Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document

2017 ◽  
Vol 21 (6) ◽  
pp. 513-524 ◽  
Author(s):  
Afsaneh Alavi ◽  
Charles Lynde ◽  
Raed Alhusayen ◽  
Marc Bourcier ◽  
Isabelle Delorme ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Hidradenitis Suppurativa ◽  
Expert Panel ◽  
Scientific Evidence ◽  
Treatment Modalities ◽  
Modified Delphi ◽  
Consensus Document ◽  
Expert Opinions ◽  
Modified Delphi Technique ◽  
Necrosis Factor

Background: Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. Objectives: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. Methods: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. Results: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. Conclusions: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti–tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.

scholarly journals Using a Delphi Technique to Define a Feedback Culture in Graduate Medical Education

2021 ◽  
Vol 53 (6) ◽  
pp. 433-442
Author(s):  
Cristen P. Page ◽  
Hannah M. Baker ◽  
Linda Myerholtz
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Delphi Technique ◽  
Expert Panel ◽  
Essential Elements ◽  
Minimum Threshold ◽  
Graduate Medical ◽  
Modified Delphi ◽  
Feedback Culture ◽  
Modified Delphi Technique

Background and Objectives: Experts in medical education hypothesize that programs with a robust culture of feedback foster learning and growth for learners and educators, yet the literature shows no consensus for what defines a feedback culture in graduate medical education. Methods: Using a two-round, modified Delphi technique in summer and fall of 2019, the authors asked a panel of experts to identify essential elements to a feedback culture. The research team compiled a list of experts and a list of 29 descriptors of a highly functioning feedback culture. Experts rated the items as an essential, compatible, or not important aspect of a highly functioning culture of feedback. Researchers set a minimum threshold of 80% agreement and used comments from panelists to revise elements that did not meet agreement during round one. Experts then rerated the elements using information on their initial ratings, aggregate panelist ratings, and comments from all panelists. Results: The response rates from our panel of experts were 68% (17/25) for round one and 88% (15/17) for round two. Seventeen elements were rated as essential to a feedback culture. Conclusions: An expert panel endorsed essential elements that can be used to assess feedback culture in graduate medical education programs.

scholarly journals Establishment of an internationally agreed minimum data set for acute telestroke

2020 ◽  
pp. 1357633X1989926 ◽  
Author(s):  
Dominique A Cadilhac ◽  
Kathleen L Bagot ◽  
Bart M Demaerschalk ◽  
Gordian Hubert ◽  
Lee Schwamm ◽  
...  
Keyword(s):  
Expert Panel ◽  
Clinical Care ◽  
International Comparisons ◽  
Patient Characteristics ◽  
Post Discharge ◽  
Data Set ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Minimum Dataset

Introduction Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes. Methods An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers ( n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email. Results Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme ( n = 12), (2) details about initiating hospital ( n = 10), (3) telestroke consultation ( n = 17), (4) patient characteristics ( n = 7), (5) presentation to hospital ( n = 5), (6) general clinical care within first 24 hours ( n = 10), (7) thrombolysis treatment ( n = 10), (8) endovascular treatment ( n = 13), (9) neurosurgery treatment ( n = 8), (10) processes of care beyond 24 hours ( n = 7), (11) discharge information ( n = 5), (12) post-discharge and follow-up data ( n = 6). Discussion The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.

scholarly journals Perioperative pain and addiction interdisciplinary network (PAIN): protocol for the perioperative management of cannabis and cannabinoid-based medicines using a modified Delphi process

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036472 ◽  
Author(s):  
Alexander McLaren-Blades ◽  
Karim Ladha ◽  
Akash Goel ◽  
Varuna Manoo ◽  
Yuvaraj Kotteeswaran ◽  
...  
Keyword(s):  
Expert Panel ◽  
Large Population ◽  
Perioperative Period ◽  
Delphi Process ◽  
Modified Delphi ◽  
Therapeutic Benefits ◽  
Clinical Scenarios ◽  
Narrative Literature ◽  
Modified Delphi Technique ◽  
Narrative Literature Review

