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To address methodological deficiencies in published randomized controlled trials and systematic reviews, this study has developed a core outcome set to guide future research in ectopic pregnancy (EP). To identify potential outcomes, we performed a comprehensive literature review and interviews with individuals with lived experience in EP. Potential core outcomes were then entered into a 3-round Delphi survey. A total of 154 participants from 6 continents, comprising health care professionals, researchers, and individuals with lived experience in EP, completed all 3 rounds of the Delphi survey. Outcomes were prioritized at 3 consensus development meetings, and recommendations were developed on how to report these outcomes where possible. Not applicable. Health care professionals, researchers, and individuals with lived experience in EP. Not applicable. Consensus for inclusion in core outcome set. Six outcomes reached full consensus, including treatment success, resolution time, the number of additional interventions, adverse events, mortality and severe morbidity, and treatment satisfaction. The core outcome set with 6 outcomes for EP will help standardize reporting of clinical trials, facilitate implementation of findings into clinical practice, and enhance patient-centered care. [ABSTRACT FROM AUTHOR]

Background: The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures.Objectives: To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology.Methods: A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered.Result: Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures.Conclusions: The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology. [ABSTRACT FROM AUTHOR]

With the currently accelerating changes in pharmacists' roles in Saudi Arabia, evidence-based developmental tools are required to guide initial pharmacy education and define competencies for early career (foundation level) pharmacists' progression. This study aimed to develop a profession-wide competency framework for foundation level pharmacists in Saudi Arabia using the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) as the source framework. An online nominal group technique was used to develop consensus on a profession-wide national competency framework in Saudi Arabia. Purposive sampling was used to recruit experts from local various pharmacy sectors. A combination of self-administered surveys and online meetings was used to measure and develop consensus. The survey items were adopted from the FIP GbCF version 2. Nine pharmacy experts participated in five iterative rounds of consensus measurement and development between July and November 2021. Consensus was achieved on appropriateness to Saudi pharmacy practice for all the behaviours in the "Pharmaceutical Public Health," "Pharmaceutical Care," and "Professional/Personal" clusters. The "Organisation and Management" cluster caused most differences of opinion. The final consensus generated a list of 125 behavioural statements for inclusion in the national competency framework. This study proposes the first competency framework for foundation level pharmacists in Saudi Arabia. The developed framework represents a consensus on competencies for foundation level pharmacists working across all pharmacy sectors and is eligible for supporting further improvement of initial pharmacy education and support excellence in pharmacists' performance to address the country's needs from pharmaceutical services. [ABSTRACT FROM AUTHOR]

Background/purpose: The implementation of competency-based medical education is a social construction process within a local and cultural context. However, little is known about the process of adaptation to different systems, known as "glocalization". We analyzed the documents in the development of a milestone project from adapting global standards into a local context and identified a framework underlying this process.Methods: Taiwan Society of Emergency Medicine (TSEM) had developed learning milestones based on the ACGME's version through series of consensus methods including committee work, nominal group technique (NGT), and a modified Delphi method. We applied qualitative content analysis to characterize the evolution of the three versions of TSEM and the original ACGME milestones documents and to explore the meaning behind the differences revealed by the glocalization process.Results: We found 48 differences between ACGME and TSEM milestones. Among these differences, one was made by committee work, 44 came from NGT, and 3 were from the modified Delphi process. Two themes and seven sub-themes emerged from the coding process to explain the contextualization process of the milestones.Conclusion: We identified a framework that incorporates local expression and local needs into the process called glocalization through which global models of competency-based standards could be optimally implemented in a local context with different systems and cultures. [ABSTRACT FROM AUTHOR]

