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Introduction: On 11th March 2020the WHO declared COVID19 a global pandemic, a challenge previously unseen for sanitary systems, including the activity in Urology departments., Material and Methods: Web and PubMed searchusing the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID surgery", "consensus methods","nominal group", "Delphi method". A narrative revision of the literature until the 20th May 2020, including articles and documents in English and Spanish.;RESULTS: Medical practice in Spain has been forced to rapidly adapt to the pandemic, dedicating most ofits material and human resources to the care of patients infected by SARS-CoV-2. This has meant a significant reduction of the routine practice in Urology, as in other medical specialities, limiting the medical attention tourgent and emergent cases. Programmed activity has been reserved for selected cases in which a delayed attention could compromise survival. Different scientific associations have made a significant effort to adapt their recommendations to the pandemic, prioritizing high-risk oncologic cases, and reducing the use of ventilators and hospital stays to the minimum. These restrictions must be dynamic, adapting to the de-escalating phases as the pandemic is more controlled, widening the range of services available. In this de-escalate there is an additional challenge, being the difficulty in generating quality scientific evidence. In order to obtain such evidence, consensus methods have been used, such as the nominal group technique or the Delphi method., Conclusions: The COVID19 pandemic has meant a complete disruption in the routine activity in Urologyin Spain, with a need for prioritizing the attention of urgent and high-risk oncologic pathology. These restrictions must be progressively modified according to the de-escalating process in the general population.

Molecular docking has been widely employed as a fast and inexpensive technique in the past decades, both in academic and industrial settings. Although this discipline has now had enough time to consolidate, many aspects remain challenging and there is still not a straightforward and accurate route to readily pinpoint true ligands among a set of molecules, nor to identify with precision the correct ligand conformation within the binding pocket of a given target molecule. Nevertheless, new approaches continue to be developed and the volume of published works grows at a rapid pace. In this review, we present an overview of the method and attempt to summarise recent developments regarding four main aspects of molecular docking approaches: (i) the available benchmarking sets, highlighting their advantages and caveats, (ii) the advances in consensus methods, (iii) recent algorithms and applications using fragment-based approaches, and (iv) the use of machine learning algorithms in molecular docking. These recent developments incrementally contribute to an increase in accuracy and are expected, given time, and together with advances in computing power and hardware capability, to eventually accomplish the full potential of this area. [ABSTRACT FROM AUTHOR]

Introduction: Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children's physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardised., Methods and Analysis: Our aim is to develop a COS for studies of school-based physical activity interventions. We will achieve this by undertaking a four-stage process:(1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritise outcomes through a two-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents), where stakeholders rate the importance of each outcome on a 9-point Likert scale (consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7%-9% and 15% or less scoring 1 to 3); (4) achieve consensus on a final COS in face-to-face meetings with a sample of stakeholders and primary school children., Ethics and Dissemination: We have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels., Trial Registration Number: Core Outcome Measures in Effectiveness Trials Initiative (COMET) number: 1322., Competing Interests: Competing interests: SS, BR and KF have received funding from 'The Daily MIle Foundation' supported by INEOS., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale, Aims, and Objectives: Clinical practice guidelines (CPGs) endeavour to incorporate the best available research evidence together with the clinically informed opinions of leading experts in order to guide clinical practice when dealing with a given condition. There has been increased interest in CPGs that are evidence based and that promote best practice, a central component of which is incorporating the best available research predicated on strong study designs. Despite this soaring interest, there remains heterogeneity in the methodological quality of many CPGs, which may have an effect on the quality of services that clinicians offer. In light of this, this study examined the quality of the methodology used to develop two CPGs of the Canadian Psychiatric Association (CPA)., Method: The CPA's guidelines for the management of anxiety disorders (2006) and for the treatment of depressive disorders (2001) were assessed by trained raters using the Appraisal of Guidelines for Research and Evaluation II Instrument scale., Results: The blind ratings of three trained raters demonstrated that the anxiety and depression CPGs had a number of strengths and important weaknesses., Conclusion: Implications for the development of future CPGs on anxiety and depression, including recommendations to improve guideline quality in psychiatry in particular, are discussed., (© 2018 John Wiley & Sons, Ltd.)

