers exist. Residents are uniquely positioned to offer perspective on practical challenges and needs of reformatting surgical education. This study aimed to establish a nationwide, Delphi consensus statement on the perceptions of Canadian residents regarding the future of general surgery training. MethodsCanadian general surgery residents participated in a moderated focus group using the Nominal Group Technique to discuss early subspecialization, competency-based medical education, and transition to practice. Qualitative verbal data were transcribed, categorized into themes, and synthesized into recommendation statements. During an iterative Delphi survey, resident leaders ranked each statement on a 5-point Likert scale of agreement. The survey was terminated once consensus was achieved (≥2 survey rounds and Cronbach’s α ≥ 0.80). ResultsA total of 66 statements were synthesized by 16 members of the Canadian Association of General Surgeons Resident Committee. A total of 49 residents participated in the Delphi consensus, which was achieved after 2 voting rounds (Cronbach’s α = 0.93). Participants agreed that (1) residency should focus on achieving standardized competencies and milestones based on resident ability to meet specific measurable metrics, (2) early streaming should be offered after “core” milestones and competencies have been achieved, and (3) an explicit period should allow transition-to-independent practice with tailored rotations, greater autonomy, and resident-run clinics. We identified 10 barriers to competency-based medical education implementation. ConclusionA nationwide consensus regarding the future of surgical training was established among current residents. These findings can inform and help implement guidelines and national curricula that meet the needs of the trainee and address the many challenges they face during their training.

Building a neuroinfectious disease consensus curriculum.

To delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field. The authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique. A comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus. The modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

Selecting the runoff pair

Although two-round voting procedures are common, the theoretical voting literature rarely discusses any such rules beyond the traditional plurality runoff rule. Therefore, using four criteria in conjunction with two data-generating processes, we define and evaluate nine “runoff pair selection rules” that comprise two rounds of voting, two candidates in the second round, and a single final winner. The four criteria are: social utility from the expected runoff winner (UEW), social utility from the expected runoff loser (UEL), representativeness of the runoff pair (Rep), and resistance to strategy (RS). We examine three rules from each of three categories: plurality rules, utilitarian rules and Condorcet rules. We find that the utilitarian rules provide relatively high UEW and UEL, but low Rep and RS. Conversely, the plurality rules provide high Rep and RS, but low UEW and UEL. Finally, the Condorcet rules provide high UEW, high RS, and a combination of UEL and Rep that depends which Condorcet rule is used.

Recommendations for the management of MPS IVA: systematic evidence- and consensus-based guidance

IntroductionMucopolysaccharidosis (MPS) IVA or Morquio A syndrome is an autosomal recessive lysosomal storage disorder (LSD) caused by deficiency of the N-acetylgalactosamine-6-sulfatase (GALNS) enzyme, which impairs lysosomal degradation of keratan sulphate and chondroitin-6-sulphate. The multiple clinical manifestations of MPS IVA present numerous challenges for management and necessitate the need for individualised treatment. Although treatment guidelines are available, the methodology used to develop this guidance has come under increased scrutiny. This programme was conducted to provide evidence-based, expert-agreed recommendations to optimise management of MPS IVA.MethodsTwenty six international healthcare professionals across multiple disciplines, with expertise in managing MPS IVA, and three patient advocates formed the Steering Committee (SC) and contributed to the development of this guidance. Representatives from six Patient Advocacy Groups (PAGs) were interviewed to gain insights on patient perspectives. A modified-Delphi methodology was used to demonstrate consensus among a wider group of healthcare professionals with experience managing patients with MPS IVA and the manuscript was evaluated against the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument by three independent reviewers.ResultsA total of 87 guidance statements were developed covering five domains: (1) general management principles; (2) recommended routine monitoring and assessments; (3) disease-modifying interventions (enzyme replacement therapy [ERT] and haematopoietic stem cell transplantation [HSCT]); (4) interventions to support respiratory and sleep disorders; (5) anaesthetics and surgical interventions (including spinal, limb, ophthalmic, cardio-thoracic and ear-nose-throat [ENT] surgeries). Consensus was reached on all statements after two rounds of voting. The overall guideline AGREE II assessment score obtained for the development of the guidance was 5.3/7 (where 1 represents the lowest quality and 7 represents the highest quality of guidance).ConclusionThis manuscript provides evidence- and consensus-based recommendations for the management of patients with MPS IVA and is for use by healthcare professionals that manage the holistic care of patients with the intention to improve clinical- and patient-reported outcomes and enhance patient quality of life. It is recognised that the guidance provided represents a point in time and further research is required to address current knowledge and evidence gaps.

Diagnostic and Therapeutic Workup of Erectile Dysfunction: Results From a Delphi Consensus of Andrology Experts.

