IMPORTANCE: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment. OBJECTIVE: To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS. DESIGN, SETTING, AND PARTICIPANTS: The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022. MAIN OUTCOMES/MEASURES: The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1. RESULTS: In the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup. CONCLUSIONS AND RELEVANCE: This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

• MeSH
• Delphi Technique MeSH
• Adult MeSH
• Eosinophilia * chemically induced   diagnosis   therapy   MeSH
• Consensus MeSH
• Drug Hypersensitivity Syndrome * diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

Úvod a cíl: Terminologie adherence (resp. compliance) popisující chování pacienta směrem k farmakoterapii je v literatuře používána často nekonzistentně a roztříštěně. V anglickém originále proto vznikla tzv. ABC taxonomie za účelem klasifikace a sjednocení používaných pojmů. Cílem této práce bylo ustanovení prvotního konsenzuálního překladu české terminologie zabývající se problematikou užívání léčiv prostřednictvím Delphi metody. Metodika: V období od února do května 2021 proběhlo tříkolové anonymní on-line dotazníkové Delphi šetření. Dotazník obsahoval otázky na překlady sedmi pojmů a jejich definic vycházejících z ABC taxonomie, přičemž výsledný konsenzus byl ustanoven na základě předem definované míry shody respondentů. Výsledky: Ze 106 kontaktovaných panelistů různých zdravotnických profesí odpovědělo v prvním kole 46 (43,4 %). Dostatečného konsenzu (≥ 85 %) bylo dosaženo u překladů dvou definic. Ve druhém kole se 32 respondentům podařilo ustanovit konsenzuální znění (> 75 %) jednoho pojmu a čtyř definic. Na třetí kolo reagovalo 24 respondentů a pro všechny zbylé pojmy a definice ustanovilo mírný (> 50 %) až silný (> 95 %) konsenzus. Soubor pojmů souvisejících s užíváním léčiv ustanovený pro český jazyk byl následující: adherence k léčbě, zahájení léčby, zavedení léčby, přerušení léčby, setrvání na léčbě, management adherence a obory související s adherencí. Závěr: Ustanovení konsenzuálních překladů všech českých pojmů a definic souvisejících s adherencí k léčbě může přispět k větší harmonizaci a možnosti porovnání vědeckých prací i ke zlepšení komunikace mezi odbornou veřejností. Je však třeba tento konsenzus ještě potvrdit na větším počtu odborníků zabývajících se danou problematikou včetně zapojení odborných společností.

Background: The terminology of adherence (or compliance) describing the patient's medication taking behavior is often used inconsistently and fragmented in the literature. Therefore, the English original of so-called ABC Taxonomy was developed to classify and unify the terminology. The aim of this paper was to establish the first consensual translation of Czech terminology dealing with the issue of medication taking behavior using Delphi method. Methods: In the period from February to May 2021, a three-round anonymous online Delphi questionnaire survey was conducted. The questionnaire contained items for translations of seven terms and their definitions based on the ABC Taxonomy, while the resulting consensus was established by a predefined degree of agreement of the respondents. Results: Out of 106 contacted panelists representing different healthcare professions, 46 (43.4%) answered in the first round. Sufficient consensus (≥ 85%) was reached for the translation of two definitions. In the second round, 32 respondents managed to establish a consensus (> 75%) of one term and four definitions and 24 respondents in the third round established a mild (> 50%) to strong (> 95%) consensus for all remaining terms and definitions. The set of terms related to medication taking for the Czech language was as follows: adherence k léčbě, zahájení léčby, zavedení léčby, přerušení léčby, setrvání na léčbě, management adherence and obory související s adherencí. Conclusion: The consensual translations of all Czech terms and definitions related to medication adherence can contribute to greater harmonization and comparability of scientific papers as well as to enhance the communication between scientific and clinical community. However, this consensus needs to be confirmed by a larger number of experts dealing with adherence issue, including the involvement of professional societies.