Objective: Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease., Methods: An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration., Results: The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential "entry criteria," which would be required for classification, from potential "additive criteria." Potential entry criteria were antinuclear antibody (ANA) ≥ 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever., Conclusion: The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease with multiorgan involvement., Objective: Identify preferences and priorities among patients and health care professionals regarding care for SSc patients in The Netherlands. Develop ideas to improve quality of care., Methods: A structured approach was followed to collect information from different perspectives to prepare a working conference. Qualitative and quantitative data from patients (n = 650), rheumatologists (n = 167), nurses (n = 51), and health professionals (n = 85) from regional centers and university hospitals were collected. In February 2018, a working conference was organized. Seventy-seven persons (including 10 SSc patients) from different backgrounds discussed the identified themes and survey results. Ideas to improve health care were formulated and prioritized using nominal group technique., Results: Five key themes were identified: (1) shared care and multidisciplinary collaboration, (2) medical data exchange, (3) information for both patients and health care professionals, (4) patient empowerment, and (5) non-pharmacological care. Shared care was the preferred model of care in 49% of patients and 82% of physicians. However, current collaboration structures, especially between hospitals, should be improved. Suggestions for improvements were explicitly formulated agreements about referral, clear task division, treatment coordination, and exploration of novel ways to exchange medical records. The creation of a national web-based information hub was highly prioritized., Conclusion: In this mixed-method study, broad-based consensus was achieved and recommendations were developed to improve health care for SSc patients. The approach, recommendations, and challenges summarized in this paper can be of use for health care professionals and other actors involved in patients with rare, chronic, and multisystem conditions.

Due to changes in social and health needs, the reorganisation of health systems towards community and primary care requires the redefinition of different professional identities and practices. This paper focuses on the specialists in the system: the physicians who work in outpatient services (local health authorities, hospitals, and other institutions) not as dependents but under private contract. This doctor has to balance the professional culture (in terms of autonomy and indipendence of judgment) with the bureaucratic logic that rules the organisations for which he or she works. Our research objective was to identify the identity variables characterising the specialist doctor ("ideal profile") and analyse the extent to which these differed from the doctor's actual identity ("actual profile"). From a methodological perspective, 1) we used a consensus method approach to identify the variables that define the specialist's identity, and 2) using a national web survey, we checked the distance between such characteristics and these professionals' actual identities. Involving different experts in the field of primary care, we identified 27 identity variables that appear to be at the core of specialist expertise. We then asked a representative sample of specialists to indicate how important and feasible these variables were in their work contexts and identified four main factors characterising their identities. The results demonstrate that, among experts, there is a clear perception of the need to build an identity that is linked to integration and to adopt a heuristic approach through teamwork and networking. However, this differs considerably from the logic of the specialists working in outpatient services: What emerges is the perceived difficulty of operational translation due to organisational problems or, otherwise, the constitutive elements of professional identity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Entrustable Professional Activities (EPAs) have emerged as a new approach to operationalise the workplace performance expectations for the transition from under- to postgraduate medical training. However, the transferability of such EPAs from one context to another appears limited. In this article, we report on the results of our approach to define a full set of core EPAs for entry into residency with the expectation to be performed under distant supervision. Methods: The EPA development involved a modified, three round Delphi study, conducted at the Charité - Universitätsmedizin Berlin. The supervision level was operationalised as supervisor being distantly available and findings being reviewed. The threshold for consent was reaching a content validity index of a least 80%. The Delphi study involved experienced physicians (n=45) and resulted in a set of core EPAs with the descriptions of the categories: title, specification/limitations, conditions and implications of entrustment decision, knowledge, skills, and attitude, link to competencies and assessment sources. Results: The response rates were 76-80% in the Delphi rounds. Key to the content validation process for the performance expectation was deciding on "to act under distant supervision". The results are full descriptions of 12 core EPAs, organised into 5 overarching EPA domains. Conclusions: Our systematic approach yielded the definition of 12 core EPAs for entry into residency at the level of "act with distant supervision" according to the practice in our context. This report may support other medical schools who plan to implement EPAs into their curricula., Competing Interests: The authors declare that they have no competing interests.

