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Item A research definition and framework for acute paediatric critical illness across resource-variable settings: a modified Delphi consensus(Elsevier, 2024) Arias, Anita V.; Lintner-Rivera, Michael; Shafi, Nadeem I.; Abbas, Qalab; Abdelhafeez, Abdelhafeez H.; Ali, Muhammad; Ammar, Halaashuor; Anwar, Ali I.; Appiah, John Adabie; Attebery, Jonah E.; Diaz Villalobos, Willmer E.; Ferreira, Daiane; González-Dambrauskas, Sebastián; Habib, Muhammad Irfan; Lee, Jan Hau; Kissoon, Niranjan; Tekleab, Atnafu M.; Molyneux, Elizabeth M.; Morrow, Brenda M.; Nadkarni, Vinay M.; Rivera, Jocelyn; Silvers, Rebecca; Steere, Mardi; Tatay, Daniel; Bhutta, Adnan T.; Kortz, Teresa B.; Agulnik, Asya; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network on behalf of the PALISI Global Health Subgroup; Pediatrics, School of MedicineThe true global burden of paediatric critical illness remains unknown. Studies on children with life-threatening conditions are hindered by the absence of a common definition for acute paediatric critical illness (DEFCRIT) that outlines components and attributes of critical illness and does not depend on local capacity to provide critical care. We present an evidence-informed consensus definition and framework for acute paediatric critical illness. DEFCRIT was developed following a scoping review of 29 studies and key concepts identified by an interdisciplinary, international core expert panel (n=24). A modified Delphi process was then done with a panel of multidisciplinary health-care global experts (n=109) until consensus was reached on eight essential attributes and 28 statements as the basis of DEFCRIT. Consensus was reached in two Delphi rounds with an expert retention rate of 89%. The final consensus definition for acute paediatric critical illness is: an infant, child, or adolescent with an illness, injury, or post-operative state that increases the risk for or results in acute physiological instability (abnormal physiological parameters or vital organ dysfunction or failure) or a clinical support requirement (such as frequent or continuous monitoring or time-sensitive interventions) to prevent further deterioration or death. The proposed definition and framework provide the conceptual clarity needed for a unified approach for global research across resource-variable settings. Future work will centre on validating DEFCRIT and determining high priority measures and guidelines for data collection and analysis that will promote its use in research.Item AOSSM Early Sport Specialization Consensus Statement(SAGE, 2016-04) LaPrade, Robert F.; Agel, Julie; Baker, Joseph; Brenner, Joel S.; Cordasco, Frank A.; Co te, Jean; Engebretsen, Lars; Feeley, Brian T.; Gould, Daniel; Hainline, Brian; Hewett, Timothy E.; Jayanthi, Neeru; Kocher, Mininder S.; Myer, Gregory D.; Nissen, Carl W.; Philippon, Marc J.; Provencher, Matthew T.; Hainline, Brian; Department of Neurology, IU School of MedicineBACKGROUND: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. PURPOSE: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. STUDY DESIGN: Think tank, roundtable discussion. RESULTS: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. CONCLUSION: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.Item Artificial Intelligence Methods and Artificial Intelligence-Enabled Metrics for Surgical Education: A Multidisciplinary Consensus(Wolters Kluwer, 2022) Vedula, S. Swaroop; Ghazi, Ahmed; Collins, Justin W.; Pugh, Carla; Stefanidis, Dimitrios; Meireles, Ozanan; Hung, Andrew J.; Schwaitzberg, Steven; Levy, Jeffrey S.; Sachdeva, Ajit K.; Collaborative for Advanced Assessment of Robotic Surgical Skills; Surgery, School of MedicineBackground: Artificial intelligence (AI) methods and AI-enabled metrics hold tremendous potential to advance surgical education. Our objective was to generate consensus guidance on specific needs for AI methods and AI-enabled metrics for surgical education. Study design: The study included a systematic literature search, a virtual conference, and a 3-round Delphi survey of 40 representative multidisciplinary stakeholders with domain expertise selected through purposeful sampling. The accelerated Delphi process was completed within 10 days. The survey covered overall utility, anticipated future (10-year time horizon), and applications for surgical training, assessment, and feedback. Consensus was agreement among 80% or more respondents. We coded survey questions into 11 themes and descriptively analyzed the responses. Results: The respondents included surgeons (40%), engineers (15%), affiliates of industry (27.5%), professional societies (7.5%), regulatory agencies (7.5%), and a lawyer (2.5%). The survey included 155 questions; consensus was achieved on 136 (87.7%). The panel listed 6 deliverables each for AI-enhanced learning curve analytics and surgical skill assessment. For feedback, the panel identified 