High-risk newborns face significant mortality risks and potential for recovery, making neonatal palliative care essential. However, existing neonatal palliative care education for neonatal intensive care unit (NICU) nurses often prioritizes end-of-life care and overlooks family involvement and long-term management needs.

To develop and prioritize neonatal palliative care educational content tailored for NICU nurses, addressing gaps in current curricula and supporting family-centered, evidence-based practice.

A three-round Delphi survey was conducted to identify key educational topics for neonatal palliative care, followed by a cross-sectional online survey to assess NICU nurses' perceived performance and importance for each topic. Participants included 148 NICU nurses from tertiary hospitals in South Korea with over six months of experience, excluding those with administrative roles. Educational needs were analyzed using the Locus for Focus model, Borich needs analysis, and Importance-Performance Analysis.

This study identified 66 educational topics grouped into five domains: "Physiological care," "Family-centered care," "Continuity of care," "Nursing professional development," and "Multidisciplinary team approach." High-priority topics included balancing critical and palliative care, managing stress, and navigating ethical challenges. Family-centered care was emphasized throughout the NICU stay, emphasizing family involvement in care, guidance on growth and development, and addressing social challenges. Continuity of care post-discharge was also highlighted, particularly rehabilitation, bereavement support, and community health resources.

This study offers a robust framework for developing evidence-based neonatal palliative care educational programs. By addressing contemporary issues and emphasizing long-term, holistic approaches, these findings contribute to advancing family-centered care and enhancing nursing competencies globally.

Public health environmental surveillance has evolved, especially during the coronavirus pandemic, with wastewater-based surveillance being a prominent example. As surveillance methods expand, it is important to have a robust evaluation of surveillance systems. This consensus study will develop an evaluation framework for public health environmental surveillance, informed by the expanding practice of wastewater-based surveillance during the pandemic.

The public health environmental surveillance evaluation framework will be developed in five steps. In Step 1, a multinational and multidisciplinary executive group will be formed to guide the framework development process. In Step 2, candidate items will be generated by conducting relevant scoping reviews and consultation with the study executive group. In Step 3, an international electronic Delphi will be conducted over two rounds to develop consensus on items for the framework. In Step 4, the executive group will reconvene to finalize the evaluation framework, discuss standout items, and determine the dissemination strategies. Lastly, Step 5 will focus on disseminating the evaluation framework to all parties involved with or affected by wastewater-based surveillance using traditional and public-oriented methods.

The Delphi consensus study will provide multidisciplinary and multinational consensus for the evaluation framework, by providing a set of minimum criteria required for the evaluation of public health environmental surveillance systems. The evaluation framework is intended to support the sustainability of environmental surveillance and improve its implementation, reliability, credibility, and value.

Patients with incurable head and neck cancer have considerable unmet needs and complex symptom burden, with evidence of substantial geographical and/or socioeconomic inequalities. Accurate information on healthcare needs, resource utilisation and service provision in the last year of life is lacking. This places limits on service delivery planning and the development and testing of interventions to better meet needs. Our partnership spans three regions, which nationally have some of the highest rates of incurable head and neck cancer.

The overall aims were to (1) establish a palliative head and neck cancer partnership, (2) identify and evaluate routine incurable head and neck cancer data sources and utilise these to develop and address research priorities.

O1. Develop a palliative head and neck cancer network within the North of England, representing a geographical area with high incidence of incurable head and neck cancer and palliative care needs. O2. Develop and refine research questions and priorities. O3. Engage with data providers to identify relevant data sets and specific data fields to understand the potential quality and utility of these to inform research priorities.

There were three interconnected work packages: WP1: A 'snowballing' approach to establish a network of clinicians, researchers, patient and public representatives, data architects and key stakeholders with an interest in head and neck cancer palliative care. WP2: A Delphi consensus process to develop and refine research questions and priorities, based on national guidance and systematic reviews of evidence gaps. WP3: Identification of national and local data sets and exploration of the potential data quality and utility, and associated information governance processes for access.

WP1: A diverse network was established, encompassing members from a wide range of professions and patient/carer groups. WP2: The Delphi consisted of two rounds involving up to 66 participants. Consensus was reached on 12 research questions representing 4 key areas of prioritisation: service provision, symptom management, psychosocial support and information provision and communication. WP3: A range of national and local data sources were identified as having the potential to address the research priorities. A directory of data sources was developed. Working in an iterative way, data sets and relevant data fields were mapped to the 12 potential research priority areas to assess the applicability of using routine data to address these priorities.

Approximately, one-third of participants in the Delphi process dropped out in round 2. Despite attempts to be flexible in our approach, retaining participants, particularly for patients and their families on a palliative care pathway, is challenging.

The established network and consensus exercise form the basis for future service evaluations and collaborative research. These will be based on gaps and priorities agreed by patients, their families and a range of other stakeholders.

The network has established a cross-sectoral collaboration for improving incurable head and neck cancer and a platform to identify 12 research priority areas. Utilising routine data to address these priorities remains a challenging area, and a range of methodological research approaches will be required to take this forward.