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., (Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking., Objective: This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9- to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT)., Methods: The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n=12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n=600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail., Results: As of October 2018, steps 1-3 are complete, and step 4 is underway., Conclusions: Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings., International Registered Report Identifier (irrid): RR1-10.2196/12006., (©Olof Molander, Rachel Volberg, Kristina Sundqvist, Peter Wennberg, Viktor Månsson, Anne H Berman. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 08.01.2019.)

Objectives: The objective of this study was to elicit feedback on consensus methodology used for core outcome set (COS) development., Study Design and Setting: An online survey of international Delphi panelists participating in a recent COS for clinical research studies evaluating acute respiratory failure (ARF) survivors was conducted. Panelists represented 14 countries (56% outside the United States)., Results: Seventy (92%) panelists completed the survey, including 32 researchers, 19 professional association representatives, 4 research funding representatives, and 15 ARF survivors/caregiver members. Among respondents, 91% reported that the time required to participate was appropriate and 96% were not bothered by reminders for timely response. Attributes of measurement instruments and voting results from previous rounds were evaluated differently across stakeholder groups. When measurement properties were explained in the stem of the survey question, 59 (84%) panelists (including 73% of survivors/families) correctly interpreted information about an instrument's reliability. Without a reminder in the stem, only 20 (29%) panelists (including 38% of researchers) correctly identified properties of a COS., Conclusion: This international Delphi panel, including >20% patients/caregivers, favorably reported on feasibility of the methodology. Providing all panelists pertinent information/reminders about the project's objective at each voting round is important to informed decision making across all stakeholder groups., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway., Materials and Methods: Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required., Results: Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy., Conclusions: Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk., (© 2018 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Background: Current ambulance quality and performance measures, such as response times, do not reflect the wider scope of care that services now provide. Using a three-stage consensus process, we aimed to identify new ways of measuring ambulance service quality and performance that represent service provider and public perspectives., Design: A multistakeholder consensus event, modified Delphi study, and patient and public consensus workshop., Setting and Participants: Representatives from ambulance services, patient and public involvement (PPI) groups, emergency care clinical academics, commissioners and policymakers., Results: Nine measures/principles were highly prioritized by >75% of consensus event participants, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to further refine and prioritize measures; 20 measures in three domains scored ≥8/9, indicating good consensus, including proportion of calls correctly prioritized, time to definitive care and measures related to pain. Eighteen patient/public representatives attended a consensus workshop, and six measures were identified as important. These include time to definitive care, response time, reduction in pain scores, calls correctly prioritized to appropriate levels of response and survival to hospital discharge for treatable emergency conditions., Conclusions: Using consensus methods, we identified a shortlist of ambulance outcome and performance measures that are important to ambulance clinicians and service providers, service users, commissioners, and clinical academics, reflecting current pre-hospital ambulance care and services. The measures can potentially be used to assess pre-hospital quality or performance over time, with most calculated using routinely available data., (© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.)

Objectives: The objective of the study was to explore the impact of different feedback strategies on (1) subsequent agreement and (2) variability in Delphi studies., Study Design and Setting: A two-round Delphi survey, with a list of outcomes generated from the results of a systematic review and interviews, was undertaken while developing a core outcomes set for prostate cancer including two stakeholder groups (health professionals and patients). Seventy-nine outcomes were scored on a scale of one (not important) to nine (critically important). Participants were randomized in round 2 to receive round 1 feedback from peers only, multiple stakeholders separately, or multiple stakeholders combined., Results: Agreement on outcomes retained for all feedback groups was high (peer: 92%, multiple separate: 90%, multiple combined: 84%). There were no statistically significant reduction in variability for peer vs. multiple separate (0.016 [-0.035, 0.067]; P = 0.529), or multiple separate vs. multiple combined feedback (0.063 [-0.003, 0.129]; P = 0.062). Peer feedback statistically significantly reduced variability compared with multiple combined feedback (0.079 [0.001, 0.157]; P = 0.046)., Conclusions: We found no evidence of a difference between different feedback strategies in terms of the number of outcomes retained or reduction in variability of opinion. However, this may be explained by the high level of existing agreement in round 1. Further methodological studies nested within Delphi surveys will help clarify the best strategy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The 'Outcome Reporting in Brief Intervention Trials: Alcohol' (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings., Methods/design: An international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI., Discussion: ORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.

