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Expert disagreement

Natalia Olchanski, Ryan N Hansen, Elle Pope, Brittany D'Cruz, Jaime Fergie, Mitchell Goldstein, Leonard R Krilov, Kimmie K McLaurin, Barbara Nabrit-Stephens, Gerald Oster, Kenneth Schaecher, Fadia T Shaya, Peter J Neumann, Sean D Sullivan
Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts...
March 2018: Open Forum Infectious Diseases
David R M Smith, F Christiaan K Dolk, Koen B Pouwels, Morag Christie, Julie V Robotham, Timo Smieszek
Objectives: To assess the appropriateness of prescribing systemic antibiotics for different clinical conditions in primary care, and to quantify 'ideal' antibiotic prescribing proportions in conditions for which antibiotic treatment is sometimes but not always indicated. Methods: Prescribing guidelines were consulted to define the appropriateness of antibiotic therapy for the conditions that resulted in antibiotic prescriptions between 2013 and 2015 in The Health Improvement Network (THIN) primary care database...
February 1, 2018: Journal of Antimicrobial Chemotherapy
Dominique Hansen, Gustavo Rovelo Ruiz, Patrick Doherty, Marie-Christine Iliou, Tom Vromen, Sally Hinton, Ines Frederix, Matthias Wilhelm, Jean-Paul Schmid, Ana Abreu, Marco Ambrosetti, Esteban Garcia-Porrero, Karin Coninx, Paul Dendale
Background Although disease-specific exercise guidelines for cardiovascular disease (CVD) are widely available, it remains uncertain whether these different exercise guidelines are integrated properly for patients with different CVDs. The aim of this study was to assess the inter-clinician variance in exercise prescription for patients with various CVDs and to compare these prescriptions with recommendations from the EXercise Prescription in Everyday practice and Rehabilitative Training (EXPERT) tool, a digital decision support system for integrated state-of-the-art exercise prescription in CVD...
January 1, 2018: European Journal of Preventive Cardiology
Fanny Sampurno, Jia Zheng, Lydia Di Stefano, Jeremy L Millar, Claire Foster, Ferran Fuedea, Celestia Higano, Hartwig Hulan, Stephen Mark, Caroline Moore, Alison Richardson, Frank Sullivan, Neil S Wenger, Daniela Wittmann, Sue Evans
PURPOSE: To develop a core set of clinical indicators that enables international benchmarking of localised prostate cancer management using data available in the TrueNTH Global Registry. MATERIALS AND METHODS: An international expert panel completed an online survey and participated in a face-to-face meeting. Participants included urologists (n=3), radiation oncologists (n=3), psychologists (n=2), medical oncologist (n=1), nurse (n=1) and an epidemiologist (n=1) with prostate cancer expertise from seven countries...
February 22, 2018: Journal of Urology
James Pavela, Rahul Suresh, Rebecca S Blue, Charles H Mathers, L Maria Belalcazar
OBJECTIVE: Individuals with diabetes are increasingly seeking pretravel advice, but updated professional recommendations remain scant. We performed a systematic review on diabetes management during air travel to summarize current recommendations, assess supporting evidence, and identify areas of future research. METHODS: A systematic review of the English literature on diabetes management during air travel was undertaken utilizing PubMed and MEDLINE. Publications regarding general travel advice; adjustment of insulin and noninsulin therapies; and the use of insulin pumps, glucometers and subcutaneous glucose sensors at altitude were included...
February 2018: Endocrine Practice
Lisa S Rotenstein, Alexander O Kerman, Joseph Killoran, Tracy A Balboni, Monica S Krishnan, Allison Taylor, Neil E Martin
PURPOSE: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a pathway tool on SFRT rates in an academic radiation oncology practice. METHODS AND MATERIALS: Using published literature, clinical guidelines, and expert input, we designed a clinical pathway for bone metastases radiation therapy displayed on a Web-based electronic interface...
December 8, 2017: Practical Radiation Oncology
S A Zafirah, Amrizal Muhammad Nur, Sharifa Ezat Wan Puteh, Syed Mohamed Aljunid
BACKGROUND: The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. METHODS: Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC)...