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR135361.

To develop an optimal outline for an online dance injury surveillance system (ODISS) based on expert consensus from a Delphi survey and evaluate the system's usability and feasibility within a fictional folk-dance academy setting.

Dance is characterized by intensive training and performance, which can elevate susceptibility to injuries. Robust surveillance systems are required to understand and mitigate this injury risk. Current systems exhibit limitations and lack uniformity.

A Delphi panel of 35 stage 1 experts were recruited through snowball sampling from online professional networks, professional dance associations, organizations, and academies. Inclusion criteria were ≥18 years of age, fluent in English, and worked as dance academics or researchers, clinicians, instructors, managers, or competitive or professional dancers. These stage 1 experts were provided with a preliminary outline of a dance injury surveillance system that covered 6 domains: dancer demographics and screening, exposure monitoring, injury identification and classification, injury management, dancer recovery and system access. Stage 1 experts then voted on the importance of and provided feedback on different design elements within each domain across 2 Delphi survey rounds to determine a consensus system design outline. A pilot system was then developed and evaluated by stage 2 experts, who were end-users and included dance instructors and administrators from various dance academies/institutions recruited through direct invitations. These stage 2 experts utilized the System Usability Scale (SUS) and System Feasibility Measure (SFM) based on application to a fictional folk-dance injury scenario.

In survey round 1, the stage 1 experts reached consensus to include 30 elements and exclude 3 elements and demonstrated mixed opinion on 30 elements that were revised into 14 elements for further consideration in round 2. All but 1 element reached consensus to include after round 2. System testing demonstrated low marginal usability (SUS score: 58.2% ± 11.6%). Stage 2 experts agreed or strongly agreed the system was feasible for 86.7% ± 10.3% of SFM statement ratings. Key areas for improvement identified from stage 2 expert feedback were a need for an improved user interface and strategies to reduce data entry time burdens. A common suggestion was to integrate more dropdown and checkbox response options within the interface to increase efficiency of data entry.

This study established a Delphi-consensus on the essential design elements for an ODISS. Expert evaluation resulted in a usable and feasible online system that can be used to improve future dance injury surveillance research across dance populations.Level of EvidenceThe usability and feasibility portion of the study falls under Level 3 evidence according to the Centre for Evidence-Based Medicine (CEBM) hierarchy. Whereas the Delphi portion of the study is at Level 5 Evidence on the CEBM hierarchy.

In resource-limited environments, setting priorities for leukemia care becomes essential to ensure effective and efficient use of available resources. This study aimed to identify the key areas of leukemia care and services by determining their prioritization within the South African healthcare system and developing a set of improvement and research priorities.

A two-round modified Delphi method was used to identify leukemia care priorities and rank areas of leukemia management improvement and research priorities. Healthcare professional experts comprised of Clinical Hematologists and Hematopathologists. In round 1, participants independently rated the importance of 125 iterative statements on leukemia care and services derived from literature. In round 2, agreement within the expert participants was considered to finalize the list of priority statements and 17 improvement and research priorities were ranked based on level of importance.

In total, a list of 67 priority statements reached consensus, and 17 improvement and research priorities were established. A high agreement (≥ 90%) was reached for 24 statements within the six themes, these included accurate and advanced diagnostic techniques, factors in determining treatment strategies (e.g., risk stratification), supportive care measures (e.g., pain management and infection prevention), ensuring adequate healthcare workforce, and creating multidisciplinary teams. The highest ranked improvement and research priorities were timely delivery of diagnosis and treatments and biomarker development for early detection, prognosis, and treatment response.

This study identified key priorities for leukemia care within the South African healthcare system, providing an evidence-based framework through expert consensus.

The medical and preventive integration(MPI) brings significant and substantial benefits to chronic disease management (CDM). Evaluating the effectiveness of MPI is curial to promote the high quality development of CDM. However, such a tool is not available in this field. We aimed to develop an evaluation index system for assessing the regional performance management level of MPI in the CDM and provide suggestions for improving quality construction of CDM at the county level.

The initial version of the performance evaluation index system was constructed based on literature analysis, panel discussions, and in-depth on-site interviews. The Delphi questionnaire was designed and 24 experts in the field of CDM were consulted in two rounds. The analytic hierarchy process method was employed to calculate the weight of indexes at the three levels.

The MPI performance evaluation index system at the county level includes five first-level indexes, 20 s-level indexes, and 69 third-level indexes. Among the five first-level indicators, "integration quality" (0.2060) ranked first, followed by "integration inputs" (0.2010), "integration effectiveness" (0.1982), "integration outputs" (0.1975), and "integration mode" (0.1973).

The MPI performance evaluation indexes for CDM at the county level are scientific and reliable. This system can act as a useful tool for diversified subjects to find the loopholes and weak points in CDM. It also provides valuable experience for other national authorities to further improve their own CDM system by MPI evaluation.