Background: The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes., Methods: The 'Core Outcome Measures in Tinnitus: International Delphi' (COMIT'ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication., Discussion: The COMIT'ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term., Trial Registration: This project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative.

Introduction: Crohn's disease (CD) and ulcerative colitis (UC), the main forms of inflammatory bowel disease (IBD), are chronic, progressive and disabling disorders of the gastrointestinal tract. Although data from randomised controlled trials (RCTs) provide the foundation of evidence that validates medical therapy for IBD, considerable heterogeneity exists in the measured outcomes used in these studies. Furthermore, in recent years, there has been a paradigm shift in IBD treatment targets, moving from symptom-based scoring to improvement or normalisation of objective measures of inflammation such as endoscopic appearance, inflammatory biomarkers and histological and radiographic end points. The abundance of new treatment options and evolving end points poses opportunities and challenges for all stakeholders involved in drug development. Accordingly, there exists a need to harmonise measures used in clinical trials through the development of a core outcome set (COS)., Methods and Analysis: The development of an IBD-specific COS includes four steps. First, a systematic literature review is performed to identify outcomes previously used in IBD RCTs. Second, semistructured qualitative interviews are conducted with key stakeholders, including patients, clinicians, researchers, pharmaceutical industry representatives, healthcare payers and regulators to identify additional outcomes of importance. Using the outcomes generated from literature review and stakeholder interviews, an international two-round Delphi survey is conducted to prioritise outcomes for inclusion in the COS. Finally, a consensus meeting is held to ratify the COS and disseminate findings for application in future IBD trials., Ethics and Dissemination: Given that over 30 novel therapeutic compounds are in development for IBD treatment, the design of robust clinical trials measuring relevant and standardised outcomes is crucial. Standardising outcomes through a COS will reduce heterogeneity in trial reporting, facilitate valid comparisons of new therapies and improve clinical trial quality., Competing Interests: Competing interests: CM has no conflicts of interest to declare. RP has received scientific advisory board fees from Abbott/AbbVie, Amgen, Janssen, Merck, Pfizer, Prometheus Laboratories, Salix Pharma, Shire, Takeda, WarnerChilcott; consulting fees from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca,Baxter, BMS, Centocor, Elan/Biogen, Eisai, Ferring, GSK, Janssen, Merck,Millennium, Pfizer, Proctor & Gamble, Prometheus Therapeutics andDiagnostics, Schering-Plough, Shire, Takeda, UCB Pharma, Warner Chilcott;research grants from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca, Baxter, BMS,Centocor, Eisai, Elan/Biogen, Ferring, GSK, Janssen, Merck, Millennium, Pfizer,Proctor & Gamble, Prometheus, Shire, Schering-Plough, Takeda, UCB Pharma,Warner Chilcott; and 495 speaker’s bureau fees from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca, Baxter, BMS, Centocor, Eisai, Elan/Biogen, Ferring, GSK, Janssen, Merck, Millennium, Pfizer, Proctor & Gamble, Prometheus, Schering-Plough, Shire, Takeda, UCB Pharma, Warner Chilcott. RF has received scientific advisory board fees from Abbott/AbbVie, Celltrion, Ferring, Janssen, Shire, VSL#3; consulting fees from