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Background: Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province‐wide standardized clinical care pathway based on evidence‐based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision‐making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management. Methods: A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision‐making tool. Forty‐seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results: A province‐wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision‐making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history‐taking, physical examination, patient education, and management. Conclusions: This clinical decision‐making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision‐making for primary care providers in both public and private sectors. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. Introduction: Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. Methods: We developed 73 evidence‐based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. Results: The 29‐item RMOS was developed. Forty‐three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. Conclusion: We have a developed an evidence‐based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia‐friendly version to promote inclusivity. Patient or Public Involvement: Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults. Design: Consensus study. Method: A modified nominal group technique, incorporating expert group face‐to‐face interaction, review of existing evidence and pre/post‐meeting questionnaire completion was undertaken November 2019–February 2020. Results: Seventy‐one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care. [ABSTRACT FROM AUTHOR]

Background: Developing a shared agenda is an important step in ensuring future research has the necessary relevance.Objective: To characterise research priority setting partnerships (PSPs) relevant to women's health.Search Strategy: Included studies were identified by searching MEDLINE and the James Lind Alliance (JLA) database.Selection Criteria: Priority setting partnerships using formal consensus methods.Data Collection and Analysis: Descriptive narrative to describe the study characteristics, methods, and results.Main Results: Ten national and two international PSPs were identified. All PSPs used the JLA method to identify research priorities. Nine PSPs had published a protocol. Potential research uncertainties were gathered from guidelines (two studies), Cochrane reviews (five studies), and surveys (12 studies). The number of healthcare professionals (31-287), patients (44-932), and others (33-139) who responded to the survey, and the number of uncertainties submitted (52-4767) varied. All PSPs entered confirmed research uncertainties (39-104) into interim priority setting surveys and healthcare professionals (31-287), patients (44-932), and others (33-139) responded. All PSPs entered a short list of research uncertainties into a consensus development meeting, which enabled healthcare professionals (six to 21), patients (eight to 14), and others (two to 13) to identify research priorities (ten to 15). Four PSPs have published their results.Conclusion: Future research priority setting studies should publish a protocol, use formal consensus development methods, and ensure their methods and results are comprehensively reported.Tweetable Abstract: Research published in @BJOGtweets highlights future research priorities across women's health, including @FertilityTop10, @jamesmnduffy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Biological invasions are a threat to biodiversity, society and the economy. There is an urgent need to provide evidence‐based assessments of the risks posed by invasive alien species (IAS) to prioritize action. Risk assessments underpin IAS policies in many ways: informing legislation; providing justification of restrictions in trade or consumer activities; prioritizing surveillance and rapid response. There are benefits to ensuring consistency in content of IAS risk assessments globally, and this can be achieved by providing a framework of minimum standards as a checklist for quality assurance. From a review of existing risk assessment protocols, and with reference to the requirements of the EU Regulation on IAS (1143/2014) and international agreements including the World Trade Organisation, Convention on Biological Diversity and International Plant Protection Convention, coupled with consensus methods, we identified and agreed upon 14 minimum standards (attributes) a risk‐assessment scheme should include. The agreed minimum standards were as follows: (1) basic species description; (2) likelihood of invasion; (3) distribution, spread and impacts; (4) assessment of introduction pathways; (5) assessment of impacts on biodiversity and ecosystems; (6) Assessment of impact on ecosystem services; (7) assessment of socio‐economic impacts; (8) consideration of status (threatened or protected) of species or habitat under threat; (9) assessment of effects of future climate change; (10) completion possible even when there is a lack of information; (11) documents information sources; (12) provides a summary in a consistent and interpretable form; (13) includes uncertainty; (14) includes quality assurance. In deriving these minimum standards, gaps in knowledge required for completing risk assessments and the scope of existing risk assessment protocols were revealed, most notably in relation to assessing benefits, socio‐economic impacts and impacts on ecosystem services but also inclusion of consideration of climate change. Policy implications. We provide a checklist of components that should be within invasive alien species risk assessments and recommendations to develop risk assessments to meet these proposed minimum standards. Although inspired by implementation of the European Union Regulation on invasive alien species, and as such developed specifically within a European context, the derived framework and minimum standards could be applied globally. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

