scholarly journals A Methodological Checklist for fMRI Drug Cue Reactivity Studies: Development and Expert Consensus

2020 ◽  
Author(s):  
Hamed Ekhtiari ◽  
Mehran Zare-Bidoky ◽  
Arshiya Sangchooli ◽  
Amy C. Janes ◽  
Marc J. Kaufman ◽  
...  
Keyword(s):  
Delphi Study ◽  
Cue Reactivity ◽  
Consensus Method ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Meta Analyses ◽  
Methodological Aspects ◽  
Drug Cue

AbstractBackgroundCue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been many promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, heterogeneities in participant characteristics, task design, craving assessment, scanning preparation and analysis decisions limit rigor and reproducibility in the field of fMRI of drug cue reactivity (FDCR), hampering clinical translation and synthesis by systematic reviews and meta-analyses. The aim of this consensus paper and Delphi study is to outline the important methodological aspects of FDCR studies and present a list of items and recommendations that should be taken into account when designing FDCR studies and reporting their results.MethodsFifty-five FDCR scientists from around the world participated. First, an initial checklist of items deemed important in FDCR studies was developed by a group of members from the ENIGMA Addiction Consortium based on a systematic review. Then, using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist. Subsequently, experts were asked to rate the importance of the items.ResultsThirty-seven items were proposed in the first round. After the commenting phase, seven new items suggested by experts were added and six were removed. The final 38 items that reached a defined consensus threshold in the rating phase were classified under seven categories and are considered important for conducting and reporting in any FDCR study.ConclusionThis paper proposes a list of items and additional recommendations that researchers in the field of FDCR are encouraged to note and report when designing an FDCR study and reporting its results. Along with the presentation of a quality control checklist with Yes/No ratable items, various challenges in moving towards greater homogeneity in FDCR research and widespread use of FDCR to investigate SUDs and develop clinically relevant biomarkers are discussed.

scholarly journals Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

2020 ◽  
Vol 29 (155) ◽  
pp. 190147 ◽  
Author(s):  
Franck F. Rahaghi ◽  
Nadera J. Sweiss ◽  
Lesley Ann Saketkoo ◽  
Mary Beth Scholand ◽  
Joseph B. Barney ◽  
...  
Keyword(s):  
Adverse Events ◽  
Delphi Study ◽  
Severe Disease ◽  
Pulmonary Sarcoidosis ◽  
Event Management ◽  
Delphi Consensus ◽  
Consensus Recommendations ◽  
Modified Delphi ◽  
Immunosuppressive Medications ◽  
Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

Altered brain function in anorexia nervosa and bulimia nervosa: A hierarchical series of task-based fMRI meta-analyses

2019 ◽  
Author(s):  
Bangshan Liu ◽  
Jin Liu ◽  
Yumeng Ju ◽  
Mi Wang ◽  
Tiebang Liu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Bulimia Nervosa ◽  
Brain Activity ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Meta Analyses

ABSTRACTBackgroundMany structural and functional magnetic resonance imaging (MRI) studies have reported differences in brain functional anatomy associated with eating disorders (EDs). We aimed to quantitatively synthesize the current literature of anorexia nervosa (AN) and bulimia nervosa (BN) with a goal of deriving a consensus across these studies.MethodsWe performed a hierarchical series of 49 activation likelihood estimation meta-analyses of 101 experiments from 63 studies at the disorder (AN+BN), diagnosis (AN or BN), and task (food-, body-, emotion- or cognitive function-related tasks) levels. We further performed sub-analyses at the diagnosis level to assess the influence of disease stage (current or recovered AN), subtype (restrictive AN, rAN), psychiatric comorbidity, medication, and data processing.ResultsWe did not observe consistent differences in brain activity across all hierarchies. Rather, we observed differences in brain activity in the right fusiform, left inferior parietal lobule and left precuneus that were primarily related to food (representing 19 experiments) and emotion (25 experiments) tasks performed by current AN patients (56 experiments).ConclusionsThe task-based functional MRI literature in AN and BN represents a heterogenous set of tasks and patients. Given this heterogeneity, we found very limited convergence across a rather large literature. Such limited convergence suggests individual task-based studies of EDs should be interpreted cautiously. We recommend that future studies of EDs carefully characterize patients based on nutritional status and that, beyond clinical diagnosis, studies utilize a trait- or cognitive-domain-based approach to define their populations of interest.Meta-ananlysis Registration“Meta-analysis of functional magnetic resonance imaging studies of eating disorders”, https://www.crd.york.ac.uk/prospero (Registration Number: CRD42018086497).