IntroductionAt the conception of this study (January 2019), a literature search by the authors found no evidence-based or consensus perioperative guidelines for patients consuming cannabis products, or for those patients in whom a cannabinoid medication could be considered for perioperative treatment. Currently, there is a large global population that consumes cannabis. The availability of cannabis has also increased this decade with greater legal access to cannabis products in some countries such as USA, Canada, Uruguay, Israel, Australia and Germany. There are recognised possible therapeutic benefits for the use of cannabis in patients with chronic pain, chronic neuropathic pain and chemotherapy-induced nausea and vomiting. There are also potential side effects from cannabis use such as psychosis, cannabis hyperemesis syndrome, misuse disorder and cannabis withdrawal syndrome. There is evidence that cannabis may also affect factors in the perioperative period such as monitoring, quality of analgesia, sleep and opioid consumption. Given the large population of persons using cannabis, the heterogeneity of cannabis products and the paucity (and heterogeneity) of perioperative literature surrounding it, perioperative guidelines for cannabis consuming patients are both lacking and necessary. In this paper, we present the design for a modified Delphi technique that has been started with the intent of deriving cannabis perioperative guidelines from the available medical literature and the consensus of multidisciplinary experts.Materials, methods and analysisThis study will use a scoping narrative literature review and modified Delphi process to generate cannabis perioperative guidelines. A scoping narrative review of cannabis in the perioperative period by the authors of this proposal was completed and provided to a panel of 17 experts. These experts were recruited for their knowledge and expertise regarding cannabis and/or perioperative medicine. They were asked to rate a series of indications and clinical scenarios in two rounds. During the first round, the expert panel was blinded to each other’s participation. During the second round of this process, the expert panel met after being provided with an analysis of the first round’s submissions so they could be discussed further and, if possible, reach a further consensus regarding them. Using the results obtained from the Delphi review process, a draft of proposed cannabis perioperative guidelines will be generated. These proposed guidelines will be returned to the expert panel for critiquing prior to their finalisation.Ethics and disseminationStudy and panellist data will be deidentified and stored as per institutional (Toronto General Hospital) guidelines. Institutional research ethics board provided a waiver for this modified Delphi protocol. Findings will be presented and published in peer-reviewed publications and conferences.

Novel treatment opportunities in Graves’ orbitopathy

2014 ◽  
Vol 155 (33) ◽  
pp. 1295-1300
Author(s):  
Annamária Erdei ◽  
Annamária Gazdag ◽  
Miklós Bodor ◽  
Eszter Berta ◽  
Mónika Katkó ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Clinical Course ◽  
Treatment Protocol ◽  
Treatment Modalities ◽  
Graves Disease ◽  
Novel Treatment ◽  
Graves Orbitopathy ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Novel Therapeutic

Graves’ orbitopathy is the most common extrathyroidal manifestation of Graves’ disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves’ orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves’ orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted. Orv. Hetil., 2014, 155(33), 1295–1300.

The Hospice Farewell: Ideological Perspectives of its Professional Practitioners

1990 ◽  
Vol 21 (4) ◽  
pp. 283-300 ◽  
Author(s):  
Anoel Rinaldi ◽  
Michael C. Kearl
Keyword(s):  
Hospice Care ◽  
National Sample ◽  
High Rate ◽  
Older Individuals ◽  
Modified Delphi ◽  
Death Denial ◽  
Cultural Climate ◽  
Quality Of Death ◽  
Modified Delphi Technique ◽  
Professional Practitioners

This research examines a social service devoted to “good deaths” in our country: hospice. Using a modified Delphi technique, a national sample of hospice experts ( n = 48) was questioned in order to elicit group judgments about hospice ideology, the issue of control over one's own death trajectory, and hospice's relevance for older individuals. The respondents generally concurred that hospice, influenced by the work of Kübler-Ross, represents a radical departure in how we die, a reaction to the quality of death within a cultural climate of death denial, and, in some sense, a demodernization movement. While a high rate of consensus was obtained on many of the issues that evolved, little evidence of a coherent ideology could be detected linking notions of hospice origins, issues of patient control, and suitability of hospice care for older individuals.

scholarly journals Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Arif Hussain ◽  
Gabriele Via ◽  
Lawrence Melniker ◽  
Alberto Goffi ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Expert Panel ◽  
Point Of Care ◽  
Expert Consensus ◽  
Future Research ◽  
Point Of Care Ultrasound ◽  
The Past ◽  
Modified Delphi ◽  
Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo 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.MethodsThe 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.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe 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.

Sign in / Sign up

Export Citation Format

Share Document