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Schizophrenia Bulletin Jul 2023There is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing consensus...
BACKGROUND AND HYPOTHESIS
There is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for the optimization of clozapine monotherapy.
STUDY DESIGN
We conducted an online Delphi survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group comprising experts from twenty-nine countries. The threshold criterion for a consensus recommendation was ≥ 75% agreement ("agree" and "strongly agree" responses) on a question. Agreement of ≥ 50% but < 75% in a second or third Delphi round was deemed to provide guidance.
STUDY RESULTS
Forty-nine (first round), 32 (second round), and 48 (third round) of the 91 current TRRIP members participated. Expert recommendations at ≥ 75% comprised second-line treatment with clozapine in cases of persistent positive symptoms with co-occurring extrapyramidal symptoms, tardive dyskinesia, or suicidality/aggression. There was considerable disagreement on myocarditis screening parameters. The management of somatic and neuropsychiatric adverse drug reactions warrants further research for more evidence-based recommendations. Rechallenge with clozapine was recommended for eosinophilia, sinus tachycardia and fever and guidance (agreement ≥ 50%) was reached for pneumonia and thrombocytopenia.
CONCLUSIONS
Given the limited evidence available, this consensus-based series of recommendations and guidance statements supports clinical decision-making to optimize clozapine monotherapy and provides guidance for future research in treatment-resistant schizophrenia.
Topics: Humans; Clozapine; Delphi Technique; Psychotic Disorders; Consensus
PubMed: 36943247
DOI: 10.1093/schbul/sbad030 -
European Journal of Vascular and... May 2024
Topics: Delphi Technique; Humans; Consensus; Voting
PubMed: 38182114
DOI: 10.1016/j.ejvs.2024.01.002 -
Australian Dental Journal Dec 2023Oral health promotion initiatives must be evidence-based and consistent with broader health messaging. The Oral Health Messages for the Australian Public were first...
BACKGROUND
Oral health promotion initiatives must be evidence-based and consistent with broader health messaging. The Oral Health Messages for the Australian Public were first produced in 2009 and sought to enable a focused, and strategic approach to oral health promotion in Australia. As the evidence base and needs of the Australian population have since changed, this consensus statement was updated in 2022-2023.
METHODS
The process of updating the messages consisted of 3 phases (preparatory phase, the Delphi technique, final revision phase). The preparatory phase included public and expert consultation, an umbrella review of published scientific literature and review of available recommendations, policies and guidelines. The Delphi technique used in this study was guided by Guidance on Conducting and REporting DElphi Studies (CREDES) and included 2 voting rounds. There were 70 experts in round 1 and 60 experts in round 2. Delphi participants comprised of experts from a variety of fields to ensure diversity and inclusion, balance expertise and maximize stakeholder representation. Consensus was defined as 75% agreement.
RESULTS
A total of 11 messages were included in the 2022 update of Oral Health Messages for Australia.
CONCLUSION
The updated oral health messages will support oral health promotion policy and activity at both individual and population level to improve the oral health of Australians.
Topics: Humans; Oral Health; Australia; Health Promotion; Consensus; Delphi Technique
PubMed: 37665214
DOI: 10.1111/adj.12973 -
Frontiers in Public Health 2023The emergence of the COVID-19 pandemic in early 2020 led countries to implement a set of public health and social measures (PHSMs) attempting to contain the spread of... (Review)
Review
INTRODUCTION
The emergence of the COVID-19 pandemic in early 2020 led countries to implement a set of public health and social measures (PHSMs) attempting to contain the spread of the SARS-CoV-2 virus. This study aims to review the existing literature regarding key results of the PHSMs that were implemented, and to identify the PHSMs considered to have most impacted the epidemiological curve of COVID-19 over the last years during different stages of the pandemic.
METHODS
The PHSM under study were selected from the Oxford COVID-19 Government Response Tracker (OxCGRT), supplemented by topics presented during the Rapid Exchange Forum (REF) meetings in the scope of the Population Health Information Research Infrastructure (PHIRI) project (H2020). The evidence- based review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify which reviews have already been published about each PHSMs and their results. In addition, two modified Delphi panel surveys were conducted among subject matter experts from 30 European countries to uphold the results found.