scholarly journals A balanced approach to identifying, prioritising and evaluating all potential consequences of quality improvement: modified Delphi study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023890 ◽  
Author(s):  
Madalina Toma ◽  
Tobias Dreischulte ◽  
Nicola M Gray ◽  
Bruce Guthrie
Keyword(s):  
Quality Improvement ◽  
Delphi Study ◽  
Qualitative Evaluation ◽  
Unintended Consequences ◽  
Consensus Methods ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Balanced Approach ◽  
Trade Offs ◽  
Qualitative Work

ObjectivesHealthcare is a complex system, so quality improvement will commonly lead to unintended consequences which are rarely evaluated. In previous qualitative work, we proposed a framework for considering the range of these potential consequences, in terms of their desirability and the extent to which they were predictable or expected during planning. This paper elaborates on the previous findings, using consensus methods to examine what consequences should be identified, why and how to prioritise, evaluate and interpret all identified consequences, and what stakeholders should be involved throughout this process.DesignTwo-round modified Delphi consensus study.Setting and participantsBoth rounds were completed by 60 panellists from an academic, clinical or management background and experience in designing, implementing or evaluating quality improvement programmes.ResultsPanellists agreed that trade-offs (expected undesirable consequences) and unpleasant surprises (unexpected undesirable consequences) should be actively considered. Measurement of harmful consequences for patients, and those with high workload or financial impact was prioritised, and their evaluation could also involve the use of qualitative methods. Clinical teams were agreed as important to involve at all stages, from identifying potential consequences, prioritising which of those to systematically evaluate, undertaking appropriate evaluation and interpreting the findings. Patients were necessary in identifying consequences, managers in identifying and prioritising, and improvement advisors in interpreting the data.ConclusionThere was consensus that a balanced approach to considering all the consequences of improvement can be achieved by carefully considering predictable trade-offs from the outset and deliberately pausing after implementation to identify any unexpected surprises and make an informed decision as to whether quantitative or qualitative evaluation is needed and feasible. Stakeholders’ roles in in the process of identifying, prioritising, evaluating and interpreting potential consequences should be explicitly addressed within planning and revisited during and after implementation.

scholarly journals Cue-reactivity in the ventral striatum characterizes heavy cannabis use, whereas reactivity in the dorsal striatum mediates dependent use

2019 ◽  
Author(s):  
Xinqi Zhou ◽  
Kaeli Zimmermann ◽  
Fei Xin ◽  
Weihua Zhao ◽  
Roelinka Derckx ◽  
...  
Keyword(s):  
Drug Use ◽  
Ventral Striatum ◽  
Reference Group ◽  
Cue Reactivity ◽  
Dorsal Striatum ◽  
Imaging Study ◽  
Magnetic Resonance Imaging Study ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Trait Impulsivity

AbstractBackgroundAnimal models of addiction suggest that the transition from incentive-driven to habitual and ultimately compulsive drug use is mediated by a shift from ventral to dorsal striatal cue-control over drug seeking. Previous studies in human cannabis users reported elevated trait impulsivity and cue-reactivity in striatal circuits, however, these studies were not able to separate addiction-related from exposure-related adaptations.MethodsTo differentiate the adaptive changes, the present functional magnetic resonance imaging study examined behavioral and neural cue-reactivity in dependent (n = 18) and non-dependent (n = 20) heavy cannabis users and a non-using reference group (n = 44).ResultsIrrespective of dependence status, cannabis users demonstrated elevated trait impulsivity as well as increased ventral striatal reactivity and striato-frontal coupling in response to drug cues. Dependent users selectively exhibited dorsal-striatal reactivity and decreased striato-limbic coupling during cue-exposure. An exploratory analysis revealed that higher ventral caudate cue-reactivity was associated with stronger cue-induced arousal and craving in dependent users, whereas this pattern was reversed in non-dependent users.ConclusionsTogether the present findings suggest that an incentive sensitization of the ventral striatal reward system may promote excessive drug use in humans, whereas adaptations in dorsal striatal systems engaged in habit formation may promote the transition to addictive use.