• MeSH
• Treatment Adherence and Compliance * MeSH
• Medication Adherence MeSH
• Patient Compliance MeSH
• Delphi Technique MeSH
• Consensus MeSH
• Humans MeSH
• Evidence-Based Medicine MeSH
• Surveys and Questionnaires MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH

BACKGROUND: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

• MeSH
• Delphi Technique MeSH
• Geriatrics education   standards   MeSH
• Curriculum MeSH
• Humans MeSH
• Aged MeSH
• Education, Medical, Graduate methods   standards   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Cieľom Delphi prieskumu realizovaného na Slovensku bolo dosiahnutie názorového konsenzu v problematike zameniteľnosti inhalačných systémov v liečbe astmy a chronickej obštrukčnej choroby pľúc. Výsledky ukázali, že inhalačný systém a liečivá látka sú rovnako dôležité pri výbere inhalačnej liečby. Pri výbere je dôležitá schopnosť pacienta inhalátor ovládať, inhalačné systémy nie sú ľahko zameniteľné, a o ich výmene nesmie rozhodovať lekárnik, ani pri úvahe o rozdielnych cenách. Poisťovne by nemali zasahovať do výberu inhalačného systému, pretože výsledkom môže byť nižšia účinnosť liečby prameniaca z možného nezvládnutia inhalačnej techniky.

The Delphi survey in Slovakia aimed to assess the use of inhalation devices in asthma and chronic obstructive pulmonary disease. The experts consider the choice of inhalation device as important as that of active substances. For patients, the ease of use is important. The experts discourage inhalation device interchangeability. Pharmacists or health insurance companies cannot switch inhalation devices without medical consultation. The consequences may be misuse, low adherence, lower pulmonary deposition and more exacerbations/poorer control of the respiratory disorder.

• MeSH
• Medication Adherence MeSH
• Asthma * drug therapy   MeSH
• Pulmonary Disease, Chronic Obstructive * drug therapy   MeSH
• Delphi Technique MeSH
• Physicians MeSH
• Humans MeSH
• Drug Substitution MeSH
• Nebulizers and Vaporizers * economics   utilization   MeSH
• Physician's Role * MeSH
• Physician-Patient Relations MeSH
• Check Tag
• Humans MeSH

Pozadí problematiky: Demence je život limitující onemocnění bez dostupnosti kurativní léčby. Pacienti a rodiny mohou potřebovat paliativní péči specifickou pro demenci. Cíl: Definovat optimální paliativní péči při demenci. Metody: Studie s využitím metody Delphi (delfské metody) o pěti kolech. Na základě literatury sestavila hlavní skupina čítající 12 odborníků ze 6 zemí soubor základních domén s hlavními doporučeními pro každou doménu. K jejich vyhodnocení formou on-line dotazníku o dvou kolech se zpětnou vazbou jsme vyzvali 89 odborníků z 27 zemí. Konsenzus byl stanoven podle předem definovaných kritérií. Náplní čtvrtého kola byla rozhodnutí hlavního týmu a páté kolo obnášelo vstup ze strany Evropské asociace paliativní péče. Výsledky: Celkem 64 (72 %) odborníků z 23 zemí vyhodnotilo soubor 11 domén a 57 doporučení. Bylo dosaženo bezprostředního a úplného konsenzu ohledně následujících osmi domén zahrnujících doporučení: péče zaměřená na pacienta, komunikace a sdílené rozhodování; optimální léčba příznaků a zajišťování komfortu (tyto dvě byly identifikovány jako ústřední pro péči a výzkum); stanovení cílů plánování péče; kontinuita péče; psychosociální a spirituální podpora; péče o rodinu a její zapojení; vzdělání zdravotnického týmu; společenské a etické otázky. Po revizi bylo dále dosaženo úplného konsenzu pro určování prognózy a včasné rozpoznání umírání. V oblasti doporučení pro výživu a hydrataci (vyvarování se nadměrně agresivní, zatěžující nebo neužitečné léčby) a pro stadia demence v souvislosti s cíli péče (použitelnost paliativní péče) bylo dosaženo středního konsenzu. Závěr: Podáváme první definici paliativní péče při demenci na základě důkazů a konsenzu, která nabízí rámec k formulování doporučení pro klinickou praxi, politiky a pro výzkum.

