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BACKGROUND: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.
METHODS: These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels.
RESULTS: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts.
CONCLUSIONS: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.

OBJECTIVE: The use of digital technology in surgery is increasing rapidly, with a wide array of new applications from presurgical planning to postsurgical performance assessment. Understanding the clinical and economic value of these technologies is vital for making appropriate health policy and purchasing decisions. We explore the potential value of digital technologies in surgery and produce expert consensus on how to assess this value.
METHODS: A modified Delphi and consensus conference approach was adopted. Delphi rounds were used to generate priority topics and consensus statements for discussion.
METHODS: An international panel of 14 experts was assembled, representing relevant stakeholder groups: clinicians, health economists, health technology assessment experts, policy-makers and industry.
METHODS: A scoping questionnaire was used to generate research questions to be answered. A second questionnaire was used to rate the importance of these research questions. A final questionnaire was used to generate statements for discussion during three consensus conferences. After discussion, the panel voted on their level of agreement from 1 to 9; where 1=strongly disagree and 9=strongly agree. Consensus was defined as a mean level of agreement of >7.
RESULTS: Four priority topics were identified: (1) how data are used in digital surgery, (2) the existing evidence base for digital surgical technologies, (3) how digital technologies may assist surgical training and education and (4) methods for the assessment of these technologies. Seven consensus statements were generated and refined, with the final level of consensus ranging from 7.1 to 8.6.
CONCLUSIONS: Potential benefits of digital technologies in surgery include reducing unwarranted variation in surgical practice, increasing access to surgery and reducing health inequalities. Assessments to consider the value of the entire surgical ecosystem holistically are critical, especially as many digital technologies are likely to interact simultaneously in the operating theatre.

BACKGROUND: Clinicians from multiple professional backgrounds are increasingly using point-of-care ultrasound in clinical practice. Performing ultrasound is a complex skill, and training is required to ensure competency and patient safety. There is a lack of skilled trainers within health professions to meet this increasing educational demand. The role of sonographers in educating other health professionals in point-of-care ultrasound has not yet been well defined. Sonographers can provide ultrasound education interprofessionally, if equipped with appropriate clinical knowledge and educational skills.
METHODS: A Delphi consensus study was conducted to define the knowledge, skills and attributes required of sonographers teaching point-of-care ultrasound to other health professionals in Australia and New Zealand. Health professionals with subject matter expertise in the leadership, facilitation, and delivery of ultrasound education by sonographers were invited to participate.
RESULTS: There were 72 expert participants in survey round one, and 49 in round two. Participants included physicians, sonographers, and other health professionals. Consensus was reached on 31 competency items for sonographers teaching ultrasound interprofessionally, with agreement of greater than 94% reached by participants.
CONCLUSIONS: This consensus study has defined the knowledge, skills and attitudes required for sonographer competence in point-of-care ultrasound education. This is an important step to developing a training pathway for sonographers engaging in this emerging area.

As a sensitive and non-invasive method for assessing changes in renal cortical blood perfusion in the elderly, contrast-enhanced ultrasound (CEUS) can indirectly reflect changes in kidney filtration and reabsorption function, thus providing feasibility for early evaluation of renal function changes. However, significant differences exist among researchers in terms of operational methods, contrast agent selection, post-data analysis, and many other aspects, leading to substantial heterogeneity in results. This hinders horizontal comparisons and greatly limits the clinical application of contrast-enhanced ultrasound for evaluating renal cortical blood flow perfusion. Based on the latest domestic and overseas literature and discussions with clinical experts, this consensus provides recommended guidelines for the evaluation of renal cortical blood flow perfusion using contrast-enhanced ultrasound. It is hoped that this consensus will promote a better understanding of CEUS among medical practitioners at all levels and standardize the examination of renal cortical blood flow perfusion with CEUS.

The French National Animal Health Surveillance Platform (NAHSP) was created in 2011. This network of animal health stakeholders was set up to improve surveillance efficiency for all health risks that threaten animal health, as well as zoonoses affecting human health. The NAHSP steering committee decides on the strategies and program of activities. It is composed of 11 institutions from both public and private sectors (policy-makers, scientific institutions, and representatives of farmers, veterinarians, hunters, and laboratories). A coordination team guarantees the implementation of the program and facilitates the activities of different working groups (WGs). Each WG is composed of technical experts with scientific, legal, and field knowledge from the sectors of animal health (livestock, companion animals, and wildlife), human health, and environmental health. Some WGs focus on a specific disease or health indicator, such as African swine fever or cattle mortality, while others cover cross-cutting topics, such as epidemic intelligence (EI), or specialize in aiding epidemiological investigations, such as the Q fever WG. The NAHSP stands out for its innovative approach because it is based on the concepts of consensus-building among participants, fostering collaboration, and embracing interdisciplinarity. Each proposal designed to improve surveillance is jointly developed by all the stakeholders involved, thereby ensuring its sustainability and acceptability among stakeholders. This process also has added value for decision-makers. As a pioneer platform, the NAHSP inspired the creation of two additional national surveillance platforms in 2018, one for plant health and the other for food chain safety. Both are organized in the same way as the NAHSP, which created a framework to place the emphasis on a One Health approach. For instance, four WGs are common to the three national surveillance platforms. This article aims to present this innovative approach to improve surveillance efficiency that could be of interest to other European countries or that could be rolled out at the European level.