This study complements the gaps in the field of MPI questionnaires in China, but the sample size is small, and it is recommended that reliability and validity tests be carried out in multiple regions of the country in later stages to increase the practicality of the questionnaire.

Currently, there is no agreed-upon data collection tool for comprehensively structured documentation of Iranian traditional medicine (ITM) from the information management perspective. As ITM practice varies significantly from current medicine in diagnosis and treatment approaches, it is not appropriate to use data platforms or information systems developed for current medicine. Consequently, the collected data are non-comparable, reducing the verdicts' generalization. Therefore, this research aims to create a minimum data set (MDS) for unified reporting of ITM diseases and interventions.

This multi-phased method study was performed from December 30, 2022 to March 20, 2023. The first phase involved a literature review, the second phase utilized the Delphi technique, and the third phase focused on validating the MDS-ITM. A list of potential data items was prepared after searching scientific databases, and grey literature, as well as reviewing existing information systems, forms, and websites related to ITM. A modified Delphi technique, including a two-round survey, was then employed. A panel of 34 individuals with clinical and research experience in ITM, was selected via purposeful sampling to rate the importance of candidate data items for inclusion in the ITM-MDS using a 5-point Likert scale. Items with an agreement level of 80% or more were deemed acceptable for inclusion in the final ITM-MDS. Finally, the content validity of the developed MDS was assessed using the content validity ratio (CVR) and content validity index (CVI) criteria.

Consensus was reached on an ITM-MDS containing 291 items grouped into seven categories: Patient admission, past medical history, six principles of health preservation, objective signs, subjective symptoms, examination of body systems, and care plans.

The development of this MDS will enable ITM care settings  to exchange information and share resources more easily. It also provides an inclusive dataset and structured documentation of medical records. This MDS can contribute to delivering high-quality care and improving clinical decision-making.

Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions.

International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken.

Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD.

Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.

Despite the significant role of consensus and dissensus in knowledge production, formal approaches to consensus are notably less common in the humanities compared to their frequent application in natural, social, and life sciences. This article therefore explores the potential of expert consensus methods in humanities-related research.

In order to do so, an interdisciplinary team of both sciences researchers experienced in consensus methods and researchers familiar with the domain of the humanities and epistemology, conducted a literary review and exchanged their expertise in multiple brainstorm sessions.

This resulted in the identification of six key elements of expert consensus methods. It also provided for an overview of different types of expert consensus methods that regularly used in the natural, social, and life sciences: Delphi studies, nominal groups, consensus conferences, and Glaser's state of the art method and illustrative examples from both sciences and humanities-related studies. An overview of possible purposes for applying these methods is provided to identify the research contexts in which these methods have proven their value, which can be extrapolated to humanities related issues for which these methods seem promising.

The comparisons and categorisation show that, when focusing on the purposes, there seem to be humanities-related issues that may lend themselves better to structured expert consensus methods than their subject matter and research methods might suggest. When deliberately applied in context chosen by researchers with expertise in a specific humanities domain, expert consensus methods can accelerate epistemic process, enhance transparency, increase replicability, stimulate diversity, and encourage fair processes in humanities research and the application of its findings.

Determine the relevance of the most frequently used patient-reported outcome measures (PROMs) for monitoring patient recovery after ankle fracture, from the clinical perspective of orthopaedic trauma surgeons, given lack of validated PROMs.

Prospective cohort.

Orthopaedic Trauma Association committee meetings, electronic correspondence.

Orthopaedic trauma surgeons.

Delphi method for consensus activities.

IV.

Most clinically relevant PROMs for ankle fracture recovery.

Several English-language PROMs were identified based on use in literature and relevance to ankle fractures. 7 were selected by expert consensus. These are the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), Foot and Ankle Ability Measure (FAAM), American Academy of Orthopaedic Surgeons (AAOS), Foot and Ankle Disability Index (FADI) Score, Lower Extremity Functional Scale (LEFS), Olerud-Molander Ankle Score (OMAS), and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). The most clinically relevant PROM is the A-FORM, followed by the AAOS, LEFS, PROMIS PF, FADI, and OMAS, and the least clinically relevant overall, the FAAM.

Understanding which PROM best matches physician expectations for tracking recovery is an important step toward a robust, evidence-based approach to patient care. The A-FORM was identified as the most clinically relevant among the most used PROMs. These results will aid surgeons, clinicians, and scientists to identify a uniformly, clinically relevant PROM for the treatment and study of outcomes and recovery after isolated ankle fracture.

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement.

This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

Objective: To determine priorities for services and policies that better support care partners of people living with dementia. Methods: A modified Delphi process engaged participants from organizations serving people living with dementia and care partners, focusing on historically and currently underserved communities. Eight thematic areas were identified. Participants (N = 40) responded to three surveys, generating ideas, rating each, and ranking priorities. Results: Each survey received 13-17 responses. Top ranked ideas were arrayed across six thematic areas: care partner supports; programs; funding; information; care coordination; and workforce development. Discussion: The Delphi process empowered participants to share knowledge, and respected their opinions. Anonymity removed power imbalances. The survey iterations blended qualitative and quantitative approaches, and built consensus. The Delphi invited the voices of diverse participants; all voices were weighed equally. This process could be extended to efforts to further engage dementia care partners, helping to value their voices in decision-making for services and policies.