RESULTS
There were 3,212 studies retrieved from PubMed, 162 full texts assessed for eligibility and 35 included in this PHSMs summary. The measures with clearest evidence on their positive impact from the evidence-based review include social distancing, hygiene measures, mask measures and testing policies. From the modified Delphi panel, the PHSMs considered most significant in the four periods analyzed were case isolation at home, face coverings, testing policy, and social distancing, respectively.
DISCUSSION
The evidence found has significant implications for both researchers and policymakers. The study of PHSMs' impact on COVID-19 illustrates lessons learned for future pan- and epidemics, serving as a contribution to the health systems resilience discussion. These lessons, drawn from both the available scientific evidence and the perspectives of relevant subject matter experts, should also be considered in educational and preparedness programs and activities in the public health space.
Topics: Humans; Public Health; COVID-19; SARS-CoV-2; Delphi Technique; Pandemics; Europe
PubMed: 37719729
DOI: 10.3389/fpubh.2023.1226922 -
The International Journal of Behavioral... Jul 2023Despite significant interest in assessing activity patterns in different populations, there has been no consensus concerning the definition and operationalisation of...
BACKGROUND
Despite significant interest in assessing activity patterns in different populations, there has been no consensus concerning the definition and operationalisation of this term. This has limited the comparability, interpretability, and synthesis of study findings to date. The aim of this study was to establish a consensus regarding the way in which activity patterns and activity pattern components are defined and reported.
METHODS
The activity patterns literature was searched to identify experts to be invited to participate and to develop a proposed definition of activity patterns and activity pattern components. A three-round modified Delphi survey was conducted online (November 2021 to May 2022). In Round 1, participants were asked to rate their agreement with a proposed activity patterns definition, which also included six activity pattern components (e.g., activity intensity, activity bout, transitions), six examples of activity patterns (e.g., frequency of postural transitions in discrete time periods) and eight items for reporting activity patterns in future research (n = 21 items). Open-ended questions enabled participants to provide further comments and suggestions for additional items. Consensus was defined a priori as ≥ 80% participants rating their agreement with an item. In Round 2, participants were asked to rate their agreement with 25 items (13 original items, eight amended, and four new). In Round 3, participants rated their agreement with 10 items (five original items, four amended, and one new).
RESULTS
Twenty experts in activity patterns research participated in Round 1, with response rates of 80% and 60% in Rounds 2 and 3, respectively. The proposed activity pattern definition, all activity pattern components definitions, four of the six activity pattern examples, and 10 items in the activity patterns reporting framework achieved consensus. The removal of one activity component item between Rounds 1 and 2 achieved consensus.
CONCLUSION
This modified Delphi study achieved consensus for defining and reporting activity patterns for the first time. This consensus definition enables standardisation of activity patterns terminology, which is important given the significant interest in quantifying how individuals accumulate their physical activity and sedentary behaviour across the lifespan to inform the development of future public health guidelines and interventions efforts.
Topics: Humans; Delphi Technique; Consensus; Exercise; Research Design; Sedentary Behavior
PubMed: 37491280
DOI: 10.1186/s12966-023-01482-6 -
Nursing in Critical Care Sep 2023
Topics: Humans; Critical Care Nursing; Delphi Technique; Health Priorities; Critical Care
PubMed: 37495262
DOI: 10.1111/nicc.12950 -
Critical Care Medicine Dec 2023To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality...
OBJECTIVES
To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM).
DESIGN
A three-round Delphi consensus process.
SETTING
Electronic surveys and virtual meeting.
SUBJECTS
Participants with broad MNM expertise from adult and pediatric intensive care backgrounds.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM-both invasive and noninvasive-for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation.
CONCLUSIONS
We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.
Topics: Adult; Child; Humans; Consensus; Delphi Technique; Surveys and Questionnaires; Reference Standards; Clinical Competence
PubMed: 37607072
DOI: 10.1097/CCM.0000000000006016 -
Anais Brasileiros de Dermatologia 2023This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the...
Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique.