January 25, 2018: BMC Health Services Research
Lars Egevad, Brett Delahunt, Dan M Berney, David G Bostwick, John Cheville, Eva Comperat, Andrew J Evans, Samson W Fine, David J Grignon, Peter A Humphrey, Jonas Hörnblad, Kenneth A Iczkowski, James G Kench, Glen Kristiansen, Katia R M Leite, Cristina Magi-Galluzzi, Jesse McKenney, Jon Oxley, Chin-Chen Pan, Hemamali Samaratunga, John R Srigley, Hiroyuki Takahashi, Lawrence D True, Toyonori Tsuzuki, Theo van der Kwast, Murali Varma, Ming Zhou, Mark Clements
AIMS: Despite efforts to standardize grading of prostate cancer, there is still a considerable variation in grading practices even among experts. In this study we describe the use of Pathology Imagebase, a novel reference image library, for setting an international standard in prostate cancer grading. METHODS AND RESULTS: The International Society of Urological Pathology (ISUP) recently launched a reference image database supervised by experts. A panel of 24 international experts in prostate pathology independently reviewed microphotographs of 90 cases of prostate needle biopsies with cancer...
January 23, 2018: Histopathology
Mahmood Nekoei-Moghadam, Mohammadreza Amiresmaili, Mohammadhosein Iranemansh, Mahla Iranmanesh
BACKGROUND: According to published evidence, accreditation is one of the evaluating tools in health care organizations. But, there is disagreement among authorities and experts in this regard. This study aims to investigate the evaluation of hospital accreditation in an Iranian context. METHODS: In this qualitative study, a purposive sample of 170 informants was used. Semi-structured interviews were conducted to gather data, which were analyzed using a framework analysis method...
January 8, 2018: International Journal of Health Planning and Management
Shamala Ayadurai, V Bruce Sunderland, Lisa Bg Tee, H Laetitia Hattingh
BACKGROUND: Studies on a structured method used by pharmacists to provide comprehensive, evidence-based diabetes care are lacking. The aim of this study was to prioritise, rank and construct validate indicators categorised as seven treatment factors utilised in the management of diabetes namely: cholesterol, blood pressure and glycaemia control; medication and lifestyle management; cardiovascular risk strategies and education using the Delphi process. METHODS: A Delphi questionnaire consisted of 29 Part 1 and nine Part 2 indicators which were incorporated into a tool called Simpler™...
December 14, 2017: Current Diabetes Reviews
Kamal K Mahawar, Jacques Himpens, Scott A Shikora, Jean-Marc Chevallier, Mufazzal Lakdawala, Maurizio De Luca, Rudolf Weiner, Ali Khammas, Kuldeepak Singh Kular, Mario Musella, Gerhard Prager, Mohammad Khalid Mirza, Miguel Carbajo, Lilian Kow, Wei-Jei Lee, Peter K Small
BACKGROUND: An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS: A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure...
February 2018: Obesity Surgery
Cassiane de Santana Lemos, Vanessa de Brito Poveda, Aparecida de Cassia Giane Peniche
OBJECTIVE: To construct and validate a nursing care protocol in anesthesia. METHOD: methodological study of face and content validation, judging clarity, relevance, pertinence and comprehensiveness of a care protocol, elaborated from the integrative review of previous literature and based on the conceptual model of assistance perioperative nursing of Castellanos and Jouclas. The protocol was evaluated by five anesthesiologists and nurses from the surgical center...
December 11, 2017: Revista Latino-americana de Enfermagem
Jessica S Merlin, Sarah R Young, Joanna L Starrels, Soraya Azari, E Jennifer Edelman, Jamie Pomeranz, Payel Roy, Shalini Saini, William C Becker, Jane M Liebschutz
BACKGROUND: Current guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed. OBJECTIVE: To establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT. DESIGN: We used a Delphi approach, which allows for generation of consensus...