Abbott/AbbVie, Celltrion, Ferring, Janssen, Shire, VSL#3; and research grant support from Abbott/AbbVie, Alba Therapeutics, BMS, Celltrion, Centocor, Genentech, GSK, Janssen, Merck, Millennium, Novartis, Pfizer, Proctor & Gamble, Roche, VSL#3. CP has no conflicts of interest todeclare. RK has received consulting fees from AbbVie, Takeda, and Janssen. BL has received consulting fees from AbbVie, Takeda, Nestle Health Sciences, and Prometheus Labs. WS has served as a consultant to AbbVie Inc., ActoGeniX NV,AGI Therapeutics, Inc, Alba Therapeutics Corporation, Albireo, Alfa Wasserman, Amgen, AM-Pharma BV, Anaphore, Astellas Pharma, Athersys, Inc, AtlanticHealthcare Limited, Axcan Pharma (now Aptalis), BioBalance Corporation,Boehringer-Ingelheim Inc, Bristol Meyers Squibb, Celgene, CelekPharmaceuticals, Cellerix SL, Cerimon Pharmaceuticals, ChemoCentryx, CoMentis,Cosmo Technologies, Coronado Biosciences, Cytokine Pharmasciences, EaglePharmaceuticals, Eisai Medical Research Inc, Elan Pharmaceuticals, EnGene, Inc,Eli Lilly, Enteromedics, Exagen Diagnostics, Inc, Ferring Pharmaceuticals,Flexion Therapeutics, Inc, Funxional Therapeutics Limited, Genzyme Corporation, Genentech (now Roche), Gilead Sciences, Given Imaging, Glaxo Smith Kline, HumanGenome Sciences, Ironwood Pharmaceuticals (previously Microbia Inc), Janssen(previously Centocor), KaloBios Pharmaceuticals, Inc, Lexicon Pharmaceuticals,Lycera Corporation, Meda Pharmaceuticals (previously Alaven Pharmaceuticals), Merck Research Laboratories, MerckSerono, Millennium Pharmaceuticals(subsequently merged with Takeda), Nisshin Kyorin Pharmaceuticals Co, Ltd, NovoNordisk A/S, NPS Pharmaceuticals, Optimer Pharmaceuticals, OrexigenTherapeutics, Inc, PDL Biopharma, Pfizer, Procter and Gamble, PrometheusLaboratories, ProtAb Limited, Purgenesis Technologies, Inc, Receptos, Relypsa,Inc, Salient Pharmaceuticals, Salix Pharmaceuticals, Inc, Santarus, ScheringPlough Corporation (acquired by Merck), Shire Pharmaceuticals, Sigmoid PharmaLimited, Sirtris Pharmaceuticals, Inc (a GSK company), SLA Pharma (UK) Limited,Targacept, Teva Pharmaceuticals, Therakos, Tillotts Pharma AG (acquired by Zeria Pharmaceutical Co, Ltd), TxCell SA, UCB Pharma, Viamet Pharmaceuticals,Vascular Biogenics Limited (VBL), Warner Chilcott UK Limited; has receivedspeaker’s fees from AbbVie Inc, Bristol Meyers Squibb and Janssen (previously Centocor); and financial support for research from AbbVie Inc, Bristol Meyers Squibb, Genentech, Glaxo Smith Kline, Janssen (previously Centocor), Millennium Pharmaceuticals (now Takeda), Novartis, Pfizer, Procter and Gamble Pharmaceuticals, Shire Pharmaceuticals and UCB Pharma. Brian Feagan hasreceived grant/research support from Millennium Pharmaceuticals, Merck,Tillotts Pharma AG, AbbVie, Novartis Pharmaceuticals, Centocor Inc, Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGenix and Wyeth Pharmaceuticals Inc; consulting fees from Millennium Pharmaceuticals, Merck, Centocor Inc, Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-MyersSquibb, Celgene, UCB Pharma, AbbVie, Astra Zeneca, Serono, Genentech, TillottsPharma AG, Unity Pharmaceuticals, Albireo Pharma, Given Imaging Inc, Salix Pharmaceuticals, Novonordisk, GSK, Actogenix, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma Inc and Sigmoid Pharma; and speakers bureau fees from UCB, AbbVie and J&J/Janssen. VJ has received scientific advisory board feesfrom AbbVie, Sandoz, Takeda, Janssen; speakers fees from Takeda, Janssen,Shire, Ferring., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: Evaluating an existing suite of health system performance (HSP) indicators for continued reporting using a systematic criteria-based assessment and