We have identified areas where uncertainly remains and for which additional resources are required. Discourse for questions 10a-10c (what should be done in difficult or complex situations) was largely hypothetical due to the small number of examples available. This corresponds to the small number of papers identified in DAMOCLES as reporting what should be done in difficult situations in the context of the DMC . The expertpanel acknowledged that this gap could be addressed if there was a resource that allowed experiences to be shared. If members of TSCs and DMCs could submit examples, this would, over time, build a repository of issues and potential solutions relating to DMC and TSC roles independently and the interaction between the two committees. This could also help to identify additional examples of questions that the TSC should not ask the DMC to make recommendations on (question 6). The way in which the TSC and DMC inter- act, as described in the MRC guidelines, is well accepted, but this does not address situations where there is disagreement between the DMC and the TSC. Further work is needed to clarify the process to be followed and the wording of the escalation clause, which is included in the terms of reference, in these situations. The suggested repository may benefit from a widened scope to include anonymised examples of TSC/DMC disagreement and how they have been handled.
In 2016, a collaboration between the University of Tasmania and the University of Melbourne commenced the development and testing of a health information workforce minimum dataset. A Delphi approach was selected as the overall study design for this study. In the first Delphi stage, ten professional bodies, employers, and government organisations were identified to nominate representatives in an ExpertPanel: Australian Digital Health Agency, Australian Information Industry Association, Australian Library and Information Association Health Libraries Australia, Australasian College of Health Informatics, Clinical Coding Society of Australia, Healthcare Financial Management Association, Health Informatics Society of Australia, Health Information Management Association of Australia, the Victorian Health and Human Services Workforce Branch. The Health Informatics New Zealand was also included in this study to ensure the minimum dataset would be applicable for other countries. Representatives were required to have extensive (i.e. >10 years) professional experience, be available to attend a full day focus group session in either Melbourne or Sydney, and consent to participate in multiple rounds for the study.
We invited 73 experts with experience in palliative care to participate in the expertpanel: general practitioners, coordinators of palliative care networks, case managers working in palliative care, researchers and policy makers in palliative care. The perspective of district nurses was included in the expertpanel through case managers and scientists in the field of nursing. Two experts declined but proposed four others to take their places and the colleague of another was added leading to the questionnaire being sent to 76 experts. Of those, 46 (61%) participated in at least one round. Twenty- four experts gave their reasons for not participating: lack of time (n = 13), lack of knowledge about case management (n = 7), prolonged illness (n = 4). Four reactions in the first round and two in the second were not traceable because they were returned an- onymously. This study is exempt from approval from an ethics committee.
The ExpertPanel met at THD on February 10 for a day-long, in-person discussion of the Ebola experience at THD in 2014. The ExpertPanel concurs with Dr. Rupp’s validation of the fact pattern developed by THR. The ExpertPanel also reviewed and agreed with the conclusions set forth in THR’s previously released learnings from the EVD event. In this report, THR’s recommendations and lessons are incorporated along with additional recommendations from the ExpertPanel to strengthen the systems and processes for quality, reliability, and patient safety in managing a novel clinical event at Texas Health Resources and Texas Health Presbyterian Dallas.
pupil’s needs and disability. 121 The ExpertPanel consulted Special Educational Needs and Disabilities (SEND) specialists through stakeholder meetings. In these, a concern was expressed about the means of assessing children and measuring their progress. There was no desire to halt the move towards inclusion, but it was thought unhelpful to assess and measure progress of some children with SEND against current criteria (National Curriculum Levels and Performance scales). 122 These representatives thought that: there is a need for something more flexible that recognises and assesses individual progress; that assessment should focus on successes rather than being grounded in failure; and a teacher’s narrative judgement should be used in assessments of a pupil’s progress. These views cohere with our notion of a revised model that focuses on inclusion, mastery and progress. However, more work needs to be done around these issues, both with respect to children with learning difficulties and those regarded as high attainers.