10 priority deliverables spanning 2-year (n = 2), 5-year (n = 4), and 10-year (n = 4) timeframes. Within 2 years, the panel expects development of methods to recognize anatomy in images of the surgical field and to provide surgeons with performance feedback immediately after an operation. The panel also identified 5 essential that should be included in operative performance reports for surgeons. Conclusions: The Delphi panel consensus provides a specific, bold, and forward-looking roadmap for AI methods and AI-enabled metrics for surgical education.Item ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Multiple Myeloma(Elsevier, 2022) Dhakal, Binod; Shah, Nina; Kansagra, Ankit; Kumar, Ambuj; Lonial, Sagar; Garfall, Alfred; Cowan, Andrew; Poudyal, Bishesh Sharma; Costello, Caitlin; Gay, Francesca; Cook, Gordon; Quach, Hang; Einsele, Herman; Schriber, Jeff; Hou, Jian; Costa, Luciano; Aljurf, Mahmoud; Chaudhry, Maria; Beksac, Meral; Prince, Miles; Mohty, Mohamad; Janakiram, Murali; Callander, Natalie; Biran, Noa; Malhotra, Pankaj; Rodriguez Otero, Paula; Moreau, Philippe; Abonour, Rafat; Iftikhar, Raheel; Silberman, Rebecca; Mailankody, Sham; Gregory, Tara; Lin, Yi; Carpenter, Paul; Hamadani, Mehdi; Usmani, Saad; Kumar, Shaji; Medicine, School of MedicineOver the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny. Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM). The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial. For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy. The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.Item Average Consensus in Wireless Sensor Networks with Probabilistic Network Links(2010) Saed, Steve; Li, Lingxi; Kim, Dongsoo S.; King, BrianThis study proposes and evaluates an average consensus scheme for wireless sensor networks. For this purpose, two communication error models, the fading signal error model and approximated fading signal error model, are introduced and incorporated into the proposed decentralized average consensus scheme. Also, a mathematical analysis is introduced to derive the approximated fading signal model from the fading signal model. Finally, differnt simulation scenarios are introduced and their results analyzed to evaluate the performance of the proposed scheme and its effectiveness in meeting the needs of wireless sensor networks.Item A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit(BMC, 2020-10-22) Brown, Wade; Santhosh, Lekshmi; Brady, Anna K.; Denson, Joshua L.; Niroula, Abesh; Pugh, Meredith E.; Self, Wesley H.; Joffe, Aaron M.; O’Neal Maynord, P.; Carlos, W. Graham; Medicine, School of MedicineEndotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.Item Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel(Elsevier, 2023) Chiang, Silvia S.; Waterous, Patricia M.; Atieno, Vivian Faith; Bernays, Sarah; Bondarenko, Yaroslava; Cruz, Andrea T.; de Oliveira, Márcia C. B.; Del Castillo Barrientos, Hernán; Enimil, Anthony; Ferlazzo, Gabriella; Ferrand, Rashida Abbas; Furin, Jennifer; Hoddinott, Graeme; Isaakidis, Petros; Kranzer, Katharina; Maleche-Obimbo, Elizabeth; Mansoor, Homa; Marais, Ben J.; Mohr-Holland, Erika; Morales, Mabel; Nguyen, Anh Phuong; Oliyo, Joshua Ochieng; Sant'Anna, Clemax Couto; Sawyer, Susan M.; Schaaf, H. Simon; Seddon, James A.; Sharma, Sangeeta; Skrahina, Alena; Starke, Jeffrey R.; Triasih, Rina; Tsogt, Bazarragchaa; Welch, Henry; Enane, Leslie A.; Pediatrics, School of MedicineBackground: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. Methods: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori, was reached. Results: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. Conclusion: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB.Item Code Status Orders: Do the Options Matter?(Springer, 2023) Patel, Roma; Comer, Amber; Pelc, Gregory; Jawed, Areeba; Fettig, Lyle; Medicine, School of MedicineBackground: Code status orders in hospitalized patients guide urgent medical decisions. Inconsistent terminology and treatment options contribute to varied interpretations. Objective: To compare two code status order options, traditional (three option) and modified to include additional care options (four option). Design: Prospective, randomized, cross-sectional survey conducted on February-March 2020. Participants were provided with six clinical scenarios and randomly assigned to the three or four option code status order. In three scenarios, participants determined the most appropriate code status. Three scenarios provided clinical details and code status and respondents were asked whether they would provide a particular intervention. This study was conducted at three urban, academic hospitals. Participants: Clinicians who routinely utilize code status orders. Of 4006 participants eligible, 549 (14%) were included. Main measures: The primary objective was consensus (most commonly selected answer) based on provided code status options. Secondary objectives