national consensus conference., Design: Modified Delphi approach with technical and leadership groups, an online survey of stakeholders and convening a national consensus conference., Setting: A national health information steward, the Canadian Institute for Health Information (CIHI)., Participants: A total of 73 participants, comprised 61 conference attendants/stakeholders from across Canada and 12 national health information steward staff., Primary and Secondary Outcome Measures: Indicator dispositions of retention, additional stakeholder consultation, further redevelopment or retirement., Results: 4 dimensions (usability, importance, scientific soundness and feasibility) typically used to select measures for reporting were expanded to 18 criteria grouped under the 4 dimensions through a process of research and testing. Definitions for each criterion were developed and piloted. Once the definitions were established, 56 of CIHI's publicly reported HSP indicators were evaluated against the criteria using modified Delphi approaches. Of the 56 HSP indicators evaluated, 9 measures were ratified for retirement, 7 were identified for additional consultation and 3 for further research and development. A pre-Consensus Conference survey soliciting feedback from stakeholders on indicator recommendations received 48 responses (response rate of 79%)., Conclusions: A systematic evaluation of HSP indicators informed the development of objective recommendations for continued reporting. The evaluation was a fruitful exercise to identify technical considerations for calculating indicators, furthering our understanding of how measures are used by stakeholders, as well as harmonising actions that could be taken to ensure relevancy, reduce indicator chaos and build consensus with stakeholders., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Patients with moderate-to-severe atopic eczema (AE) often require photo- or systemic immunomodulatory therapies to induce disease remission and maintain long-term control. The current evidence to guide clinical management is small, despite the frequent and often off-label use of these treatments. Registries of patients on photo- and systemic immunomodulatory therapies could fill this gap, and the collection of a core set concerning these therapies in AE will allow direct comparisons across registries as well as data sharing and pooling. Using an eDelphi approach, the international TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek consensus between key stakeholders internationally on a core set of domains and domain items for AE patient registries with a research focus that collect data of children and adults on photo- and systemic immunomodulatory therapies., Methods/design: Participants from six stakeholder groups will be invited: doctors, nurses, non-clinical researchers, patients, as well as industry and regulatory body representatives. The eDelphi will comprise three sequential online rounds, requesting participants to rate the importance of each proposed domain and domain items. Participants will be able to add domains and domain items to the proposed list in round 1. A final consensus meeting will be held with representatives of each stakeholder group., Discussion: Identifying a uniform core set of domains and domain items to be captured by AE patient registries will increase the utility of individual registries, and provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies to guide clinical management across dermatology centres and country borders., Trial Registration: Not applicable. This eDelphi study was registered in the Core Outcome Measures for Effectiveness Trials (COMET) database.