Background: Dementia is a life-limiting disease without curative treatments. Patients and families may need palliative care specific to dementia. Aim: To define optimal palliative care in dementia. Methods: Five-round Delphi study. Based on literature, a core group of 12 experts from 6 countries drafted a set of core domains with salient recommendations for each domain. We invited 89 experts from 27 countries to evaluate these in a two-round online survey with feedback. Consensus was determined according to predefined criteria. The fourth round involved decisions by the core team, and the fifth involved input from the European Association for Palliative Care. Results: A total of 64 (72%) experts from 23 countries evaluated a set of 11 domains and 57 recommendations. There was immediate and full consensus on the following eight domains, including the recommendations: person-centred care, communication and shared decision-making; optimal treatment of symptoms and providing comfort (these two identified as central to care and research); setting care goals and advance planning; continuity of care; psychosocial and spiritual support; family care and involvement; education of the health care team; and societal and ethical issues. After revision, full consensus was additionally reached for prognostication and timely recognition of dying. Recommendations on nutrition and dehydration (avoiding overly aggressive, burdensome or futile treatment) and on dementia stages in relation to care goals (applicability of palliative care) achieved moderate consensus. Conclusion: We have provided the first definition of palliative care in dementia based on evidence and consensus, a framework to provide guidance for clinical practice, policy and research.

• Keywords
• Bílá kniha,
• MeSH
• Delphi Technique MeSH
• Dementia * therapy   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Palliative Care * standards   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Úvod: V léčbě pacientů s chronickou bronchiální obstrukcí (astma, CHOPN) je preferována inhalační cesta podání léků. Studie zkoumala vliv možné záměny inhalačního systému lékárníkem na kontrolu astmatu a CHOPN. Metodika: Ve dvoukolovém průzkumu provedeném delfskou metodou vybraní experti (5 alergologů, 5 pneumologů) odpovídali anonymně (v programu Survey Monkeys) na dotazník, který obsahoval celkem 11 otázek týkajících se úlohy inhalačních systémů, jejich výběru a jejich možné záměny. Výsledky: Experti se shodli na skutečnosti, že inhalační systém je stejně důležitý jako léčivá látka a že je důležité, aby pacient inhalační systém dobře ovládal. Dále se experti většinově shodli na tom, že inhalační systémy se stejnými léčivými látkami jsou do jisté míry zaměnitelné, ale nikoliv zaměnitelné lékárníkem (např. z cenových důvodů), bez vědomí preskribujícího lékaře. Závěr: Záměna, tj. substituce, inhalačního systému lé- kárníkem bez vědomí preskribujícího lékaře je experty neakceptovatelná.

Objectives: The inhaled route is the first line administration method in the management of disease with chronic airways obstruction (asthma, COPD). This study aimed to effect of potential interchangeability of inhalation devices and theirs substitution by pharmacist on asthma and COPD control. Methods: In this two-round Delphi survey, 10 experts in asthma and COPD (5 allergologists, 5 pulmonologists) completed a 11-item, internet-based (Survey Monkeys), self-administered questionnaire about the role and choice of inhalation devices, and theirs potential substitution. Results: Experts considered that the role of inhalation device was as important as that active substance and that is also important good manipulation with inhalation device by patient. Experts considered that inhalation devices are into reliable scale interchangeable, but experts discouraged inhalation device interchangeability and switching (for example for cost reasons) by pharmacist without medical consultation. Conclusions: The interchangeability of inhalation devices and theirs substitution by pharmacist without medical consultation is not recommended by experts.

• MeSH
• Administration, Inhalation * MeSH
• Asthma * drug therapy   MeSH
• Pulmonary Disease, Chronic Obstructive drug therapy   MeSH
• Delphi Technique * MeSH
• Pharmacists MeSH
• Drug Prescriptions MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Data Collection MeSH
• Statistics as Topic MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Local treatment improves the outcomes for oligometastatic disease (OMD, i.e. an intermediate state between locoregional and widespread disseminated disease). However, consensus about the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer is lacking. The aim of this study was to develop a multidisciplinary European consensus statement on the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer. METHODS: In total, 65 specialists in the multidisciplinary treatment for oesophagogastric cancer from 49 expert centres across 16 European countries were requested to participate in this Delphi study. The consensus finding process consisted of a starting meeting, 2 online Delphi questionnaire rounds and an online consensus meeting. Input for Delphi questionnaires consisted of (1) a systematic review on definitions of oligometastatic oesophagogastric cancer and (2) a discussion of real-life clinical cases by multidisciplinary teams. Experts were asked to score each statement on a 5-point Likert scale. The agreement was scored to be either absent/poor (<50%), fair (50%-75%) or consensus (≥75%). RESULTS: A total of 48 experts participated in the starting meeting, both Delphi rounds, and the consensus meeting (overall response rate: 71%). OMD was considered in patients with metastatic oesophagogastric cancer limited to 1 organ with ≤3 metastases or 1 extra-regional lymph node station (consensus). In addition, OMD was considered in patients without progression at restaging after systemic therapy (consensus). For patients with synchronous or metachronous OMD with a disease-free interval ≤2 years, systemic therapy followed by restaging to consider local treatment was considered as treatment (consensus). For metachronous OMD with a disease-free interval >2 years, either upfront local treatment or systemic treatment followed by restaging was considered as treatment (fair agreement). CONCLUSION: The OMEC project has resulted in a multidisciplinary European consensus statement for the definition, diagnosis and treatment of oligometastatic oesophagogastric adenocarcinoma and squamous cell cancer. This can be used to standardise inclusion criteria for future clinical trials.