This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.
Topics: Humans; Brazil; Delphi Technique; Dermatitis, Atopic; Consensus; Dermatology; Phototherapy
PubMed: 37302894
DOI: 10.1016/j.abd.2023.04.003 -
Military Medicine Jul 2023As the burgeoning roles of women afford them the opportunities to perform in all combat and combat support assignments, the impact of all environmental, occupational,... (Review)
Review
INTRODUCTION
As the burgeoning roles of women afford them the opportunities to perform in all combat and combat support assignments, the impact of all environmental, occupational, physical, and psychosocial factors inherent in military training and operations on their health must be considered. A robust foundation of knowledge is necessary to ascertain, prevent, and treat the potential impacts on women's health. However, a systematic review of the literature from 2000-2015 revealed widespread gaps in scientific knowledge of the musculoskeletal, psychological, occupational, and reproductive health of military women. The purpose of this study is to determine priorities for military women's health (MWH) research that will serve to fill these gaps in knowledge.
METHODS
An advisory group of 11 senior military and women's health experts conducted a structured gap analysis of the results of a scoping review of literature from 2000 to 2015 and Military Health System utilization data to identify 15 topics for prioritization in MWH research. A modified e-Delphi study was conducted and consensus was achieved after two rounds. Participants (N = 32) included subject matter experts (SME) representing various professions enrolled, 23 completed both rounds. In round 1, topics were rated on forced Likert scales for relevance and feasibility to medical readiness and comments were elicited from the SMEs. Relevance and feasibility scores and themes from the comments guided the development of the round 2 survey, in which SMEs categorized the topics in terms of urgency and forced-choice ranked the priority of each topic. The quantitative data were analyzed using multilevel regression methods. Linear mixed models were fit separately on the numeric outcomes for feasibility, relevance, and urgency with research topic as the primary predictor. To analyze the rankings of research topic priority, crude and adjusted linear regression models were fit on the numeric outcome rank.
RESULTS
The adjusted top five topics for research priorities as indicated by ranking were: genitourinary health, sleep, physical assault, behavioral health, and menstrual cycle research. The advisory group reviewed the findings in the context of Department of Defense strategic priorities and provided guidance on the design and dissemination of the MWH research agenda.
CONCLUSIONS
The MWH research agenda is a validated research agenda of high-priority research topics that will promote enduring efforts to ensure evidence-based practices and health policies for military women through research.
Topics: Humans; Female; Delphi Technique; Women's Health; Health Services Research; Military Personnel; Surveys and Questionnaires
PubMed: 36342779
DOI: 10.1093/milmed/usac271 -
Complementary Therapies in Clinical... Aug 2023Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat...
BACKGROUND
Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat challenging however, due to interprofessional and interjurisdictional variations in reported barriers. An efficient, systematic, comprehensive and innovative approach to isolating the barriers to evidence implementation is therefore needed.
MATERIALS AND METHODS
Using a mixed methods design, the study aimed to develop, refine and validate a tool to assess the evidence implementation environment for complementary medicine (CM) professions. The tool was developed using a five-stage process, and refined and validated using a two-round e-Delphi technique.
RESULTS
Informed by reviews examining the barriers and enablers to evidence implementation in CM, and shaped by the Behaviour Change Wheel Framework, a preliminary 33-item tool was created (i.e. the Global Assessment of the Evidence Implementation Environment [GENIE] tool). A two-round Delphi technique was used to refine the criteria, with a panel of 23 experts agreeing to the removal of two criteria, and the addition of two items. In the end, the Delphi panel reached consensus on 33 criteria, which were sorted into nine stakeholder groups.
CONCLUSION
This study has for the first time, created an innovative tool to assess the capacity and capability of CM professions to engage in evidence-based practice at an optimal level. By assessing the evidence implementation environment of CM professions, the GENIE tool is able to determine where resources, infrastructure and personnel should be directed in order to optimise the uptake of evidence-based practices within CM professions.
Topics: Humans; Delphi Technique; Evidence-Based Practice; Consensus; Complementary Therapies
PubMed: 37137208
DOI: 10.1016/j.ctcp.2023.101764