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Towards an individualized management strategy for patients with chronic venous disease: Results of a Delphi consensus.

ABSTRACT: Objective To obtain consensus on management criteria for symptomatic patients with chronic venous disease (CVD; C2-C6) and superficial venous reflux. Method We used a Delphi method by means of 36 statements sent by email to experts in the field of phlebology across the world over the course of three rounds. The statements addressed criteria for different venous treatments in patients with different characteristics (e.g. extensive comorbidities, morbid obesity and peripheral arterial disease). If at least 70% of the ratings for a specific statement were between 6 and 9 (agreement) or between 1 and 3 (disagreement), experts' consensus was reached. Results Twenty-five experts were invited to participate, of whom 24 accepted and completed all three rounds. Consensus was reached in 25/32 statements (78%). However, several statements addressing UGFS, single phlebectomies, patients with extensive comorbidities and morbid obesity remained equivocal. Conclusion Considerable consensus was reached within a group of experts but also some gaps in available research were highlighted.

SUBMITTER: van der Velden SK

PROVIDER: S-EPMC6047201 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Towards an individualized management strategy for patients with chronic venous disease: Results of a Delphi consensus.

van der Velden S K SK van den Bos R R RR Pichot O O Nijsten T T De Maeseneer Mgr M

Phlebology 20170714 7

Objective To obtain consensus on management criteria for symptomatic patients with chronic venous disease (CVD; C2-C6) and superficial venous reflux. Method We used a Delphi method by means of 36 statements sent by email to experts in the field of phlebology across the world over the course of three rounds. The statements addressed criteria for different venous treatments in patients with different characteristics (e.g. extensive comorbidities, morbid obesity and peripheral arterial disease). If ...[more]

PMID: 28707962

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Project description:ObjectiveIn epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus.MethodsThe consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements.ResultsOf 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements.SignificanceWith the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt.Plain language summaryThis work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Project description:ObjectiveHealth care providers and recipients have been using artificial intelligence and its subfields, such as natural language processing and machine learning technologies, in the form of search engines to obtain medical information for some time now. Although a search engine returns a ranked list of webpages in response to a query and allows the user to obtain information from those links directly, ChatGPT has elevated the interface between humans with artificial intelligence by attempting to provide relevant information in a human-like textual conversation. This technology is being adopted rapidly and has enormous potential to impact various aspects of health care, including patient education, research, scientific writing, pre-visit/post-visit queries, documentation assistance, and more. The objective of this study is to assess whether chatbots could assist with answering patient questions and electronic health record inbox management.MethodsWe devised two questionnaires: (1) administrative and non-complex medical questions (based on actual inbox questions); and (2) complex medical questions on the topic of chronic venous disease. We graded the performance of publicly available chatbots regarding their potential to assist with electronic health record inbox management. The study was graded by an internist and a vascular medicine specialist independently.ResultsOn administrative and non-complex medical questions, ChatGPT 4.0 performed better than ChatGPT 3.5. ChatGPT 4.0 received a grade of 1 on all the questions: 20 of 20 (100%). ChatGPT 3.5 received a grade of 1 on 14 of 20 questions (70%), grade 2 on 4 of 16 questions (20%), grade 3 on 0 questions (0%), and grade 4 on 2/20 questions (10%). On complex medical questions, ChatGPT 4.0 performed the best. ChatGPT 4.0 received a grade of 1 on 15 of 20 questions (75%), grade 2 on 2 of 20 questions (10%), grade 3 on 2 of 20 questions (10%), and grade 4 on 1 of 20 questions (5%). ChatGPT 3.5 received a grade of 1 on 9 of 20 questions (45%), grade 2 on 4 of 20 questions (20%), grade 3 on 4 of 20 questions (20%), and grade 4 on 3 of 20 questions (15%). Clinical Camel received a grade of 1 on 0 of 20 questions (0%), grade 2 on 5 of 20 questions (25%), grade 3 on 5 of 20 questions (25%), and grade 4 on 10 of 20 questions (50%).ConclusionsBased on our interactions with ChatGPT regarding the topic of chronic venous disease, it is plausible that in the future, this technology may be used to assist with electronic health record inbox management and offload medical staff. However, for this technology to receive regulatory approval to be used for that purpose, it will require extensive supervised training by subject experts, have guardrails to prevent "hallucinations" and maintain confidentiality, and prove that it can perform at a level comparable to (if not better than) humans. (JVS-Vascular Insights 2023;1:100019.).

Project description:BackgroundThe general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care.MethodThis study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response.ResultsResponse rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed.ConclusionOverall, the study findings witnessed the expert panel's support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia.

Project description:BackgroundGlobally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.MethodsUsing a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.ResultsThere was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.ConclusionsIn summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

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Towards an individualized management strategy for patients with chronic venous disease: Results of a Delphi consensus.

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Towards an individualized management strategy for patients with chronic venous disease: Results of a Delphi consensus.

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