• MeSH
• Delphi Technique MeSH
• Humans MeSH
• Neoplasms * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH
• Geographicals
• Europe MeSH

Social prescribing has become a global phenomenon. A Delphi study was recently conducted with 48 social prescribing experts from 26 countries to establish global agreement on the definition of social prescribing. We reflect on the use and utility of the outputs of this work, and where we go from here.

• MeSH
• Delphi Technique * MeSH
• Consensus * MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Letter MeSH

OBJECTIVE: Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to report the results of the international Delphi validation study for the Turkish Inappropriate Medication use in the Elderly (TIME) criteria set, which aims to detect inappropriate prescribing in older adults in Eastern Europe. METHODS: The study was conducted between June 2019 and March 2020. Delphi rounds were conducted by the TIME international working group, which included 11 internationally recognized experts in geriatric pharmacotherapy as Delphi panelists. They were asked to indicate to what extent they agreed or disagreed with each TIME criterion, taking into account both the available evidence and their own experience. We used a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) and an online software program (SurveyMonkey®) to grade the level of agreement. Criteria with a median value of 1 or 2 and a 75th centile value of 1 or 2 were accepted, and criteria with a median value > 2 were rejected. Those with a median value of 1 or 2 but a 75th centile value > 2 were retained, to be assessed in the following round. The initial list of Delphi criteria comprised 153 TIME items. RESULTS: After three Delphi rounds, 134 criteria were accepted and seven criteria were rejected, while 12 criteria did not achieve consensus, and so were not included in the final validated set of TIME criteria. CONCLUSION: We developed the internationally validated TIME criteria set based on a Delphi process involving international experts. The validation study suggests that the TIME criteria set can be applied in both central and Eastern European settings. Further studies are needed to assess the utility and benefit of the TIME criteria in reducing inappropriate drug use and improving clinical outcomes.

• MeSH
• Delphi Technique MeSH
• Consensus MeSH
• Humans MeSH
• Inappropriate Prescribing * prevention & control   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

BACKGROUND/OBJECTIVE: Increasing infectious rate estimates and low microbiological surveillance affect safety of gastrointestinal endoscopy globally. Single use endoscopes and accessories have been claimed to improve safety, but there is lack of data on their indication and sustainability. We aimed to identify a series of best practice recommendations for the use of single use endoscopes and accessories using a modified Delphi. METHODS/DESIGN: Consensus statements for the use of single use endoscopy and accessories were developed using a modified Delphi process, utilizing an international endoscopist expert panel of 62 experts from 33 nations. The main steps in the process were selecting the consensus group, conducting systematic literature reviews, developing statements, and anonymous voting on the statements until consensus was reached. High-risk patients were defined as those with multi-drug-resistant infections, immunosuppressive medication or chemotherapy, post-transplantation, or with severe neutropenia. RESULTS: Of the 26 statements that were voted upon through two rounds, 17 statements reached consensus. Category 1: single use accessories (8 statements), related to defining recommendations for the use of single use accessories in all patient populations or high-risk patients. Category 2: clinical indication for single use endoscopes (9 statements), including indications to high-risk patients, protecting the endoscope apparatus and contamination measures in endoscopy units. Category 3: technical factors (4 statements), related to superior performance and technical specifications with the new innovation. Category 4: environmental issues (2 statements), concerning mechanisms that reduce the detrimental burden to the environment. Category 5: financial implications (3 statements), related to healthcare policies, cost neutrality and other financial associations of single use endoscopy. CONCLUSIONS: This is the first international initiative in determining clinical indications for single use endoscopy and accessories. The study's findings should serve as a framework for future physicians to guide future research and aid the proper evidence-based indications for the implementation of single use endoscopes in clinical practice.

• MeSH
• Delphi Technique MeSH
• Endoscopy, Gastrointestinal * MeSH
• Consensus MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH