Medical Assessment by a Delphi Group Opinion Technic

Milholland, Arthur V.; Wheeler, Stanley G.; Heieck, John J.

doi:10.1056/nejm197306142882405

Cited by 197 publications

(121 citation statements)

References 1 publication

Supporting

Mentioning

118

Contrasting

Unclassified

Order By: Relevance

“…After review and appraisal of evidence, two independent moderators developed online Delphi-like questionnaires (47,48) to measure the degree of consensus for a set of statements and recommendations that were believed to summarize and reflect available evidence. For each of these, we sought to achieve consensus, defined as agreement by a supermajority ($67%) of voting delegates, consistent with other medical consensus conferences (49 Table 1).…”

Section: Consensus Development Processmentioning

confidence: 99%

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

et al. 2016

View full text Add to dashboard Cite

BACKGROUNDDespite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIMThe 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODSA multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTSGiven its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ‡40 kg/m 2 ) and in those with class II obesity (BMI 35.0-39.9 kg/m 2 ) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m 2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m 2 for Asian patients. CONCLUSIONSAlthough additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.

show abstract

Section: Consensus Development Processmentioning

confidence: 99%

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

et al. 2016

View full text Add to dashboard Cite

show abstract

“…This inclusive de nition was chosen to re ect both the variable and multisystem nature of preeclampsia at presentation and the spectrum of women seen in clinical practice. 20,21 The components of the combined adverse maternal outcome were developed by Delphi consensus (members of consensus listed in the Appendix), 22,23 as follows:…”

mentioning

confidence: 99%

PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome

Payne¹,

Côté²,

Hutcheon³

et al. 2011

Journal of Obstetrics and Gynaecology Canada

View full text Add to dashboard Cite

Objective: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes Methods:We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time) Models with AUC ≥ 070 were considered of interest Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessmentsResults: More women were proteinuric by urinary dipstick (≥ 2+, 614%) than by spot urine Pr/Cr (≥ 30g/mol, 504%) or 24-hour urine collection (≥ 03g/d, 347%) Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods No single method was predictive of adverse perinatal outcome Conclusion:The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events

show abstract

“…El método aprovecha la sinergia del debate en el grupo eliminando las interacciones no deseables que existen dentro de todo grupo y de esta forma identificar de modo fiable los elementos de consenso 9,10 . Aunque estas técnicas cualitativas pueden introducir sesgos, si el grupo de expertos es suficientemente amplio, la información obtenida será contrastada y si además, como es nuestro caso, el grupo procede de diferentes sectores relacionados con el tema, se posibilita un abanico de enfoques que permite detectar un conocimiento más amplio del problema [11][12][13][14] . …”

Section: Discussionunclassified