IntroductionErectile dysfunction is a highly prevalent condition. Existing guidelines provide recommendations for diagnosis and treatment, but they are often disregarded in clinical practice in favor of a “patient-tailored” approach.ObjectivesWe planned a Delphi consensus method to bridge the gap between evidence-based medicine and the real-life approach in daily practice.Materials and MethodsThe Advisory Board prepared 15 statements on debated topics in andrology, each including 4–6 items designed as a 5-point Likert scale. After a validation phase, the questionnaire was sent by e-mail to a panel of experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the “hot topics” identified in the first round.ResultsThe first round of the Delphi consensus involved 101 experts; 71 (70%) also took part in the second round of voting. The Advisory Board deemed 22 items to be worthy of debate, and these underwent the second round of voting. “Real-life” results from the survey proved quite different from evidence-based recommendations.ConclusionAlthough guidelines suggest the best approach for a “standard” patient, real-life settings require flexibility. Diagnostic and therapeutic approaches should be tailored to the patients’ needs. Phosphodiesterase type 5 inhibitors are recognized as the first-line therapy in both settings, including the newly introduced sildenafil orodispersible film. Indications from the panel might help close the gap between recommendations from guidelines and real-life practice in relation to the diagnosis and treatment of erectile dysfunction.Isidori AM, Giammusso B, Corona G, et al. Diagnostic and Therapeutic Workup of Erectile Dysfunction: Results From a Delphi Consensus of Andrology Experts. Sex Med 2019;7:292–302.

Recommendations for the management of MPS VI: systematic evidence- and consensus-based guidance

IntroductionMucopolysaccharidosis (MPS) VI or Maroteaux-Lamy syndrome (253200) is an autosomal recessive lysosomal storage disorder caused by deficiency in N-acetylgalactosamine-4-sulfatase (arylsulfatase B). The heterogeneity and progressive nature of MPS VI necessitates a multidisciplinary team approach and there is a need for robust guidance to achieve optimal management. This programme was convened to develop evidence-based, expert-agreed recommendations for the general principles of management, routine monitoring requirements and the use of medical and surgical interventions in patients with MPS VI.Methods26 international healthcare professionals from various disciplines, all with expertise in managing MPS VI, and three patient advocates formed the Steering Committee group (SC) and contributed to the development of this guidance. Members from six Patient Advocacy Groups (PAGs) acted as advisors and attended interviews to ensure representation of the patient perspective. A modified-Delphi methodology was used to demonstrate consensus among a wider group of healthcare professionals with expertise and experience managing patients with MPS VI and the manuscript has been evaluated against the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument by three independent reviewers.ResultsA total of 93 guidance statements were developed covering five domains: (1) general management principles; (2) recommended routine monitoring and assessments; (3) enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT); (4) interventions to support respiratory and sleep disorders; (5) anaesthetics and surgical interventions. Consensus was reached on all statements after two rounds of voting. The greatest challenges faced by patients as relayed by consultation with PAGs were deficits in endurance, dexterity, hearing, vision and respiratory function. The overall guideline AGREE II assessment score obtained for the development of the guidance was 5.3/7 (where 1 represents the lowest quality and 7 represents the highest quality of guidance).ConclusionThis manuscript provides evidence- and consensus-based recommendations for the management of patients with MPS VI and is for use by healthcare professionals that manage the holistic care of patients with the intention to improve clinical- and patient-reported outcomes and enhance patient quality of life. It is recognised that the guidance provided represents a point in time and further research is required to address current knowledge and evidence gaps.

Consensus Recommendations for the Conduct, Training, Implementation, and Research of Perioperative Handoffs.

Consensus Recommendations for the Conduct, Training, Implementation, and Research of Perioperative Handoffs.

Appropriate Therapeutic Drug Monitoring of Biologic Agents for Patients With Inflammatory Bowel Diseases

Therapeutic drug monitoring (TDM) is widely available for biologic therapies in patients with inflammatory bowel disease (IBD). We reviewed current data and provided expert opinion regarding the clinical utility of TDM for biologic therapies in IBD. We used a modified Delphi method to establish consensus. A comprehensive literature review was performed regarding the use of TDM of biologic therapy in IBD and presented to international IBD specialists. Subsequently, 28 statements on the application of TDM in clinical practice were rated on a scale of 1 to 10 (1 = strongly disagree and 10 = strongly agree) by each of the panellists. Statements were accepted if 80% or more of the participants agreed with a score ≥7. The remaining statements were discussed and revised based on the available evidence followed by a second round of voting. The panel agreed on 24 (86%) statements. For anti-tumor necrosis factor (anti-TNF) therapies, proactive TDM was found to be appropriate after induction and at least once during maintenance therapy, but this was not the case for the other biologics. Reactive TDM was appropriate for all agents both for primary non-response and secondary loss of response. The panellists also agreed on several statements regarding TDM and appropriate drug and anti-drug antibody (ADA) concentration thresholds for biologics in specific clinical scenarios. Consensus was achieved towards the utility of TDM of biologics in IBD, particularly anti-TNF therapies. More data are needed especially on non-anti-TNF biologics to further define optimal drug concentration and ADA thresholds as these can vary depending on the therapeutic outcomes assessed.