For policy development purposes, it would be desir- able to have some kind of outlook of the future. One of the leading tools in future science is the Delphi method: "Delphi may be characterized as a method for structur- ing a group communication process so that the process is effective in allowing a group of individuals, as a whole, to deal with a complex problem" . Originating from the cold war era, the Delphi method was developed for defense technology forecasting . Although Delphi and other expertpanel methods for planning for the future are widely utilized in health and social sciences [8, 9], e.g. in alcohol policy development , their use within the field of drug abuse has been next to non-existent. Literature searches on psychoactive drug misuse fore- sight studies yielded only very few publications. Two of these publications were written by a single expert based on his insight [11, 12]. More recently, McBride et al. used Delphi to summarize experts’ views on reducing misuse of over-the-counter drugs . The most notable drug policy foresight project has been the Drugs Futures 2025, a Technology Foresight Programme in the United Kingdom . An editorial written by David Nutt  summarizes the main message as a future of growth in drug use: in addition to most of the current drugs of abuse still being around, new drugs with abuse potential will emerge by year 2025. A list of probable future develop- ments in and around drug issues was presented together with possible options and their likely consequences for politicians to choose from . Detailed predictions were made e.g. under the headings "Future medicines for mental health", "Future treatment for addiction", "The future of so- called 'recreational' drugs", "Future cognition enhancers", "Management of treatments for mental health", "Manage- ment of cognition enhancers for the healthy" and "Drug testing". The program has been criticized for not exploring the social and cultural contexts of drug use nor the drug users’ views, and presenting an unnecessarily gloomy future using “war against drugs” rhetoric . A smaller scale foresight project was conducted in Sweden in 2010, bring- ing together the knowledge of around twenty experts . The results were reported in one chapter in a book on the drug situation and included predictions such as general in- crease in use and harm resulting from use.
Serono Symposia International convened an expertpanel to review the impact of environmental influences on the regulation of pubertal onset and progression while identifying critical data gaps and future research priorities. An expertpanel reviewed the literature on endocrine-disrupting chemicals, body size, and puberty. The panel concluded that available experimental animal and human data support a possible role of endocrine-disrupting chemicals and body size in relation to alterations in pubertal onset and progression in boys and girls. Critical data gaps prioritized for future research initiatives include (1) etiologic research that focus on environmen- tally relevant levels of endocrine-disrupting chemicals and body size in relation to normal puberty as well as its variants, (2) exposure assessment of relevant endo- crine-disrupting chemicals during critical windows of human development, and (3) basic research to identify the primary signal(s) for the onset of gonadotropin- releasing hormone– dependent/central puberty and gonadotropin-releasing hor- mone–independent/peripheral puberty. Prospective studies of couples who are plan- ning pregnancies or pregnant women are needed to capture the continuum of exposures at critical windows while assessing a spectrum of pubertal markers as outcomes. Coupled with comparative species studies, such research may provide insight regarding the causal ordering of events that underlie pubertal onset and progression and their role in the pathway of adult-onset disease.
Background: With rising health care costs and the diversity of scientific and clinical information available to health care providers it is essential to have methodologies that synthesize and distill the quality of information and make it practical to clinicians, patients and policy makers. Too often research synthesis results in the statement that “more and better research is needed” or the conclusions are slanted toward the biases of one type of stakeholder. Such conclu- sions are discouraging to clinicians and patients who need better guidance on the decisions they make every day. Method: Expert panels are one method for offering valuable insight into the scientific evidence and what experts believe about its application to a given clinical situation. However, with improper management their conclusions can end up being biased or even wrong. There are several types of expert panels, but two that have been extensively involved in bringing evidence to bear on clinical practice are consensus panels, and appropriateness panels. These types of panels are utilized by organizations such as the National Institutes of Health, the Institute of Medicine, RAND, and other organizations to provide clinical guidance. However, there is a need for a more cost effective and efficient approach in conducting these panels. In this paper we describe both types of expert panels and ways to adapt those models to form part of Samueli Institute’s Scientific Evaluation and Research of Claims in Health Care (SEaRCH ™ ) program.
Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.
Results: The panel identified seven major themes regarding economic evaluation that are particularly salient to determining the economics of CAIM: standardization (in order to compare CAIM with conventional therapies, the same basic economic evaluation methods and framework must be used); identifying the question being asked, the audience targeted for the results and whose perspective is being used (e.g., the patient perspective is especially relevant to CAIM because of the high level of self-referral and out-of-pocket payment); the analytic methods to be used (e.g., the importance of treatment description and fidelity); the outcomes to be measured (e.g., it is important to consider a broad range of outcomes, particularly for CAIM therapies, which often treat the whole person rather than a specific symptom or disease); costs (e.g., again because of treating the whole person, the impact of CAIM on overall healthcare costs, rather than only disease-specific costs, should be measured); implementation (e.g., highlighting studies where CAIM allows cost savings may help offset its image as an “ add on ” cost); and generalizability (e.g., proper reporting can enable study results to be useful beyond the study sample).
the question about the actual observed 2-year decline that was asked for the reference diagnosis (indicated by 1 expert). Insufficient clinical information was reported to be available for several reasons: one expert would have preferred information on clinical history at follow- up, and two experts stated that they would have liked to have a ‘real’ clinical picture or to see the patient in real life. The experts indicated that their reference diag- nosis was partly influenced by the concluded baseline care-as-usual diagnosis (diagnostic review bias). Although none of the panel members felt impeded in expressing their opinion during the panel discussion meeting, one expert thought that members had an unequal share in the discussion. The experts also stated that a 2 year follow-up period is sometimes insufficient; it is ‘a compromise between desirable and feasible’ and in an ideal situation they would prefer a longer period.