• Consensus-based methods were used to improve vaccine product label information. • Stakeholders developed structure, language, and content for product labels. • Emergent methods exposed divergent understandings of the purpose of product labels. • Stakeholders were concerned about how product labels are regulated. • Developers of product label information should consider involving end users. Product labelling information describing the use of vaccines in pregnancy continues to contain cautionary language even after clinical and epidemiological evidence of safety becomes available. This language raises safety concerns among healthcare providers who may hesitate to recommend vaccines during pregnancy. To develop clear evidence-based language about vaccine safety and effectiveness in pregnancy for inclusion in vaccine product labels. We conducted a three-stage consensus-methods project with stakeholders, including: healthcare providers, vaccine regulators, industry representatives, and experts in public health, communication, law, ethics, and social sciences. Using qualitative and quantitative methods, we held a nominal group technique (NGT) meeting, followed by a Delphi survey, and then a consensus workshop with a subset of Delphi participants. We developed a methodological tool to analyse data for consensus. Stakeholders (N = 14) at the NGT meeting drafted product label statements for evaluation in the Delphi survey. Survey participants (N = 41) provided feedback on statements for five hypothetical vaccines. Workshop participants (N = 27) initiated discussions that demonstrated a lack of awareness that the regulatory purpose of product labels is to provide a scientific summary of product-specific pre-clinical and clinical trial data. Each stage of this project built on earlier stages until we achieved strong consensus on the language, structure, and types of data that stakeholders wanted to include in inactivated influenza vaccine (IIV) and tetanus-diphtheria-acellular pertussis (Tdap) vaccine product labels in Canada. The revised statements for IIV and Tdap aligned with workshop participants' goals that the product label be evidence-based, with a consistent structure and language that is easily understood by healthcare providers. Emergent methods uncovered stakeholder concerns about the regulatory purpose, content, and evidence used in product labels. Involving healthcare providers in the development and regular updating of product information could prevent interpretations of that information that contribute to vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Abstract Background and aim The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) aims to further develop its role in international medical and scientific guidance in the field of Clinical Microbiology and Infectious Diseases, where many types of guidance documents exist. The ESCMID Executive Committee and the Clinical Microbiology and Infection (CMI) editorial board wish to clarify the terminology and format to be used in ESCMID guidance documents submitted for publication in CMI , and to highlight the principles behind ESCMID guidance documents. Types of guidance documents There are five types of ESCMID guidance documents: White Papers, Clinical Practice Guidelines, Consensus Statements, State-of-the-Science Statements, and Position Papers. They differ in scope, methods of development, drafting group composition and preferred publication format. Guidance documents can be proposed, developed and published by ESCMID Study Groups, Committees and individual members; often, other scientific societies are involved. The full disclosure of potential conflicts of interest of all drafting group members is a requirement. Final remarks Guidance documents constitute a common cultural and scientific background to people in the same and related professions. Also, they are an important educational and training tool. Developing a guidance document is a scientific endeavour, where a sound and transparent development process is needed, requiring multidisciplinary and personal skills. [ABSTRACT FROM AUTHOR]

The most recent data show that shellfish farming represents approximately 60% of the total aquaculture production in Europe. Bivalves molluscs are internationally recognized as a potential vehicle for foodborne diseases especially when consumed raw or improperly cooked. Bivalves are filter-feeding animals that may accumulate particles present in the surrounding water, including viruses and pathogenic microorganisms. For these reasons consumers have to be careful during purchasing, handling and cooking of this food. In Europe several regulations have been adopted to protect consumers’ health. However in the development of new food safety strategies it is also crucial to find an effective approach to guide authorities’ decisions on priorities for controlling foodborne risks. In the article a study for the selection and ranking of behavioural information on bivalve risks is reported. The “consensus methods” provide a means of synthesising information and of harnessing the insights of experts to enable decisions shared and validated by the scientific community. The Delphi method and Nominal Group technique (NGT) were applied for their capability to assess the level of agreement and to develop consensus among participants. In the article, the NGT is presented as a way to involve relevant stakeholders in the ranking of risky behaviours from the production to the consumption of bivalve molluscs previously selected by scientific experts through the Delphi method. The inclusion of a full range of experts and stakeholders in a community participatory research project regarding food risk management represents an innovative approach in the Italian public health context, especially in the analysis of bivalve risks. [ABSTRACT FROM AUTHOR]