The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

The minimum sample size for multistakeholder Delphi surveys remains understudied. Drawing from three large international multistakeholder Delphi surveys, this study aimed to: 1) investigate the effect of increasing sample size on replicability of results; 2) assess whether the level of replicability of results differed with participant characteristics: for example, gender, age, and profession.

We used data from Delphi surveys to develop guidance for improved reporting of health-care intervention trials: SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) extension for surrogate end points (n = 175, 22 items rated); CONSORT-SPI [CONSORT extension for Social and Psychological Interventions] (n = 333, 77 items rated); and core outcome set for burn care (n = 553, 88 items rated). Resampling with replacement was used to draw random subsamples from the participant data set in each of the three surveys. For each subsample, the median value of all rated survey items was calculated and compared to the medians from the full participant data set. The median number (and interquartile range) of medians replicated was used to calculate the percentage replicability (and variability). High replicability was defined as ≥80% and moderate as 60% and <80% RESULTS: The average median replicability (variability) as a percentage of total number of items rated from the three datasets was 81% (10%) at a sample size of 60. In one of the datasets (CONSORT-SPI), a ≥80% replicability was reached at a sample size of 80. On average, increasing the sample size from 80 to 160 increased the replicability of results by a further 3% and reduced variability by 1%. For subgroup analysis based on participant characteristics (eg, gender, age, professional role), using resampled samples of 20 to 100 showed that a sample size of 20 to 30 resulted to moderate replicability levels of 64% to 77%.

We found that a minimum sample size of 60-80 participants in multistakeholder Delphi surveys provides a high level of replicability (≥80%) in the results. For Delphi studies limited to individual stakeholder groups (such as researchers, clinicians, patients), a sample size of 20 to 30 per group may be sufficient.

Lumbar Spinal Stenosis (LSS) is a slow progressive degenerative disorder associated with chronic pain and disability. Although consensus-based international guidelines for invasive treatment of patients with LSS exist, few consensus-based guidelines for optimal conservative management strategies have been published.

To achieve manual therapists' consensus on optimal physiotherapeutic management strategies for LSS.

The study employed a three-round, email-based International Delphi survey. All qualified members of the International Maitland Teacher Association (IMTA) (n = 30) were invited to participate.

Twelve IMTA teachers participated in the study. Eight essential physiotherapy management strategies were identified, as follows: 1. Detailed assessment with in-depth interview; 2. Recognition of red flags, contraindications and precautions; 3. Neurological examination; 4. Postural and movement analysis with related ergonomics; 5. Functional analysis; 6. Individualized treatment based on assessment findings and research evidence; 7. Aerobic training and 8. Patient education.

This Delphi survey provides a foundation for physiotherapists to individualize and optimise management approaches for patients with LSS. With a growing elderly population, there is an increasing need for evidence-based conservative management guidelines based on high quality research.

Adolescent idiopathic scoliosis (AIS) is present in 2%-3% of those under 18 years old and has a significant impact on pain, function and quality of life. Up to 10% of adolescents with AIS progress to spinal fusion surgery, and of those individuals many experience reduced musculoskeletal function and do not return to sports postoperatively. Physiotherapists have a significant role in promoting participation and offering a graded return to sports, exercise and physical activity. However, there is a lack of evidence and variability between surgeons and physiotherapists worldwide regarding rehabilitation milestones and return to exercise, sports and physical activity. This study aims to reach a consensus on when it is safe and how an individual might begin a graded return to sports, exercise and physical activity.

This protocol was written in accordance with the Guidance on Conducting and REporting DElphi Studies (CREDES) guidelines. An international expert sample of surgeons and physiotherapists in AIS will be recruited. This electronic Delphi is anticipated to consist of three iterative rounds. Round 1 will be a series of open-ended questions examining rehabilitation milestones and return to sports, exercise and physical activity postoperatively. Round 2 will commence with a summary of the existing literature for participants to review. Rounds 2 and 3 will involve a collated summary of results from the previous round, including any dissonance. During rounds 2 and 3, participants will be asked to privately rate responses on a 5-point Likert scale. The study steering group and patient and public involvement representative have been involved from conceptualisation and will continue to be involved until final dissemination.

Full ethical approval has been provided by the University of Birmingham, reference number: ERN_1617-Nov2023. Dissemination will take place through conference presentation and peer-reviewed publications.

Individual professions seek to define their professional practice through competencies which describe the behaviours and technical attributes to perform effectively within role. Professional body and regulatory frameworks define universal standards for radiography but there is limited evidence of the technical competencies expected of the workforce in Computed Tomography (CT). This study aimed to address this gap by agreeing the essential competencies for the early career radiography workforce who have CT as part of their clinical responsibilities. This is the first step in developing a competency framework for CT across all radiography expertise levels.

