Study of Optimal Perimetric Testing In Children (OPTIC): developing consensus and setting research priorities for perimetry in the management of children with glaucoma

Abstract Background Perimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research. Methods Experts were invited to participate in a modified Delphi consensus process. Panel selection was based on clinical experience of managing children with glaucoma and UK-based training to minimise diversity of view due to healthcare setting. Questionnaires were delivered electronically, and analysed to establish ‘agreement’. Divergence of opinions was investigated and resolved where possible through further iterations. Results 7/9 experts invited agreed to participate. Consensus (≥5/7 (71%) in agreement) was achieved for 21/26 (80.8%) items in 2 rounds, generating recommendations to start perimetry from approximately 7 years of age (IQR: 6.75–7.25), and use qualitative methods in conjunction with automated reliability indices to assess test quality. There was a lack of agreement about defining progressive visual field (VF) loss and methods for implementing perimetry longitudinally. Panel members highlighted the importance of informing decisions based upon individual circumstances—from gauging maturity/capability when selecting tests and interpreting outcomes, to accounting for specific clinical features (e.g. poor IOP control and/or suspected progressive VF loss) when making decisions about frequency of testing. Conclusions There is commonality of expert views in relation to implementing perimetry and interpreting test quality in the management of children with glaucoma. However, there remains a lack of agreement about defining progressive VF loss, and utilising perimetry over an individuals’ lifetime, highlighting the need for further research.

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Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

Multiple Sclerosis Journal ◽

10.1177/1352458520952310 ◽

2020 ◽

pp. 135245852095231 ◽

Cited By ~ 1

Author(s):

Agostino Riva ◽

Valeria Barcella ◽

Simone V Benatti ◽

Marco Capobianco ◽

Ruggero Capra ◽

...

Keyword(s):

Multiple Sclerosis ◽

Seasonal Influenza ◽

Careful Consideration ◽

Delphi Consensus ◽

Consensus Process ◽

Disease Modifying Drugs ◽

Risks And Benefits ◽

Modified Delphi ◽

Increased Risk ◽

Evidence Based Decision Making

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

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Developing a Fracture Risk Clinical Assessment Protocol for Long-Term Care: A Modified Delphi Consensus Process

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.08.015 ◽

2020 ◽

Author(s):

Caitlin McArthur ◽

Loretta Hillier ◽

George Ioannidis ◽

Jonathan D. Adachi ◽

Lora Giangregorio ◽

...

Keyword(s):

Fracture Risk ◽

Clinical Assessment ◽

Long Term Care ◽

Delphi Consensus ◽

Consensus Process ◽

Term Care ◽

Assessment Protocol ◽

Modified Delphi

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Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach

Rheumatology ◽

10.1093/rheumatology/keaa863 ◽

2020 ◽

Author(s):

Seza Özen ◽

Erdal Sag ◽

Eldad Ben-Chetrit ◽

Marco Gattorno ◽

Ahmet Gül ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Nominal Group ◽

Evidence Based ◽

Delphi Consensus ◽

Modified Delphi ◽

Health Authorities ◽

Colchicine Resistance ◽

Mediterranean Fever ◽

Definition Of ◽

The Impact

Abstract Objectives Colchicine is the main treatment for familial Mediterranean fever (FMF). Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. Methods A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and pediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. Results Consensus among the panel was achieved on 8 core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period), or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. Conclusion Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.

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Home therapy for inherited bleeding disorders in South Africa: Results of a modified Delphi consensus process

South African Medical Journal ◽

10.7196/samj.2019.v109i9.13637 ◽

2019 ◽

Vol 109 (9) ◽

pp. 639

Author(s):

J N Mahlangu ◽

Y Naidoo ◽

Y Goga ◽

M Vaithlingum ◽

J Joubert ◽

...

Keyword(s):

South Africa ◽

Bleeding Disorders ◽

Home Therapy ◽

Delphi Consensus ◽

Consensus Process ◽

Modified Delphi

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Quality Indicators for Non-Small Cell Lung Cancer Operations With Use of a Modified Delphi Consensus Process

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.03.001 ◽

2014 ◽

Vol 98 (1) ◽

pp. 183-190 ◽

Cited By ~ 21

Author(s):

Gail Darling ◽

Richard Malthaner ◽

John Dickie ◽

Leigh McKnight ◽

Cindy Nhan ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Quality Indicators ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Delphi Consensus ◽

Consensus Process ◽

Modified Delphi

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Establishing a set of research priorities in care homes for older people in the UK: a modified Delphi consensus study with care home staff

Age and Ageing ◽

10.1093/ageing/afw204 ◽

2016 ◽

Cited By ~ 1

Author(s):

Victoria Shepherd ◽

Fiona Wood ◽

Kerenza Hood

Keyword(s):

Older People ◽

Care Home ◽

Research Priorities ◽

Care Homes ◽

Delphi Consensus ◽

Care Home Staff ◽

Modified Delphi ◽

The Uk

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Developing a Scoring Guide for the Appraisal of Guidelines for Research and Evaluation II Instrument in Korea: A Modified Delphi Consensus Process

Journal of Korean Medical Science ◽

10.3346/jkms.2013.28.2.190 ◽

2013 ◽

Vol 28 (2) ◽

pp. 190 ◽

Cited By ~ 11

Author(s):

You Kyoung Lee ◽

Ein Soon Shin ◽

Jae-Yong Shim ◽

Kyung Joon Min ◽

Jun-Mo Kim ◽

...

Keyword(s):

Delphi Consensus ◽

Consensus Process ◽

Modified Delphi

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Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2015.27 ◽

2015 ◽

Vol 9 (3) ◽

pp. 283-290 ◽

Cited By ~ 7

Author(s):

Gabor D. Kelen ◽

Lauren Sauer ◽

Eben Clattenburg ◽

Mithya Lewis-Newby ◽

James Fackler

Keyword(s):

Classification System ◽

Early Discharge ◽

Likert Scale ◽

Risk Tolerance ◽

Delphi Consensus ◽

Consensus Process ◽

Surge Capacity ◽

Hospital Capacity ◽

Modified Delphi ◽

Pediatric Inpatient

AbstractBackgroundCritically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of “reverse triage,” with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.MethodsWe conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.ResultsPanelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1–2%); 7% (5–10%), 18% (10–20%), 46% (20–65%), and 72% (50–90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).ConclusionsThe classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events. (Disaster Med Public Health Preparedness. 2015;9:283-290)

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