Opportunities and Problems of the Consensus Conferences in the Care Robotics

Care robots represent an opportunity for the health domain. The use of these devices has important implications. They can be used in surgical operating rooms in important and delicate clinical interventions, in motion, in training-and-simulation, and cognitive and rehabilitation processes. They are involved in continuous processes of evolution in technology and clinical practice. Therefore, the introduction into routine clinical practice is difficult because this needs the stability and the standardization of processes. The agreement tools, in this case, are of primary importance for the clinical acceptance and introduction. The opinion focuses on the Consensus Conference tool and: (a) highlights its potential in the field; (b) explores the state of use; (c) detects the peculiarities and problems (d) expresses ideas on how improve its diffusion.

Controversial issues of biliary stenting in patients with proximal biliary obstruction

The management of biliary decompression in malignant hilar carcinoma remains controversial. This review shows the most relevant aspects of endoprosthetics for proximal biliary obstruction, including necessity of stenting and morphological verification before radical surgery, selection of approach to drain etc. The main contradictions and ways to solve them are presented in this article, based on evidence researches, international and expert consensus conferences.

The 32-Item Multilingual Naming Test: Cultural and Linguistic Biases in Monolingual Chinese-Speaking Older Adults

ABSTRACT Objectives: This study describes the performance of the Multilingual Naming Test (MINT) by Chinese American older adults who are monolingual Chinese speakers. An attempt was also made to identify items that could introduce bias and warrant attention in future investigation. Methods: The MINT was administered to 67 monolingual Chinese older adults as part of the standard dementia evaluation at the Alzheimer’s Disease Research Center (ADRC) at the Icahn School of Medicine at Mount Sinai (ISMMS), New York, USA. A diagnosis of normal cognition (n = 38), mild cognitive impairment (n = 12), and dementia (n = 17) was assigned to all participants at clinical consensus conferences using criterion sheets developed at the ADRC at ISMMS. Results: MINT scores were negatively correlated with age and positively correlated with education, showing sensitivity to demographic factors. One item, butterfly, showed no variations in responses across diagnostic groups. Inclusion of responses from different regions of China changed the answers from “incorrect” to “correct” on 20 items. The last five items, porthole, anvil, mortar, pestle, and axle, yielded a high nonresponse rate, with more than 70% of participants responding with “I don’t know.” Four items, funnel, witch, seesaw, and wig, were not ordered with respect to item difficulty in the Chinese language. Two items, gauge and witch, were identified as culturally biased for the monolingual group. Conclusions: Our study highlights the cultural and linguistic differences that might influence the test performance. Future studies are needed to revise the MINT using more universally recognized items of similar word frequency across different cultural and linguistic groups.

Optimizing Loco Regional Management of Oligometastatic Colorectal Cancer: Technical Aspects and Biomarkers, Two Sides of the Same Coin

Colorectal cancer (CRC) is the third most common cancer worldwide and has a high rate of metastatic disease which is the main cause of CRC-related death. Oligometastatic disease is a clinical condition recently included in ESMO guidelines that can benefit from a more aggressive locoregional approach. This review focuses the attention on colorectal liver metastases (CRLM) and highlights recommendations and therapeutic locoregional strategies drawn from the current literature and consensus conferences. The different percutaneous therapies (radiofrequency ablation, microwave ablation, irreversible electroporation) as well as trans-arterial approaches (chemoembolization and radioembolization) are discussed. Ablation margins, the choice of the imaging guidance as well as characteristics of the different ablation techniques and other technical aspects are analyzed. A specific attention is then paid to the increasing role of biomarkers (in particular molecular profiling) and their role in the selection of the proper treatment for the right patient. In conclusion, in this review an up-to-date state of the art of the application of locoregional treatments on CRLM is provided, highlighting both technical aspects and the role of biomarkers, two sides of the same coin.

Are voters influenced by the results of a consensus conference?