A modified e-Delphi study was used to identify and gain agreement on essential practice competencies for this group. Structured surveys over two rounds were completed by an expert panel with CT knowledge and experience. Participants were asked to rate the essentiality of competencies for the novice CT workforce. Structured feedback was provided between surveys for consensus building, defined by the content validity ratio (CVR).

Survey responses were received from 34 participants across different diagnostic imaging roles and settings. A total of 56 competency statements were agreed as essential for the early career CT workforce, including some appropriate to assistant radiographer practitioner roles. Competencies could be divided into those that were relevant to diagnostic radiography but could be applied to the CT setting (n = 32) and technical attributes unique to the CT context (n = 24).

CT competencies for this group centre around understanding technical concepts of image formation and image quality optimisation; patient preparation and contrast media administration.

The competencies presented in this research represent the agreed minimum standards for the workforce in CT. Further work is required to validate competencies in practice.

Formal Thought Disorder (FTD) is a recognised psychiatric symptom, yet its characterisation remains debated. This is problematic because it contributes to poor efficiency and heterogeneity in psychiatric research, with salient clinical impact.

This study aimed to investigate expert opinion on the concept, measurement and clinical utility of FTD using the Delphi technique.

Across three rounds, experts were queried on their definitions of FTD, methods for the assessment and measurement of FTD, associated clinical outcomes and treatment options.

Responses were obtained from 56 experts, demonstrating varying levels of consensus across different aspects of FTD. While consensus (>80 %) was reached for some aspects on the concept of FTD, including its definition and associated symptomology and mechanisms, others remained less clear. Overall, the universal importance attributed to the clinical understanding, measurement and treatment of FTD was clear, although consensus was infrequent as to the reasons behind and methods for doing so.

Our results contribute to the still elusive formal definition of FTD. The multitude of interpretations regarding these topics highlights the need for further clarity with this phenomenon. Our findings emphasised that the measurement and clinical utility of FTD are closely tied to the concept; hence, until there is agreement on the concept of FTD, difficulties with measuring and understanding its clinical usefulness to inform treatment interventions will persist. Future FTD research should focus on clarifying the factor structure and dimensionality to determine the latent structure and elucidate the core clinical phenotype.

Falls are a significant public health problem and constitute a major cause of injuries and mortality. Risk factors for falls are multifactorial and include medication use.

To develop and investigate the content validity of the Medication-Related fall (MRF) screening and scoring tool.

The MRF tool was developed from clinical practice guidelines addressing medication-related problems, and additional medications identified by specialist pharmacists across a region of the United Kingdom (Northern Ireland). Medication classes were categorised according to their 'potential to cause falls' as: high-risk (three points), moderate-risk (two points) or low-risk (one point). The overall medication-related falls risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of surveys were conducted using SurveyMonkey®. Twenty-two experts from 10 countries determined their agreement with the falls risk associated with each medication on a 5-point Likert scale. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round.

Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool; ten were classified as high-risk, eight as moderate-risk and one as low-risk.

The MRF tool is simple and has the potential to be integrated into medicines optimisation to reduce falls risk and negative fall-related outcomes. The score from the MRF tool can be used as a clinical parameter to assess the need for medication review and clinical interventions.

Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions.

In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions.

The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS.

The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0.

To construct and validate a physical fitness evaluation index system for elite male singles badminton players.

Utilizing the Delphi method to establish a comprehensive evaluation system, the analytic hierarchy process (AHP) was employed to calculate the influence weights of various indicators. The validity of the comprehensive evaluation system was verified using testing methods.

After three rounds of expert selection, the physical fitness evaluation index system for elite male singles badminton players includes three primary indicators, nine secondary indicators, and twenty-one tertiary indicators. Among the primary indicators, specialized physical fitness holds a significant weight in the evaluation with a value of 0.651, whereas body morphology has a smaller weight of 0.077. Among the secondary indicators, specialized agility, strength, and endurance have higher weights of 0.223, 0.217, and 0.210, respectively. Among the tertiary indicators, four-corner ball touch, 400 m × 5 shuttle run, smash-and-rush, and vertical jump height hold higher weights of 0.119, 0.114, 0.104, and 0.096, respectively. The results after randomly selecting ten elite male singles badminton players and applying the evaluation index system demonstrated that this system has high feasibility and validity. It can not only comprehensively assess the physical fitness of athletes but also provide significant practical guidance for enhancing their competitive performance.

The evaluation system and weight assignments constructed in this study can scientifically and comprehensively reflect the physical fitness status of athletes. It can guide coaches in formulating targeted training plans and optimizing training outcomes.

Artificial intelligence (AI) holds immense potential for enhancing clinical and administrative health care tasks. However, slow adoption and implementation challenges highlight the need to consider how humans can effectively collaborate with AI within broader socio-technical systems in health care.

In the example of intensive care units (ICUs), we compare data scientists' and clinicians' assessments of the optimal utilization of human and AI capabilities by determining suitable levels of human-AI teaming for safely and meaningfully augmenting or automating 6 core tasks. The goal is to provide actionable recommendations for policy makers and health care practitioners regarding AI design and implementation.