included variables associated with participant responses, participant code status model preference, and participant confidence about whether their selections would match their peers. Key results: In the three scenarios participants selected the appropriate code status, there was no difference in consensus for the control scenario, and higher consensus in the three option group (p-values < 0.05) for the remaining two scenarios. In the scenarios to determine if a clinical intervention was appropriate, two of the scenarios had higher consensus in the three option group (p-values 0.018 and < 0.05) and one had higher consensus in the four option group (p-value 0.001). Participants in the three option model were more confident that their peers selected the same code status (p-value 0.0014); however, most participants (72%) preferred the four option model. Conclusions: Neither code status model led to consistent results. The three option model provided consistency more often; however, the majority of participants preferred the four option model.Item Consensus Minimum MRI Protocol for the Child With Acute Recurrent or Chronic Pancreatitis(American Roentgen Ray Society, 2024) Trout, Andrew T.; Squires, Judy H.; Rees, Mitchell A.; Plunk, Matthew R.; Murati, Michael A.; Marine, Meghan B.; Browne, Lorna P.; Anupindi, Sudha A.; Abu-El-Haija, Maisam; Radiology and Imaging Sciences, School of MedicineImaging plays an important role in the diagnosis and follow-up of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Consensus is lacking for a minimum MRI protocol for the child with known or suspected ARP or CP. Lack of standardization contributes to variable diagnostic performance and hampers application of uniform interpretive criteria for clinical diagnosis and multicenter research studies. We convened a working group to achieve consensus for a minimum MRI protocol for children with suspected ARP or CP. The group included eight pediatric radiologists experienced in interpreting MRI for pediatric pancreatitis and one medical pancreatologist and functioned from November 2022 to March 2023. Existing clinical protocols were summarized across sites represented by group members, and commonly used sequences guided the group’s discussion. The final consensus minimum MRI protocol includes five noncontrast sequences and two postcontrast sequences (which are required only in select clinical scenarios). The working group also provides recommended acquisition parameters, sequence-specific technical suggestions, and general recommendations for optimal imaging technique. We recommend that all sites imaging children with ARP and CP for clinical care, and particularly those engaged in cooperative group trials for pancreatitis, ensure that their local protocol includes these minimum sequences.Item Consensus Report on Glucagon-Like Peptide-1 Receptor Agonists as Adjunctive Treatment for Individuals With Type 1 Diabetes Using an Automated Insulin Delivery System(Sage, 2024-11-08) Shah, Viral N.; Peters, Anne L.; Umpierrez, Guillermo E.; Sherr, Jennifer L.; Akturk, Halis Kaan; Aleppo, Grazia; Bally, Lia; Cengiz, Eda; Cinar, Ali; Dungan, Kathleen; Fabris, Chiara; Jacobs, Peter G.; Lal, Rayhan A.; Mader, Julia K.; Masharani, Umesh; Prahalad, Priya; Schmidt, Signe; Zijlstra, Eric; Ho, Cindy N.; Ayers, Alessandra T.; Tian, Tiffany; Aaron, Rachel E.; Klonoff, David C.; Medicine, School of MedicineWith increasing prevalence of obesity and cardiovascular diseases, there is a growing interest in the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an adjunct therapy in type 1 diabetes (T1D). The GLP-1RAs are currently not approved by the US Food and Drug Administration for the treatment of T1D in the absence of randomized controlled trials documenting efficacy and safety of these agents in this population. The Diabetes Technology Society convened a series of three consensus meetings of clinicians and researchers with expertise in diabetes technology, GLP-1RA therapy, and T1D management. The project was aimed at synthesizing current literature and providing conclusions on the use of GLP-1RA therapy as an adjunct to automated insulin delivery (AID) systems in adults with T1D. The expert panel members met virtually three times on January 17, 2024, and April 24, 2024, and August 14, 2024, to discuss topics ranging from physiology and outcomes of GLP-1RAs in T1D to limitations of current sensors, algorithms, and insulin for AID systems. The panelists also identified research gaps and future directions for research. The panelists voted to in favor of 31 recommendations. This report presents the consensus opinions of the participants that, in adults with T1D using AID systems, GLP-1RAs have the potential to (1) provide effective adjunct therapy and (2) improve glycemic and metabolic outcomes without increasing the risk of severe hypoglycemia or diabetic ketoacidosis.
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