There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.
To ...develop consensus statements for all domains of DAT.
A protocol-driven, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) a consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted the consensus were strictly followed.
A total of 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and three patients, where consensus was achieved in additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low-risk disease, and the role of multiparametric magnetic resonance imaging in determining disease stage and aggressiveness as a criterion for inclusion and exclusion.
Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials.
We undertook a project aimed at standardising the elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.
The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations has developed comprehensive consensus statements for deferred active treatment for localised prostate cancer covering all domains, aimed at guiding and informing routine clinical practice and research.
This paper reports on research undertaken to determine the baseline trends in logistics and supply chain management and associated environmental effects up to 2020. Factors affecting freight ...transport demand, truck fuel consumption and related CO
2 emissions are classified into six categories in relation to different levels of logistical decision-making. The projections are based on the results of seven focus group discussions and a large-scale Delphi survey. Three scenarios are constructed to assess CO
2 emission levels from road freight transport in 2020. The likely changes in the key logistics variables are discussed and the complexity of the problem is highlighted.
Purpose:
Stuttering is a fluency disorder that mostly begins in childhood and affects many people in our societies. No standardized screening tools are available to check for stuttering in the Indian ...school-going population. Thus, the study aimed at developing a screening tool to identify children who stutter among the school-going population using a Delphi-based approach.
Methods:
This study was carried out in four phases. During the first phase, five Speech Language Pathologists (SLPs) were asked about the need for screening and the nature & attributes of a stuttering screening test for school-going children. The second phase involved constructing appropriate stimuli for the screening tool based on expert opinion, relevant literature and students’ academic textbooks. The third phase involved content validation of the speech elicitation stimuli by four teachers, five SLPs and an English Lecturer teaching in a university. The fourth phase encompassed the development of differential diagnosis criteria for stuttering identification in children using a rank analysis of the expert opinions.
Results:
A stuttering screening stimuli comprising age, language and culture-specific reading, picture description and narration tasks for 1
st
to 10
th
-standard students was developed. The contents of the tool obtained satisfactory consensus of agreement among the panel of experts. Further, the tool outlined five critical diagnostic criteria which could differentially diagnose school-going children with stuttering from typically speaking counterparts using the developed material.
Conclusion:
The developed screening tool could help practicing clinicians quickly identify stuttering in school-going populations. This would enable early identification and build up the statistical data to estimate the prevalence of stuttering among the school-going population. Further studies examining the psychometric properties of the developed test are in progress.
This study advocates establishing an indicator system for Critical Infrastructure (CI) resilience assessment to ensure consistency and comparability in future endeavors. Resilience has emerged as a ...fundamental framework for effectively managing the performance of CIs in response to the challenges posed by disaster events. However, it is evident that a lack of uniformity exists in the choice and standardization of resilience assessment across the identified frameworks. This paper proposes key attributes for facilitating resilience assessment of CIs using an in-depth literature survey for identification and two rounds of Delphi survey in the Sri Lankan context for their verification. The literature survey has analyzed the resilience assessment attributes under four types of capacities: planning (anticipative), absorptive, restorative, and adaptive. Twenty-seven resilience attributes (Planning: 6; Absorptive: 12; Restorative: 6; Adaptive: 3) under different capacities were identified, including sub-indicators for evaluating each resilience attribute. Outcomes of the Delphi survey were analyzed through descriptive statistics. The proposed attributes received high levels of agreement from the experts, indicating their suitability and applicability for assessing the resilience of the CIs. The mean ratings of the attributes varied from 4.0 to 5.0, with the majority exceeding 4.5 out of 5. The evaluation of these attributes will be useful for assessing the resilience capacity of the CIs and thereby to model the overall resilience of the CIs. The results of this study will provide a solid basis for formulating hypotheses in future research aimed at assessing CI resilience.
Background Survival and quality of life for patients on hemodialysis therapy remain poor despite substantial research efforts. Existing trials often report surrogate outcomes that may not be relevant ...to patients and clinicians. The aim of this project was to generate a consensus-based prioritized list of core outcomes for trials in hemodialysis. Study Design In a Delphi survey, participants rated the importance of outcomes using a 9-point Likert scale in round 1 and then re-rated outcomes in rounds 2 and 3 after reviewing other respondents’ scores. For each outcome, the median, mean, and proportion rating as 7 to 9 (critically important) were calculated. Setting & Participants 1,181 participants (202 17% patients/caregivers, 979 health professionals) from 73 countries completed round 1, with 838 (71%) completing round 3. Outcomes & Measurements Outcomes included in the potential core outcome set met the following criteria for both patients/caregivers and health professionals: median score ≥ 8, mean score ≥ 7.5, proportion rating the outcome as critically important ≥ 75%, and median score in the forced ranking question < 10. Results Patients/caregivers rated 4 outcomes higher than health professionals: ability to travel, dialysis-free time, dialysis adequacy, and washed out after dialysis (mean differences of 0.9, 0.5, 0.3, and 0.2, respectively). Health professionals gave a higher rating for mortality, hospitalization, decrease in blood pressure, vascular access complications, depression, cardiovascular disease, target weight, infection, and potassium (mean differences of 1.0, 1.0, 1.0, 0.9, 0.9, 0.8, 0.7, 0.4, and 0.4, respectively). Limitations The Delphi survey was conducted online in English and excludes participants without access to a computer and internet connection. Conclusions Patients/caregivers gave higher priority to lifestyle-related outcomes than health professionals. The prioritized outcomes for both groups were vascular access problems, dialysis adequacy, fatigue, cardiovascular disease, and mortality. This process will inform a core outcome set that in turn will improve the relevance, efficiency, and comparability of trial evidence to facilitate treatment decisions.