UNASSIGNED: Clinical acupuncture decisions are highly operator-dependent and require physician-patient interactions. The Delphi method allows subjective factors such as expert experience and preference of patients to be taken into account in clinical decision making, which is particularly applicable to acupuncture. Currently, the Delphi method is widely used to support clinical decisions in acupuncture. Therefore, it is necessary to provide high-quality and complete descriptions of the Delphi process when making clinical decisions. This study aims to evaluate the quality of the Delphi process in acupuncture, facilitate its standardization and rigor for further clinical decision making in acupuncture.
UNASSIGNED: Articles sourced from six databases were searched systematically to assess the quality of the Delphi consensus process based on the standards for conducting and reporting Delphi studies (CREDES). Descriptive statistics and analysis were presented according to the percentage of each item. Five-score Likert scale was used to evaluate the reporting quality of four domains as well as each item in CREDES by two independent researchers, combined with ICC-value to assess the consistency.
UNASSIGNED: A total of 37 qualified articles were included according to eligibility criteria. As for the low reporting rate, the item \"External validation\" was reported as the lowest positive rate at 32.43% and the item \"Prevention of bias\" was 48.65%. The item \"Adequacy of conclusions\", \"Definition and attainment of consensus\", and \"Discussion of limitations\" were reported at a positive ratio of 62.16%, 64.86%, and 67.57% individually. The average scores of the four domains based on CREDES from highest to lowest were, respectively, as follows: planning and design (68.75%), reporting (66.07%), rationale for the choice of the Delphi technique (65.54%), study conduct (45.10%).
UNASSIGNED: The reporting quality of the Delphi consensus process in acupuncture is acceptable currently, but the reporting rate on some items is still low. Further standardization, including either clearer checklists or study reports, should be developed and strengthened to guide clinical decisions in acupuncture.

BACKGROUND: Effective risk communication about medicines is crucial to the success of all pharmacovigilance activities but remains a worldwide challenge. Risk communication has been conducted in Malaysia for decades, yet awareness on the communication methods remains low among healthcare professionals. While international guidelines are available, clear guidance on effectively communicating the risks of medicines in specific countries is scarce. This study aimed to establish a consensus on the priority strategies for enhancing risk communication about medicines by regulators.
METHODS: We conducted a two-round modified Delphi survey among local and international communication experts, and also recipients of medicines risk communication in Malaysia. We developed a list of 37 strategies based on the findings of our previous studies. In Round 1, participants were asked to rate the priority for each strategy using a 5-point Likert scale and suggest additional strategies via free-text comments. Strategies scoring a mean of ≥ 3.75 were included in Round 2. We defined consensus for the final list of strategies a priori as > 75% agreement. Data were analysed using descriptive statistics and thematic analysis.
RESULTS: Our final Delphi panel (n = 39, 93% response rate) comprised medicines communication experts from nine countries and Malaysian healthcare professionals. Following Round 1, we dropped 14 strategies and added 11 strategies proposed by panellists. In the second round, 21 strategies achieved consensus. The priority areas identified were to improve the format and content of risk communication, increase the use of technology, and increase collaboration with various stakeholders. Priority ratings for the strategy \"to offer incentives to pharmaceutical companies which maintain effective communication systems\" were significantly higher among recipients compared to communicators [χ2(1, N = 39) = 10.1; p = 0.039] and among local versus international panellists [χ2(1, N = 39) = 14.3; p = 0.007].
CONCLUSIONS: Our study identified 21 priority strategies, which were used to develop a strategic plan for enhancing medicines risk communication. This plan is potentially adaptable to all countries with developing pharmacovigilance systems. The difference in views between communicators and recipients, as well as local and international panellists, highlights the importance of involving multiple stakeholders in research.

OBJECTIVE: The objective of this study was to validate the main therapies used in the treatment of heart failure through a clinical consensus conducted by cardiology experts in Colombia.
METHODS: The Delphi technique was employed, which involves a series of consultation rounds with experts to reach a consensus. Cardiologists with experience in HF treatment were selected, and they were sent electronic questionnaires to assess the relevance of various therapeutic interventions. Consensus was defined when at least 70% of the experts agreed on the relevance of an intervention.
RESULTS: Fourteen cardiology experts participated in the study. In the first round, nine therapeutic interventions were evaluated, but insufficient agreement was reached to form a consensus. A second round was conducted, where feedback was provided to the experts, and they were asked to rate the relevance of the interventions using a Likert scale. Consensus was achieved for eight of the evaluated therapeutic interventions. The focus of the third round was on the interventions that had not reached consensus in the previous rounds.
CONCLUSIONS: This study provides clinical consensus on therapeutic interventions for HF in Colombia. Nine therapeutic interventions were identified as relevant by the experts. These findings can help improve HF treatment and optimize clinical outcomes in Colombia. It is important to note that this study was conducted with local experts, and the results may not be generalizable to other populations.

Endo-periodontal lesions (EPLs) involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms, including unique anatomical and microbiological characteristics and multiple contributing factors. This etiological complexity leads to difficulties in determining patient prognosis, posing great challenges in clinical practice. Furthermore, EPL-affected teeth require multidisciplinary therapy, including periodontal therapy, endodontic therapy and others, but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy. By compiling the most recent findings on the etiology, pathogenesis, clinical characteristics, diagnosis, therapy, and prognosis of EPL-affected teeth, this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.