In this multimethod study, we combine a systematic task analysis across 6 ICUs with an international Delphi survey involving 19 health data scientists from the industry and academia and 61 ICU clinicians (25 physicians and 36 nurses) to define and assess optimal levels of human-AI teaming (level 1=no performance benefits; level 2=AI augments human performance; level 3=humans augment AI performance; level 4=AI performs without human input). Stakeholder groups also considered ethical and social implications.

Both stakeholder groups chose level 2 and 3 human-AI teaming for 4 out of 6 core tasks in the ICU. For one task (monitoring), level 4 was the preferred design choice. For the task of patient interactions, both data scientists and clinicians agreed that AI should not be used regardless of technological feasibility due to the importance of the physician-patient and nurse-patient relationship and ethical concerns. Human-AI design choices rely on interpretability, predictability, and control over AI systems. If these conditions are not met and AI performs below human-level reliability, a reduction to level 1 or shifting accountability away from human end users is advised. If AI performs at or beyond human-level reliability and these conditions are not met, shifting to level 4 automation should be considered to ensure safe and efficient human-AI teaming.

By considering the sociotechnical system and determining appropriate levels of human-AI teaming, our study showcases the potential for improving the safety and effectiveness of AI usage in ICUs and broader health care settings. Regulatory measures should prioritize interpretability, predictability, and control if clinicians hold full accountability. Ethical and social implications must be carefully evaluated to ensure effective collaboration between humans and AI, particularly considering the most recent advancements in generative AI.

Metacarpal fractures are viewed as minor injuries, potentially leading to reduced hand function and productivity, especially in working-age people. The study aimed to develop and finalise a second to fifth metacarpal fractures clinical hand rehabilitation guideline.

A three-round eDelphi method, employing REDCap questionnaires and informed by a previous clinical hand rehabilitation guideline, facilitated expert consensus. Experience and qualifications guided expert selection. Consensus was defined as 75% or more experts selecting four or five on a Likert scale or 'yes' in 'yes/no' questions. Open-ended responses were incorporated, following Conducting and Reporting of Delphi Studies recommendations.

Fifteen experts specialising in hand injury management, including orthopaedic surgeons, occupational therapists and physiotherapists, were invited to participate, with attrition of one expert in three rounds. In Round 1, 10 (28.5%), Round 2, 6 (18%) and Round 3, 16 (36%) guideline statements were accepted. Consensus was reached for including grasp types in rehabilitation; activities of daily living (ADLs) types under light, medium and heavy categories; time when early active mobilisation should commence and splint types after conservative management, K-wires and surgical fixation.

The finalised clinical hand rehabilitation guideline based on the Occupational Therapy Intervention Process Model (OTIPM) framework may benefit occupation return.

An increase in reusable Elastomeric Half Mask Respirators (EHMRs) among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.

Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses.

Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined.

In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus.

The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses' perspectives on the competencies anticipated from newly graduated nurses.

Most ethics and research integrity (ERI) training approaches are based on teaching moral rules, duties or responsibilities, often not sufficiently addressing virtue-based ethics. This study aimed to obtain a consensus among relevant experts on the importance of essential virtues for ERI training and their acquisitions. A modified Delphi consensus process was conducted in three rounds; 31 ERI experts participated in Round 1 and 23 in Round 2 and Round 3. Based on findings generated from qualitative data in Round 1, a structured questionnaire with 90 different statements grouped under five domains was developed for Round 2 and Round 3. After the final round, a consensus was achieved on two-thirds of statements included in this study. The experts agreed that virtues are based on learned and reflected attitudes and that the appropriate direction to acquire research virtues is through continuing education using case studies and discussions based on real-life scenarios. Furthermore, the consensus was obtained on 35 scientific virtues that should be stimulated in ERI training, prioritizing honesty, integrity, accountability, criticism and fairness as the most essential scientific virtues for good research practice. These results should be considered in developing or adjusting the ERI training program and materials.

Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records.

The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers.

From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions.

This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.

Growing demands on educators have resulted in increased levels of burnout and stress and decreasing wellbeing. This study aimed to establish expert consensus on the key characteristics required in prospective educator wellbeing initiatives.

The Delphi approach is a process of forecasting that is based on the aggregated opinion of panel members (or experts) within a field of study. Using a Delphi approach, academic and practitioner expertise were sought over a two-rounds, with 17 and 14 participants in each round respectively. The study aimed to identify how systemic factors (e.g., leadership) could be utilised to promote educator wellbeing. The study also sought expert consensus on enablers and barriers for engagement in educator wellbeing initiatives.

Findings highlighted the importance of fostering positive relationships with colleagues, communities and families, and the active role of wellbeing teams to promote wellbeing initiatives. The need for leaders to address their own wellbeing and build trust within teams was also identified. Panel members identified the need for prospective funding to prioritise wellbeing initiatives. There was also a preference for ongoing initiatives rather than stand-alone wellbeing events that conveyed the ongoing importance of managing one's wellbeing.