Still, they exposed the lack of public opinion in decision-making and advocated that common beliefs and values of people financially participating in the healthcare system should represent the basis to deter- mine healthcare priorities, target populations and target medicines to be funded. This may be achieved by con- sidering several criteria and by including lay people in the process or at least assure that the criteria are ac- cepted by them . Also, the panel exposed that there is a huge need to review the national healthcare prior- ities, despite this being a topic the experts and policy-makers would rather avoid.
The guidelines were drawn up by a group of twelve experts convened by the SRLF and the SFMU. The group’s agenda was defined beforehand. The organizing committee first defined the questions to be addressed with the coordinators and then designated the experts in charge of each question. The questions were formu- lated according to a Patient Intervention Comparison Outcome (PICO) format after a first meeting of the expert group. Literature was analyzed and the guide- lines were formulated using Grade of Recommendation Assessment, Development and Evaluation (GRADE) methodology. A level of evidence was defined for each bibliographic reference cited as a function of the type of study and could be reassessed in light of the meth- odological quality of the study. An overall level of evi- dence was determined for each endpoint, taking into account the level of evidence of each bibliographic ref- erence, the between-study consistency of the results, the direct or indirect nature of the results, and cost analysis. Three levels of proof were used (Table 1):
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modali‑ ties of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decan‑ nulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1 + / − ) and 6 a low level of proof (Grade 2 + / − ). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
The ability to estimate the prevalence of hyponatremia in the U.S. population was enabled by the availability of two key data elements. First, publicly available hospital dis- charge data provided empirical evidence of how many patients are treated for hyponatremia in an inpatient set- ting each year in the U.S. The U.S. Government's Health- care Cost & Utilization Project (HCUP) database contains hospital discharge data from a 20% sample of U.S. hospi- tals (approximately 7 million hospital stay records from 1,000 hospitals in 33 states) and yields nationally repre- sentative estimates of inpatient care . In 2002 there were an estimated 923,473 hospital stays with either a principal or secondary discharge diagnosis of hyponatremia (ICD-9-CM diagnosis code 276.1). We assumed an average of 1.25 hospital stays per patient, based on a study by Tierney et al.  which reported 954 admissions for the 763 hyponatremic patients in their sample, to arrive at an estimated 738,778 patients treated for hyponatremia in an inpatient setting in the U.S. Second, using the four-level classification system, the expertpanel provided "low" and "high" estimates of the proportion of hyponatremic patients who are treated; and "low" and "high" estimates of the proportion initially treated in an inpatient setting (Table 1). All possible com- binations of the three sets of low and high estimates in Table 1 (e.g., one combination would include the "low" estimate for classification, the "low" estimate for percent- age treated, and the "low" estimate for percentage treated as inpatient) were evaluated and resulted in eight separate estimates of the proportion of all hyponatremic patients who are treated in an inpatient setting. Based on these cal- culations, we were able to extrapolate from the number of "known" hospitalized hyponatremia patients (i.e. 738,778 patients) to produce eight separate estimates of the total number of persons with hyponatremia in the U.S.
The ExpertPanel (see Appendix 1) used eight resource and user attributes to assess 49 known river swimming locations in the Hawke’s Bay Region. The method was applied to differentiate swimming sites of regional significance (n=9) from those of local significance. Few data were available, so the ExpertPanel relied on their own assessments for most attributes. Minor revision was made to the travel distance attribute threshold, and the RiVAS+ methodology was also applied to assess future potential value of swimming sites. This suggested that the four sites could be of regional swimming value (rather than local significance in their existing state) if identified management actions were taken to enhance the site for swimming.
Sensory profiling is a valuable tool to evaluate the market potential und success of apple varieties and advanced selections from breeding programmes. The expertpanel test reported here has shown that disease resistant apples are competitive with non-resistant varieties. However, some of them lack firmness and sweetness.