Introduction: There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy., Methods: This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania., Results: A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.', Conclusions: The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science., Competing Interests: Conflicts of interest:The authors report no conflicts of interest.

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

In the last few years, several statistically consistent consensus methods for species tree inference have been devised that are robust to the gene tree discordance caused by incomplete lineage sorting in unstructured ancestral populations. One source of gene tree discordance that has only recently been identified as a potential obstacle for phylogenetic inference is ancestral population structure. In this article, we describe a general model of ancestral population structure, and by relying on a single carefully constructed example scenario, we show that the consensus methods Democratic Vote, STEAC, STAR, R(∗) Consensus, Rooted Triple Consensus, Minimize Deep Coalescences, and Majority-Rule Consensus are statistically inconsistent under the model. We find that among the consensus methods evaluated, the only method that is statistically consistent in the presence of ancestral population structure is GLASS/Maximum Tree. We use simulations to evaluate the behavior of the various consensus methods in a model with ancestral population structure, showing that as the number of gene trees increases, estimates on the basis of GLASS/Maximum Tree approach the true species tree topology irrespective of the level of population structure, whereas estimates based on the remaining methods only approach the true species tree topology if the level of structure is low. However, through simulations using species trees both with and without ancestral population structure, we show that GLASS/Maximum Tree performs unusually poorly on gene trees inferred from alignments with little information. This practical limitation of GLASS/Maximum Tree together with the inconsistency of other methods prompts the need for both further testing of additional existing methods and development of novel methods under conditions that incorporate ancestral population structure., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Diagnosing a patient's condition is one of the most important and challenging tasks in medicine. We present a study of the application of collective intelligence in medical diagnosis by applying consensus methods. We compared the accuracy obtained with this method against the diagnostics accuracy reached through the knowledge of a single expert. We used the ontological structures of ten diseases. Two knowledge bases were created by placing five diseases into each knowledge base. We conducted two experiments, one with an empty knowledge base and the other with a populated knowledge base. For both experiments, five experts added and/or eliminated signs/symptoms and diagnostic tests for each disease. After this process, the individual knowledge bases were built based on the output of the consensus methods. In order to perform the evaluation, we compared the number of items for each disease in the agreed knowledge bases against the number of items in the GS (Gold Standard). We identified that, while the number of items in each knowledge base is higher, the consensus level is lower. In all cases, the lowest level of agreement (20%) exceeded the number of signs that are in the GS. In addition, when all experts agreed, the number of items decreased. The use of collective intelligence can be used to increase the consensus of physicians. This is because, by using consensus, physicians can gather more information and knowledge than when obtaining information and knowledge from knowledge bases fed or populated from the knowledge found in the literature, and, at the same time, they can keep updated and collaborate dynamically., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how 'consensus' is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of 'experts.' Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.

Objective: To assess review completion rates, RADPEER score distribution, and sources of disagreement when using a workstation-integrated radiology peer review program, and to evaluate radiologist perceptions of the program., Design: Retrospective review of prospectively collected data., Setting: Large private outpatient radiology practice., Participants: Radiologists (n = 66) with a mean of 16.0 (standard deviation, 9.2) years of experience., Interventions: Prior studies and reports of cases being actively reported were randomly selected for peer review using the RADPEER scoring system (a 4-point scale, with a score of 1 indicating agreement and scores of 2-4 indicating increasing levels of disagreement)., Main Outcome Measures: Assigned peer review completion rates, review scores, sources of disagreement and radiologist survey responses., Results: Of 31 293 assigned cases, 29 044 (92.8%; 95% CI 92.5-93.1%) were reviewed. Discrepant scores (score = 2, 3 or 4) were given in 0.69% (95% CI 0.60-0.79%) of cases and clinically significant discrepancy (score = 3 or 4) was assigned in 0.42% (95% CI 0.35-0.50%). The most common cause of disagreement was missed diagnosis (75.2%; 95% CI 66.8-82.1%). By anonymous survey, 94% of radiologists felt that peer review was worthwhile, 90% reported that the scores they received were appropriate and 78% felt that the received feedback was valuable., Conclusion: Workstation-based peer review can increase completion rates and levels of radiologist acceptance while producing RADPEER scores similar to those previously reported. This approach may be one way to increase radiologist engagement in peer review quality assurance., (© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.)

Species tree estimation is complicated by processes, such as gene duplication and loss and incomplete lineage sorting (ILS), that cause discordance between gene trees and the species tree. Furthermore, while concatenation, a traditional approach to tree estimation, has excellent performance under many conditions, the expectation is that the best accuracy will be obtained through the use of species tree estimation methods that are specifically designed to address gene tree discordance. In this article, we report on a study to evaluate MP-EST-one of the most popular species tree estimation methods designed to address ILS-as well as concatenation under maximum likelihood, the greedy consensus, and two supertree methods (Matrix Representation with Parsimony and Matrix Representation with Likelihood). Our study shows that several factors impact the absolute and relative accuracy of methods, including the number of gene trees, the accuracy of the estimated gene trees, and the amount of ILS. Concatenation can be more accurate than the best summary methods in some cases (mostly when the gene trees have poor phylogenetic signal or when the level of ILS is low), but summary methods are generally more accurate than concatenation when there are an adequate number of sufficiently accurate gene trees. Our study suggests that coalescent-based species tree methods may be key to estimating highly accurate species trees from multiple loci., (© The Author(s) 2014. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)