February 2018: Journal of General Internal Medicine
Joanna Rachel Doley, Laura Merilyn Hart, Arthur Anthony Stukas, Amy Joanna Morgan, Danielle Lisa Rowlands, Susan Jessica Paxton
Background: Concerns exist around how to talk about eating disorders (EDs) due to evidence that suggests discussing ED symptoms and behaviours may cause or worsen symptoms in vulnerable people. Using expert consensus, we developed a set of guidelines for giving safe community presentations about EDs. Methods: Participants with professional ED expertise, and people with lived experience of an ED, were recruited for a Delphi study. N  = 26 panel members rated 367 statements for both a) inclusion in guidelines, and b) their potential to be helpful (increase knowledge, reduce stigma) or harmful (increase stigma, cause/worsen ED symptoms)...
2017: Journal of Eating Disorders
T Numan, M van den Boogaard, A M Kampen, P J T Rood, L M Peelen, A J C Slooter
OBJECTIVE: To determine the degree of agreement between delirium experts on the diagnosis of delirium based on exactly the same information, and to assess the sensitivity of delirium screening methods used by clinical nurses. DESIGN: Prospective observational longitudinal study. METHOD: Older patients (≥ 60 years) who underwent major surgery were included. During the first three days after surgery they had a standardised cognitive screening test which was recorded on video...
2017: Nederlands Tijdschrift Voor Geneeskunde
Luke Wolfenden, Nicole K Nathan, Rachel Sutherland, Sze Lin Yoong, Rebecca K Hodder, Rebecca J Wyse, Tessa Delaney, Alice Grady, Alison Fielding, Flora Tzelepis, Tara Clinton-McHarg, Benjamin Parmenter, Peter Butler, John Wiggers, Adrian Bauman, Andrew Milat, Debbie Booth, Christopher M Williams
BACKGROUND: A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES: The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use...
November 29, 2017: Cochrane Database of Systematic Reviews
X Nogués, J M Nolla, E Casado, E Jódar, M Muñoz-Torres, J M Quesada-Gómez, L Canals, M Balcells, L Lizán
To reach a Spanish expert consensus on a treat-to-target strategy in osteoporosis, a Delphi Consensus Study has been developed. Most of the experts (59.8%) were rheumatologist with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items. Therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been defined. INTRODUCTION: The paper aims to achieve a Spanish expert consensus on a treat-to-target (T2T) strategy in osteoporosis...
February 2018: Osteoporosis International
A Biedermann, S Bozza, F Taroni, C Aitken
In this paper we reply to recent comments in this Special Issue according to which subjective probability is not considered to be a concept fit for use in forensic evaluation and expert reporting. We identify the source of these criticisms to lie in a misunderstanding of subjective probability as unconstrained subjective probability; a lack of constraint that neither corresponds to the way in which we referred to subjective probability in our previous contributions, nor to the way in which probability assignment is understood by current evaluative guidelines (e...
November 2017: Science & Justice: Journal of the Forensic Science Society
Huan Yu Xie, Dan Feng, Dong Mei Wei, Ling Mei, Hui Chen, Xun Wang, Fang Fang
BACKGROUND: Vulvovaginal candidiasis (VVC) is estimated to be the second most common form of infection after bacterial vaginosis. The ability of probiotics in maintaining and recovering the normal vaginal microbiota, and their potential ability to resist Candidas give rise to the concept of using probiotics for the treatment of VVC. OBJECTIVES: To assess the effectiveness and safety of probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women...
November 23, 2017: Cochrane Database of Systematic Reviews
Myat Su Yin, Peter Haddawy, Siriwan Suebnukarn, Phattanapon Rhienmora
BACKGROUND AND OBJECTIVE: We address the problem of automated outcome assessment in a virtual reality (VR) simulator for endodontic surgery. Outcome assessment is an essential component of any system that provides formative feedback, which requires assessing the outcome, relating it to the procedure, and communicating in a language natural to dental students. This study takes a first step toward automated generation of such comprehensive feedback. METHODS: Virtual reference templates are computed based on tooth anatomy and the outcome is assessed with a 3D score cube volume which consists of voxel-level non-linear weighted scores based on the templates...
January 2018: Computer Methods and Programs in Biomedicine
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