A common and far-reaching fallacy among physicians is to believe that the terms evidence and knowledge mean the same thing. Evidence means the result(s) of research, whereas knowledge stands for 'true justifiable belief.' This difference becomes obvious when we take a look at the results from different studies on the same issue. Results of studies on the same issue sometimes vary considerably and make it difficult for the physician to know which results are relevant for the patient sitting or lying in front of him. Two examples for illustration; within the last ten years about 600 studies evaluating the diagnostic accuracy of D-Dimer in the diagnosis of venous thrombosis have been published and the values for the sensitivity of the test varies between 70% and 98%. Trial results reporting the effect of steroids on survival in patients with septic shock differ between no effect at all and a significant reduction of mortality. Which of these results should physicians trust? As a consequence the transformation of evidence to knowledge, including the handling of varying and partially contradictory results, could and should be one of the main tasks of academic medicine. The transformation of evidence to knowledge makes the results from research applicable to daily practice. An attempt to accomplish this demand is to synthesize the results of various primary studies in systematic reviews with meta-analyses. The efforts of the Cochrane Collaboration can be mentioned favorably, but some reservations against the assembly line like production of systematic reviews are justified. It is not understandable why primary studies of low methodological quality, rated as such by the reviewers, are still included in systematic reviews. Further, the concern that results from studies with very different patient populations are pooled in systematic reviews pertains. Two approaches to generate medical knowledge that is helpful for physicians will be presented in the lecture for further discussion; the broader utilization of consensus methods, and the derivation of probability functions. Medical knowledge can be defined as 'shared experts belief' and consensus methods (Delphi technique and others) are appropriate to specify these beliefs. Beside consensus a valuable result of a carefully performed consensus process is the precise specification where and why disagreement remains. The ideal form of medical knowledge is a comprehensive set of probability functions, for the diagnostic, the prognostic and the etiognostic domain. These probability functions, stored in cyberspace can be used to calculate the probabilities about the presence of an illness, the future course of an illness and the etiology of an illness. Such probability functions can be derived from harvesting experts' knowledge - the quasi scientific method -, or from patient data - the scientific method. The emerging opportunities in computational science and information technology will make the dream - a comprehensive set of probability functions - to become reality. [ABSTRACT FROM AUTHOR]

PAUL C.L., SANSON-FISHER R., DOUGLAS H.E., CLINTON-MCHARG T., WILLIAMSON A. & BARKER D. (2011) European Journal of Cancer Care, 345-353 Despite the burden of illness associated with haematological cancers, little research is available about improving psychosocial outcomes for this group. Given scarce research funds, it is important to ensure that resources are used strategically for improving their psychosocial well-being. This study aimed to identify the perceptions of professionals, patients and carers regarding prioritising psychosocial research efforts. First, an expert panel's views on priorities for research were identified. This was followed by a web survey to obtain the perceptions of 117 health professionals, patients and carers. The value-weighting survey used points allocation, allowing respondents to indicate the relative priority of each option. A substantial proportion of resources were allocated to patients who were newly diagnosed or receiving treatment. Less priority was given to other stages of the cancer journey or non-patient populations. There was no indication that any type of psychosocial research was a priority; however, some differences were identified when comparing the priorities of the three respondent groups. To improve psychosocial outcomes for haematological cancer patients, resources should be directed towards patients in the early stages of the cancer journey. There may be a need for research investigating potential interventions to improve psychosocial outcomes for patients with haematological cancers. [ABSTRACT FROM AUTHOR]

To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. Consensus on principles and indicators of successful consumer involvement in NHS research. Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice. [ABSTRACT FROM AUTHOR]

Research guidelines for the Delphi survey technique Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology. [ABSTRACT FROM AUTHOR]

This paper deals with the problem of aggregating different partitions of a set of units, in order to obtain an overall classification summarizing the aspects considered in each partition. We consider a new method of fuzzy clustering and the consensus of classifications, and we compare the two approaches in a theoretical and applicative framework. The previous methods are applied in a research about the features of the most important Italian banks using a set of 8 indicators. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]