Objectives Consensus methods are used by healthcare professionals and educators within nursing education because of their presumed capacity to extract the profession's’ “collective knowledge” which is often considered tacit knowledge that is difficult to verbalize and to formalize. Since their emergence, consensus methods have been criticized and their rigour has been questioned. Our study focuses on the use of consensus methods in nursing education and seeks to explore how extensively consensus methods are used, the types of consensus methods employed, the purpose of the research and how standardized the application of the methods is. Design and data sources A systematic approach was employed to identify articles reporting the use of consensus methods in nursing education. The search strategy included keyword search in five electronic databases [Medline (Ovid), Embase (Ovid), AMED (Ovid), ERIC (Ovid) and CINAHL (EBSCO)] for the period 2004–2014. We included articles published in English, French, German and Greek discussing the use of consensus methods in nursing education or in the context of identifying competencies. Review method A standardized extraction form was developed using an iterative process with results from the search. General descriptors such as type of journal, nursing speciality, type of educational issue addressed, method used, geographic scope were recorded. Features reflecting methodology such as number, selection and composition of panel participants, number of rounds, response rates, definition of consensus, and feedback were recorded. Results 1230 articles were screened resulting in 101 included studies. The Delphi was used in 88.2% of studies. Most were reported in nursing journals (63.4%). The most common purpose to use these methods was defining competencies, curriculum development and renewal, and assessment. Remarkably, both standardization and reporting of consensus methods was noted to be generally poor. Areas where the methodology appeared weak included: preparation of the initial questionnaire; the selection and description of participants; number of rounds and number of participants remaining after each round; formal feedback of group ratings; definitions of consensus and a priori definition of numbers of rounds; and modifications to the methodology. Conclusions The findings of this study are concerning if interpreted within the context of the structural critiques because our findings lend support to these critiques. If consensus methods should continue being used to inform best practices in nursing education, they must be rigorous in design. [ABSTRACT FROM AUTHOR]

This paper addresses the design problem of a resilient consensus algorithm for agents with continuous-time dynamics. The main proposal is that by incorporating a switching mechanism selecting the network topology to avoid malicious nodes from communicating, the remaining nodes will converge to a value closer to the original steady-state without the attacker being present. The switching occurs at discrete-time steps where each node evaluates the reputation score of the neighbors and deactivates/ignores edges in the network. We explore the proposed method with illustrative examples ranging from static topologies to dynamic ones, considering directed and undirected graphs, presenting several attacking scenarios that are successfully mitigated with our method. Finally, we compare the best undetectable attacking strategy and the commonly used approach named MSR, highlighting the advantages of our method. [ABSTRACT FROM AUTHOR]

Abstract: Approximate string matching (ASM) is a well-known computational problem with important applications in database searching, plagiarism detection, spelling correction, and bioinformatics. The two main issues with most ASM algorithms are (1) computational complexity, and (2) low specificity due to a large amount of false positives being reported. In this paper, a very efficient ASM method is proposed, along with a post -processing stage designed to significantly reduce the amount of false positives. Results with random strings show that the proposed method is capable of performing a search within a large (1M b) string in about 100ms, with a sensitivity and specificity of nearly 100%. [Copyright &y& Elsevier]

Abstract: Background: Multiparametric magnetic resonance imaging (mpMRI) may have a role in detecting clinically significant prostate cancer in men with raised serum prostate-specific antigen levels. Variations in technique and the interpretation of images have contributed to inconsistency in its reported performance characteristics. Objective: Our aim was to make recommendations on a standardised method for the conduct, interpretation, and reporting of prostate mpMRI for prostate cancer detection and localisation. Design, setting, and participants: A consensus meeting of 16 European prostate cancer experts was held that followed the UCLA-RAND Appropriateness Method and facilitated by an independent chair. Measurement: Before the meeting, 520 items were scored for “appropriateness” by panel members, discussed face to face, and rescored. Results and limitations: Agreement was reached in 67% of 260 items related to imaging sequence parameters. T2-weighted, dynamic contrast-enhanced, and diffusion-weighted MRI were the key sequences incorporated into the minimum requirements. Consensus was also reached on 54% of 260 items related to image interpretation and reporting, including features of malignancy on individual sequences. A 5-point scale was agreed on for communicating the probability of malignancy, with a minimum of 16 prostatic regions of interest, to include a pictorial representation of suspicious foci. Limitations relate to consensus methodology. Dominant personalities are known to affect the opinions of the group and were countered by a neutral chairperson. Conclusions: Consensus was reached on a number of areas related to the conduct, interpretation, and reporting of mpMRI for the detection, localisation, and characterisation of prostate cancer. Before optimal dissemination of this technology, these outcomes will require formal validation in prospective trials. [Copyright &y& Elsevier]