Management of patients with interstitial lung disease (ILD) requires subspecialized, comprehensive, multidisciplinary care. The Pulmonary Fibrosis Foundation established the Care Center Network (CCN) ...in 2013 with identified criteria to become a designated CCN site. Despite these criteria, the essential components of an ILD clinic remain unknown.
How are ILD clinics within the CCN structured? What are the essential components of an ILD clinic according to ILD physician experts, patients, and caregivers?
This study had three components. First, all 68 CCN sites were surveyed to determine the characteristics of their current ILD clinics. Second, an online, three-round modified Delphi survey was conducted between October and December 2019 with 48 ILD experts participating in total. Items for round 1 were generated using expert interviews. During rounds 1 and 2, experts rated the importance of each item on a 5-point Likert scale. The a priori threshold for consensus was more than 75% of experts rating an item as important or very important. In round 3, experts graded items that met consensus and ranked items deemed essential for an ILD clinic. Third, ILD patient and caregiver focus groups were conducted and analyzed for content to determine their perspectives of an ideal ILD clinic.
Forty items across four categories (members, infrastructure, resources, and multidisciplinary conference) achieved consensus as essential to an ILD clinic. Patient and caregiver focus groups identified three major themes: comprehensive, patient-centered medical care; expanded access to care; and comprehensive support for living and coping with ILD.
The essential components of an ILD clinic are well-aligned between physician experts and patients. Future research can use these findings to evaluate the impact of these components on patient outcomes and to inform best practices for ILD clinics throughout the world.
Organizations increasingly adopt technologies and logistics measures to improve their social sustainability, reduce transportation‐related carbon emissions, or even design their supply chains carbon ...negative. However, the speed at which this adoption is progressing is not fast enough to address the sustainability challenges of the world today. To gain deeper knowledge about the adoption process of sustainability‐related measures in road freight transportation, this paper examines barriers currently hindering a broader market penetration and derives expected timeframes when mass adoption of 14 relevant technologies will occur. Furthermore, the technologies' impacts on the economic, environmental, and social dimensions of sustainability are discussed providing recommendations, on which technologies the respective stakeholders might focus on in the future. Since we want to examines a long‐term technology perspective of the next 25 years, we rely on systematic foresight methodology. More specifically, we collect empirical data by use of a real‐time Delphi survey, which particularly suits complex and uncertain environments. Our global panel includes 116 experts from 25 different countries. The assessments are grouped into short‐term, midterm, midterm to long‐term, and long‐term developments. The categories shed light on potential drivers and barriers to the implementation of the surveyed technologies. The findings emphasize the need to systematically select suitable measures and promote those that are expected to deliver short‐term sustainability improvements to address current deficits in a timely manner. The article further outlines the crucial role of politics in developing necessary regulative frameworks to drive sustainability in road freight transportation.
Objective
This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM).
Design
Delphi survey and ...consensus process.
Setting
International.
Population
A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries.
Methods
A systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM.
Main outcome measures
Preliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM).
Results
The first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively.
Conclusions
These COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.
•Identifying the practical benefits of BIM & sustainability practices implementation is critical to their adoption in construction projects.•The perceptions of 14 international experts were gathered ...via a two-round Delphi survey.•Key benefits to its integration were identified as well as a strong consensus among the expert panel was reached.•Strategies were recommended for the practical and successful adoption of BIM and sustainability practices in the construction industry.
The recent initiatives of the construction industry to embed sustainable strategies in its processes can be enhanced when clear and practical benefits of such integration are available to project stakeholders to support their decision-making. Hence, this study purports to evaluate the perceived benefits of integrating BIM initiatives and sustainability practices in construction projects. Delphi survey technique was used to solicit the perceptions of expert panel on the 36 identified benefits. Statistical tools were employed to analyze the derived data, and the consensus reached by the expert panel was validated using the interrater agreement statistics. The three most important benefits included the ability to enhance overall project quality and efficiency and improve the ability to simulate building performances and energy usage and facilitate better design products and multi-design alternatives. Comparative analyses among the expert groups lend credence to the strong consensus reached by the expert panel. Meanwhile, the study recommended strategies to enable the construction industry to key-in to these benefits as well as identifying prevalent research gaps in practice. The studyös findings will enhance the drive for the realization of the sustainable smart city as well as equip various stakeholders of the possibilities in its full adoption and implementation.
There are two different approaches to involve participants in consecutive rounds of a Delphi survey: (1) invitation to every round independent of response to the previous round (“all-rounds”) and (2) ...invitation only when responded to the previous round (“respondents-only”). This study aimed to investigate the effect of invitation approach on the response rate and final outcome of a Delphi survey.
Both experts (N = 188) and patients (N = 188) took part in a Delphi survey to update the core outcome set (COS) for axial spondyloarthritis. A study with 1:1 allocation to two experimental groups (ie, “all-rounds” N = 187 and “respondents-only” N = 189) was built-in.
The overall response rate was lower in the “respondents-only group” (46%) compared to the “all-rounds group” (61%). All domains that were selected for inclusion in the COS by the “respondents-only group” were also selected by the “all-rounds group.” Additionally, the four most important domains were identical between groups after the final round, with only minor differences in the other domains.
Inviting panel members who missed a round to a subsequent round will lead to a better representation of opinions of the originally invited panel and reduces the chance of false consensus, while it does not influence the final outcome of the Delphi.
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