This paper presents practical recommendations that can be used to inform the development and evaluation of future initiatives and policy. Applying the consensus derived from this study is likely to make wellbeing initiatives more viable and facilitate uptake amongst educators.

Adequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. To address this issue, we recently published reporting guidance documentation for studies of HIV drug resistance prevalence and incidence.

In this study, we describe the methods used to develop this reporting guidance.

We used a mixed-methods sequential explanatory design involving authors and users of studies of HIV drug resistance prevalence. In the quantitative phase, we conducted a cross-sectional electronic survey (n=51). Survey participants rated various reporting items on whether they are essential to report. Validity ratios were computed to determine the items to discuss in the qualitative phase. In the qualitative phase, two focus group discussions (n=9 in total) discussed this draft item checklist, providing a justification and examples for each item. We conducted a descriptive qualitative analysis of the group discussions to identify emergent themes regarding the qualities of an essential reporting item.

We identified 38 potential reporting items that better characterise the study participants, improve the interpretability of study results and clarify the methods used for HIV resistance testing. These items were synthesised to create the reporting item checklist. Qualitative insights formed the basis of the explanation, elaboration, and rationale components of the guidance document.

We generated a list of reporting items for studies on the incidence or prevalence of HIV drug resistance along with an explanation of why researchers believe these items are important. Mixed methods allowed for the simultaneous generation and integration of the item list and qualitative insights. The integrated findings were then further developed to become the subsequently published reporting guidance.

Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios.

A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics.

Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions.

Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.

Several health policy institutes recommend reducing the number of indicators monitored by hospitals to better focus on indicators most relevant to local contexts. To determine which indicators are the most appropriate to eliminate, one must understand how indicator selection processes are undertaken. This study classifies hospital indicator selection processes and analyzes how they align with practices outlined in the 5-P Indicator Selection Process Framework. This qualitative, multiple case study examined indicator selection processes used by four large acute care hospitals in Ontario, Canada. Data were collected through 13 semistructured interviews and document analysis. A thematic analysis compared processes to the 5-P Indicator Selection Process Framework. Two types of hospital indicator selection processes were identified. Hospitals deployed most elements found within the 5-P Indicator Selection Process Framework including setting clear aims, having governance structures, considering indicators required by health agencies, and categorizing indicators into strategic themes. Framework elements largely absent included: adopting evidence-based selection criteria; incorporating finance and human resources indicators; considering if indicators measure structures, processes, or outcomes; and engaging a broader set of end users in the selection process. Hospitals have difficulty in balancing how to monitor government-mandated indicators with indicators more relevant to local operations. Hospitals often do not involve frontline managers in indicator selection processes. Not engaging frontline managers in selecting indicators may risk hospitals only choosing government-mandated indicators that are not reflective of frontline operations or valued by those managers accountable for improving unit-level performance.

There is an increasing need for Primary Care Behavioral Health (PCBH) workforce development (i.e., increase in well-trained PCBH providers) given the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler and Ogbeide in Psychol Trauma 12(S1):S177-S179, https://doi.org/10.1037/tra0000761 , 2020). Therefore, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings specific competencies, given there are no current competencies specific to clinical supervision within the PCBH Model. Using a Delphi process, the authors identified and reached expert consensus on competencies for BH clinical supervisors in primary care. A purposive sample (in: Patton, Qualitative evaluation and research methods, Sage, Newbury Park, 1990) of fifteen experts (n = 15) in PCBH clinical training and education evaluated quantitative and qualitative domains and specific competencies associated with PCBH supervision gathered during an initial in-depth qualitative interview. This was followed by two subsequent rounds of quantitative Delphi surveys to reach consensus. The response rates from our panel of experts were 100% (15/15) for all stages (interviews, round one and round two surveys). Three domains (Primary Care Knowledge, Clinical Supervisor Development, and Clinical Supervision Skills) were rated as essential for providing clinical supervision with PCBH for pre-licensure level learners. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence. This will also have a great impact on the development of the future BH workforce within primary care.

Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF.

We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from 7 centres between January 2019 and October 2023. The patients were divided into derivation (n = 194) and validation (n = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the light gradient boosting machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen's weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs [CWK 0.866, 95% confidence interval (CI) 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively]. During a median follow-up period of 391 (inter-quartile range 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (hazard ratio 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates.

Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.

The Delphi method has been extensively used to reach a consensus in traditional Chinese medicine (TCM) syndrome diagnosis research when subjective judgment is not uniform and objective evidence is lacking. The conduct and reporting of the Delphi method in TCM syndrome diagnosis research have never been critiqued. Our study aims to explore the consistency of using this technique and assess the reporting quality.

A cross-sectional study was employed to scope articles reporting the conduct of the Delphi method in TCM syndrome diagnosis research. We searched the PubMed, Web of Science, CNKI, VIP, Wanfang and SinoMed databases with the restriction of Chinese and English language from their inception to March 25, 2023. A standardized extraction form was designed to collect demographics and methodological processes reflecting the rigor and transparency in TCM syndrome diagnosis research.