Objective: To propose a comprehensive set of competencies and educational objectives for communication and social competencies in undergraduate medical education and to support the nationwide implementation of these issues in all medical schools. Methods: Thirty experts from different medical and psychosocial disciplines participated in a 2-day workshop using the Nominal Group Technique (NGT) to develop an initial set of educational objectives. These were refined, structured, and rated according to their importance by means of a two-step Delphi Survey involving additional experts in medical education. Results: The initial workshop resulted in 188 educational objectives assigned to 26 different topics. After the Delphi Survey, 131 objectives remained, assigned to 19 different topics. Some objectives that could be assigned to more than one topic were subsumed under a new more general category. Conclusion: The described consensus process proved successful as one method to develop a set of educational objectives. Practical implications: The Basel consensus statement can be used to orientate curriculum reform and development in medical education. [Copyright &y& Elsevier]

Abstract: Let be a positive integer and let be a finite nonempty set. A closed -system of sets on is a collection of subsets of E such that implies , , and whenever with . If is a class of closed -systems of sets and is a positive integer, then is a consensus method. In this paper we study consensus methods that satisfy a structure preserving condition called removal independence. The basic idea behind removal independence is that if two input profiles in agree when restricted to a subset of , then their consensus outputs agree when restricted to . By working with the axiom of removal independence and classes of closed -systems of sets we obtain a result for consensus methods that is in the same spirit as Arrow’s Impossibility Theorem for social welfare functions. [Copyright &y& Elsevier]

Abstract: Background: Most contraceptive users are medically fit and can use any available method. Some medical conditions are associated with theoretical safety concerns when certain contraceptives are used. Nevertheless, most contraceptive clinical trials exclude subjects with chronic medical conditions, and direct evidence on which to base sound contraceptive prescribing is limited. The World Health Organization (WHO) Medical Eligibility Criteria provide recommendations on the safe use of contraception. This document is aimed at policymakers and program managers working in less developed countries in which the risks of pregnancy usually far outweigh the risks associated with contraceptive use. Study Design: The Faculty of Sexual and Reproductive Healthcare used formal consensus methods to adapt the WHO document to reflect clinical practice and health care systems in the United Kingdom. Conclusion: This structured group consensus method adds authority, rationality and scientific credibility to the UK version, which makes best use of published evidence and captures collective expert knowledge. Not all clinicians will agree with the recommendations made in the UK version of the Medical Eligibility Criteria, but for the vast majority, they will be a valuable reference to guide clinical practice for women with many conditions that theoretically affect contraceptive use. [Copyright &y& Elsevier]

Objective: To define the components of a self-management programme of lifestyle and behavioural interventions for symptom control in men with uncomplicated LUTS. The use of lifestyle and behavioural interventions for symptom control in men with uncomplicated LUTS is widespread in the UK, however the effectiveness of these interventions has never been formally evaluated. Defining the components of a self-management programme will allow effectiveness studies to take place.Materials and methods: An eight member multidisciplinary panel rated 94 items for their appropriateness to be incorporated into the self-management programme using The Research and Development Appropriateness Method—RAM (UCLA). The item list was developed using semi-structured interviews with health care professionals and a national UK practice survey. RAM is a formal consensus process where an expert panel rate items over two rounds. The first round is conducted by post and in the second round the panel meets to discuss their initial ratings chaired by an independent moderator, then a second and final vote is made.Results: The panel agreed that 57 of the original 94 items were appropriate to be incorporated in the self-management programme. These interventions were contained within the following categories: patient assessment prior to starting a self-management programme (6), education and reassurance (4), fluid management (6), caffeine (4), alcohol (2), concurrent medication (2), types of toileting (2), bladder re-training (15), miscellaneous (1), and implementation of a self-management programme (15).Conclusions: The components of a self-management programme of lifestyle and behavioural interventions for men with uncomplicated LUTS has been defined using the RAM consensus process. Now this problem of definition has been overcome, the effectiveness of self-management can be formally explored. [Copyright &y& Elsevier]

Abstract: Context: Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. Objectives: This article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care. Methods: Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer. Results: Small multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms. Conclusion: A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts. [Copyright &y& Elsevier]