We evaluate whether people will outsource their opinion on public policy to consensus conference participants. The ideal consensus conference brings together a representative sample of citizens and introduces them to the range of perspectives and evidence related to some policy. The sample is given the opportunity to ask questions of experts and to deliberate. Attitudes about each policy are queried before and after the conference to see if the event has changed minds. In general, such conferences do produce opinion shifts. Our hypothesis is that the shift can be leveraged by simply communicating conference results – absent substantive information about the merits of the policies discussed – to scale up the value of conferences to the population at large. In five studies, we tell participants about the impact of a consensus conference on a sample of citizens’ opinions for a range of policies without providing any new information about the inherent value of the policy itself. For several of the policies, we see a shift in opinion. We conclude that the value of consensus conferences can be scaled up simply by telling an electorate about its results. This suggests an economical way to bring evidence and rational argument to bear on citizens’ policy attitudes.

Hormonal Contraception. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry Number 015/015, January 2020)

Aims This is an official interdisciplinary guideline published and coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking regions and is backed by numerous professional societies and organizations. The aim of this guideline is to provide an evidence- and consensus-based overview of the diagnostic approach and the management of hormonal contraception based on a systematic evaluation of the relevant literature. Methods To compile this S3-guideline, a systematic search for evidence was carried out in PubMed and the Cochrane Library to adapt existing guidelines and identify relevant reviews and meta-analyses. A structured evaluation of the evidence was subsequently carried out on behalf of the Guidelines Commission of the DGGG, and a structured consensus was achieved based on consensus conferences attended by representative members from the different specialist societies and professions. Recommendations Evidence-based recommendations about the advice given to women requesting contraception were compiled. The guideline particularly focuses on prescribing contraceptives which are appropriate to womenʼs individual needs, take account of her personal circumstances, and have few or no side effects.

Leveraging Existing Institutional Resources to Maintain Quality Assurance Practices in Anatomic Pathology in the Era of Social Distancing

Introduction/Objective Due to the COVID-19 pandemic, hospitals had to adapt practices to incorporate social distancing while maintaining quality assurance (QA) in anatomic pathology (AP). Prior to this, our general surgical pathology (SP) and cytopathology (CP) services held daily consensus conferences (CC) at a multi-headed microscope. Implementing social distancing meant only a few faculty were present onsite and avoidance of interactions at the multi-headed scope. In an effort to preserve QA through CC, faculty exploited the use of web conferencing through our HIPAA-compliant Zoom. We describe the utility of this new practice. Methods From 3/25-4/30/20, all SP and CP cases selected for CC were presented by respective pathologists (n=8) in their own offices by using individual microscopes with cameras, image acquisition software, and screen-sharing through Zoom. One pathologist was responsible for sending out a new CC Zoom link daily and recording the consensus diagnosis. All onsite pathologists and those at home participated. Results We presented 95 SP and 31 CP cases through Zoom compared to 300 SP and 60 CP cases presented at a similar timeframe prior to social distancing. This 68% and 48% decline could be attributed to elective procedure cancellation. We assigned a consensus diagnosis to all cases, with 77% overall being malignant diagnoses, and breast being the most common SP specimen type (22%). Additionally, all participating pathologists felt comfortable with the new format irrespective of being onsite or at home. Apart from minor audio issues, we did not notice significant lag time or visual disturbances that interfered with diagnostic abilities. Importantly, the transition did not involve investing in new technology. Conclusion The new virtual CC allowed our department to maintain QA practices in AP without sacrificing quality and serves as a starting point to investigating the use of this technology to other applications in AP, such as overnight frozen sections.

Abrir la ciencia para cambiar el mundo

La noción de open science no sólo tiene que conjugar todas las formas de dar acceso (papers, data y notebooks), sino también las de promover participación, ya sea incentivando la colaboración entre una heterogeneidad de actores (science shops, citizen panels, consensus conferences, participatory action-research, living labs, hackerspaces, laboratorios ciudadanos, design assemblies) ya sea expandiendo el diálogo de saberes y haciendo más porosas las fronteras entre la academia y la urbe, los expertos y los amateurs, el conocimiento de laboratorio y el de campo, el aula y la plaza o el experimental y el experiencial. Abrir la ciencia también involucra el diseño de infraestructuras que garanticen la soberanía de la comunidad científica, como también abrir el ecosistema o, en otros términos, problematizar los protocolos que regulan la evaluación, financiación y licencia de la investigación, como también la gobernanza de la vida académica, incluidas las convocatorias y los jurados, o los premios, concursos, comisiones y, desde luego, los dispositivos de planeación.