A total of 1832 studies were screened, and 50 were included. The median number of panels was 30 (IQR 20-34.5) and only 12 (24.0 %) studies were with a heterogeneous sample of panels. Two rounds was most common (37/50; 74.0 %), followed by three (7/50; 14.0 %), and only 13 (26.0 %) studies determined the number of rounds a priori. The reporting quality varied, with 18.0 % (9/50) reporting anonymity, 30.0 % (15/50) describing the controlled feedback, 20.0 % (10/50) reporting the procedure duration (7.14 ± 3.29 months) and 26.0 % (13/50) predefining the consensus.

The Delphi method is inconsistently conducted and nontransparently reported in TCM syndrome diagnosis research. Standardized criteria are urgently needed for best practices in future research.

We aimed to identify caregivers' opinions on the outcome measures that matter in clinical trials in individuals with Dravet syndrome (DS). We conducted a prospective European multicenter study based on an 11 closed questions survey developed by the French reference center for rare epilepsies and DS patients' advocacy groups. Items included questions on seizures and daily life outcomes that a clinical trial on a therapy for individuals with DS should target. Statistical analyses were performed to evaluate the impact of the country of residence and of the patients' age. The survey was answered by 153 caregivers (68%: France, 28%: Germany, and 24%: Italy) off individuals with DS. Individuals with DS included 86 males (mean age of 11.4 [interquartile: 7-20.4] years). Families ranked as important almost all the items proposed. However, items related to daily life had the highest rank in all three countries compared to items about seizures (P = 0.02). Increase in individuals' age was associated with a higher age at diagnosis (ρ = 0.26, P = 0.02), and a lower impact of seizure duration (ρ = -0.25, P = 0.005) and on the need of hospital referral (ρ = -0.26, P = 0.005). These data can help tailor patient-centered outcome measures in future clinical and real-life trials for DS.

Over the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners' guideline on pain was recently updated and now aims to reduce opioid prescriptions and high-risk opioid use for non-cancer pain. The guideline, however, lacks practical measures for implementation.

This study aims to determine practical components for a tool that should assist Dutch primary care prescribers and implements the recently updated guideline to reduce opioid prescriptions and high-risk use.

A modified Delphi approach was used. The practical components for the tool were identified based on systematic reviews, qualitative studies, and Dutch primary care guidelines. Suggested components were divided into Part A, containing components designed to reduce opioid initiation and stimulate short-term use, and Part B, containing components designed to reduce opioid use among patients on long-term opioid treatment. During three rounds, a multidisciplinary panel of 21 experts assessed the content, usability, and feasibility of these components by adding, deleting, and adapting components until consensus was reached on the outlines of an opioid reduction tool.

The resulting Part A consisted of six components, namely education, opioid decision tree, risk assessment, agreements on dosage and duration of use, guidance and follow-up, and interdisciplinary collaboration. The resulting Part B consisted of five components, namely education, patient identification, risk assessment, motivation, and tapering.

In this pragmatic Delphi study, components for an opioid reduction tool for Dutch primary care-givers are identified. These components need further development, and the final tool should be tested in an implementation study.

Globally, more than 12 million girls under the age of 18 are forced to marry every year. Progress on ending child marriage in the Arab region is slowing, and risks being reversed, due to an increase in conflict-affected populations and widespread economic crisis. The aim of this paper is to consider the research priorities across the region to inform effective and accelerated child marriage prevention and response programming within the Arab region. Seventy-three specialists supporting child marriage prevention and response programming in the Arab region engaged with up to three phases of an online Delphi consultation process on research gaps and the research environment between July 2019 and December 2021. Proposals of research gaps were elicited, reviewed, and rated by participants to confirm a shared learning agenda. Participants identified 50 different research gaps across 7 main areas, reaching a high level of consensus support for 23 of 50 statements. Clear consensus was reached in relation to an increased need to produce and use evidence to support programme development, and further research on specific drivers and consequences of child marriage. The least consensus was found in relation to how research can inform prevention and response efforts within the law and legal system. The results provide the foundation of a child marriage research agenda for the Arab region which takes into account regional distinctiveness and builds on the global momentum for child marriage research. Mechanisms are in place to do this through the Regional Action Forum, and other networks across the region.

Self-determination related skills are central for achieving a life of quality for people with intellectual disability and develop as the person interacts with his/her contexts, such as home. As such, families are crucial agents in supporting the self-determination of their children with intellectual disability, although to date, little is known about how to support those families.

To address this need, the present study used a Delphi technique to build and reach a consensus on the critical components that should inform interventions targeting families to promote their children's self-determination.

Academics and professionals participated in this three-round Delphi study that concluded with a 90-item list of critical components for intervention, concretely relating to general principles, format, content, and methodology.

This knowledge has the potential to guide emergent intervention initiatives to support families in fostering their children's self-determination. Implications for research and practice fields are provided and discussed.