ISHLT Consensus on Standardization of Bronchoalveolar Lavage in Lung Transplantation

Summary of Objectives Bronchoalveolar lavage (BAL) is a key tool for clinical monitoring and research in lung transplantation (LTx). However, BAL collection and processing are not standardized across LTx centers, resulting in significant variability of practices. This ISHLT-supported consensus statement on BAL standardization aims to clarify definitions and propose common approaches to improve: a) clinical and research practice standards, b) comparison and validation of research data, and c) collaboration between centers. Methods After an open invitation to ISHLT members, an international workgroup of 68 LTx specialists from 10 countries (75% North America, 16% Europe, 9% Australia/Asia) was created and divided into 9 subgroups covering the following topics: 1) bronchoscopy procedure and BAL collection, 2) sample handling in the bronchoscopy department, 3) sample processing for clinical microbiology, 4) clinical cytology, 5) research and 6) microbiome, 7) sample inventory and tracking, 8) donor bronchoscopy and 9) pediatric considerations. The workgroup designed and administered an online survey to capture practices of BAL collection and processing in LTx, according to the 9 subgroup topics. Results from 112 of 159 invited LTx centers (response rate 70%) indicate significant inter-center discrepancies in the definitions and methodology of BAL collection and processing. A systematic literature analysis performed by the workgroup identified 525 relevant articles; a specifically designed questionnaire was used to a) identify relevant articles for each subgroup and b) assess the quality of published BAL methodology. Endpoints Based on the large-scale international survey and a systematic literature review, the ISHLT BAL Standardization Workgroup is currently preparing consensus statements relevant to the 9 subgroup topics above. The statements will be subjected to three rounds of voting by the workgroup according to the Delphi method (consensus goal >80% of responders within two integers of the median). This abstract will be updated in March 2019 with key excerpts from finalized statements, which will be presented at the ISHLT 2019 annual meeting and submitted for publication. This consensus document will be instrumental for the harmonization of clinical and research practices and will help improve the performance of the international LTx community in this regard.

Interpretation of Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition)

The surgical treatment for adenocarcinoma of esophagogastric junction (AEG) involves thoracic and abdominal cavities. With no general consensus on the surgical treatment modality for AEG in China, the understanding and surgical practice of AEG are controversial between thoracic and gastrointestinal surgeons. Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) was released in September 2018 by the Chinese expert panel including 19 thoracic surgeons and 20 gastrointestinal surgeons. The formulation and publication of this consensus has increased homogeneity of the understanding of the disease in different disciplines to a certain extent, and has facilitated standardized surgical treatment for adenocarcinoma of esophagogastric junction. The consensus was based on the best available clinical evidence and the latest national and international guidelines and consensus. Several rounds of discussion and voting were conducted. Finally, 27 statements on surgery-related recommendations and 9 issues requiring further investigation were reached in the consensus, which basically cover the fields and research hotspots of surgical treatment for adenocarcinoma of esophagogastric juncton. This review will explain in details the Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction.

Development of the family needs questionnaire – pediatric version [FNQ-P] – phase I

ABSTRACTObjective: To adapt the well-validated 37-item adult Family Needs Questionnaire to make it suitable for families of children and youth with acquired brain injury (ABI).Methods: Measurement construction employed a modified Delphi technique to identify the most relevant content items for the pediatric Family Needs Questionnaire (FNQ-P). The Delphi process involved a panel of 11 ABI-team clinicians and seven family caregivers of children/youth with an ABI and four rounds of anonymous voting on each item’s importance. Qualitative responses related to each item’s review were incorporated into item content and wording decisions. Cognitive interviews were conducted with three parents after the Delphi to evaluate face and content validity.Results: The outcome of the final Delphi round was a set of 40 items within the original FNQ’s original six categories: Health Information (n = 10), Emotional Support (n = 6), Instrumental Support (n = 4), Professional Support (n = 6), Community Support (n = 6), and Involvement with Care (n = 8). Cognitive interviews resulted in changes to formatting, rating scale, and item wording, and culminated in overall consensus about the FNQ-P’s face/content validity.Conclusions: Use of the Delphi process with family and clinical partners resulted in content-endorsed pediatric FNQ that is ready for validation work prior to transfer to clinical practice.