scholarly journals Computer-Aided Detection False Positives in Colonoscopy

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1113
Author(s):  
Yu-Hsi Hsieh ◽  
Chia-Pei Tang ◽  
Chih-Wei Tseng ◽  
Tu-Liang Lin ◽  
Felix W. Leung
Keyword(s):  
False Positives ◽  
Computer Aided Detection ◽  
Delphi Consensus ◽  
Detection Rates ◽  
Modified Delphi ◽  
Use Of Resources ◽  
Adenoma Detection ◽  
Computer Aided ◽  
Cade System ◽  
Meta Analyses

Randomized control trials and meta-analyses comparing colonoscopies with and without computer-aided detection (CADe) assistance showed significant increases in adenoma detection rates (ADRs) with CADe. A major limitation of CADe is its false positives (FPs), ranked 3rd in importance among 59 research questions in a modified Delphi consensus review. The definition of FPs varies. One commonly used definition defines an FP as an activation of the CADe system, irrespective of the number of frames or duration of time, not due to any polypoid or nonpolypoid lesions. Although only 0.07 to 0.2 FPs were observed per colonoscopy, video analysis studies using FPs as the primary outcome showed much higher numbers of 26 to 27 per colonoscopy. Most FPs were of short duration (91% < 0.5 s). A higher number of FPs was also associated with suboptimal bowel preparation. The appearance of FPs can lead to user fatigue. The polypectomy of FPs results in increased procedure time and added use of resources. Re-training the CADe algorithms is one way to reduce FPs but is not practical in the clinical setting during colonoscopy. Water exchange (WE) is an emerging method that the colonoscopist can use to provide salvage cleaning during insertion. We discuss the potential of WE for reducing FPs as well as the augmentation of ADRs through CADe.

scholarly journals Expert opinion on the UK standard of care for haemophilia patients with inhibitors: a modified Delphi consensus study

2021 ◽  
Vol 12 ◽  
pp. 204062072110070
Author(s):  
Kate Khair ◽  
Elizabeth Chalmers ◽  
Thuvia Flannery ◽  
Annabel Griffiths ◽  
Felicity Rowley ◽  
...  
Keyword(s):  
Delphi Study ◽  
Online Survey ◽  
Treatment Options ◽  
Tolerance Induction ◽  
Standard Of Care ◽  
Steering Committee ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Bypassing Agents ◽  
The Uk

Background and Aims: Despite advances in haemophilia care, inhibitor development remains a significant complication. Although viable treatment options exist, there is some divergence of opinion in the appropriate standard approach to care and goals of treatment. The aim of this study was to assess consensus on United Kingdom (UK) standard of care for child and adult haemophilia patients with inhibitors. Methods: A modified Delphi study was conducted using a two-round online survey. A haemophilia expert steering committee and published literature informed the Round 1 questionnaire. Invited participants included haematologists, haemophilia nurses and physiotherapists who had treated at least one haemophilia patient with inhibitors in the past 5 years. Consensus for 6-point Likert scale questions was pre-defined as ⩾70% participants selecting 1–2 (disagreement) or 5–6 (agreement). Results: In all, 46.7% and 35.9% questions achieved consensus in Rounds 1 ( n = 41) and 2 ( n = 34), respectively. Consensus was reached on the importance of improving quality of life (QoL) and reaching clinical goals such as bleed prevention, eradication of inhibitors and pain management. There was agreement on criteria constituting adequate/inadequate responses to immune tolerance induction (ITI) and the appropriate factor VIII dose to address suboptimal ITI response. Opinions varied on treatment aims for adults and children/adolescents, when to offer prophylaxis with bypassing agents and expectations of prophylaxis. Consensus was also lacking on appropriate treatment for mild/moderate patients with inhibitors. Conclusion: UK healthcare professionals appear to be aligned on the clinical goals and role of ITI when managing haemophilia patients with inhibitors, although novel treatment developments may require reassessment of these goals. Lack of consensus on prophylaxis with bypassing agents and management of mild/moderate cases identifies a need for further research to establish more comprehensive, evidence-based treatment guidance, particularly for those patients who are unable/prefer not to receive non-factor therapies.

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