Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process

Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA.

Developing the specifications of an open angle glaucoma screening intervention in the United Kingdom: a Delphi approach.

Abstract
BACKGROUND:
Glaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT.
METHODS:
A two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility.
RESULTS:
Using a cut-off of a median rating of feasibility of =5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a 'glaucoma risk score' ascertained by questionnaire. The advisory panel recommended that further exploration of the feasibility of screening higher risk populations and detailed specification of the screening tests was required.
CONCLUSIONS:
With systematic use of expert opinions, a shortlist of potential screening interventions was identified. Views of users, service providers and cost-effectiveness modeling are now required to identify a feasible intervention to evaluate in a future glaucoma screening trial.

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

OBJECTIVES: Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

Core Outcomes in Ventilation Trials (COVenT): protocol for a core outcome set using a Delphi survey with a nested randomised trial and observational cohort study

Background
Among clinical trials of interventions that aim to modify time spent on mechanical ventilation for critically ill patients there is considerable inconsistency in chosen outcomes and how they are measured. The Core Outcomes in Ventilation Trials (COVenT) study aims to develop a set of core outcomes for use in future ventilation trials in mechanically ventilated adults and children.

Methods/design
We will use a mixed methods approach that incorporates a randomised trial nested within a Delphi study and a consensus meeting. Additionally, we will conduct an observational cohort study to evaluate uptake of the core outcome set in published studies at 5 and 10 years following core outcome set publication. The three-round online Delphi study will use a list of outcomes that have been reported previously in a review of ventilation trials. The Delphi panel will include a range of stakeholder groups including patient support groups. The panel will be randomised to one of three feedback methods to assess the impact of the feedback mechanism on subsequent ranking of outcomes. A final consensus meeting will be held with stakeholder representatives to review outcomes.

Discussion
The COVenT study aims to develop a core outcome set for ventilation trials in critical care, explore the best Delphi feedback mechanism for achieving consensus and determine if participation increases use of the core outcome set in the long term.

Consensus on Outcome Measures for Glaucoma Effectiveness Trials: Results From a Delphi and Nominal Group Technique Approaches

PURPOSE: Comparing the relative effectiveness of interventions across glaucoma trials can be problematic due to differences in definitions of outcomes. We sought to identify a key set of clinical outcomes and reach consensus on how best to measure them from the perspective of glaucoma experts.

METHODS: A 2-round electronic Delphi survey was conducted. Round 1 involved 25 items identified from a systematic review. Round 2 was developed based on information gathered in round 1. A 10-point Likert scale was used to quantify importance and consensus of outcomes (7 outcomes) and ways of measuring them (44 measures). Experts were identified through 2 glaucoma societies membership-the UK and Eire Glaucoma Society and the European Glaucoma Society. A Nominal Group Technique (NGT) followed the Delphi process. Results were analyzed using descriptive statistics.

RESULTS: A total of 65 participants completed round 1 out of 320; of whom 56 completed round 2 (86%). Agreement on the importance of outcomes was reached on 48/51 items (94%). Intraocular pressure (IOP), visual field (VF), safety, and anatomic outcomes were classified as highly important. Regarding methods of measurement of IOP, "mean follow-up IOP" using Goldmann applanation tonometry achieved the highest importance, whereas for evaluating VFs "global index mean deviation/defect (MD)" and "rate of VF progression" were the most important. Retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) was identified as highly important. The NGT results reached consensus on "change of IOP (mean of 3 consecutive measurements taken at fixed time of day) from baseline," change of VF-MD values (3 reliable VFs at baseline and follow-up visit) from baseline, and change of RNFL thickness (2 good quality OCT images) from baseline.

CONCLUSIONS: Consensus was reached among glaucoma experts on how best to measure IOP, VF, and anatomic outcomes in glaucoma randomized controlled trials.

Defining consensus norms for palliative care of people with intellectual disabilities in Europe using Delphi methods: A White Paper from the European Association of Palliative care

Background: People with intellectual disabilities often present with unique challenges that make it more difficult to meet their
palliative care needs.
Aim: To define consensus norms for palliative care of people with intellectual disabilities in Europe.
Design: Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus
were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for
Palliative Care reviewed and approved the final version.
Setting and participants: Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members’ networks.
Results: A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training
and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents’ comments, several items were modified and one item was deleted.
Conclusion: This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice.

Orquiectomia em bovinos empregando abraçadeira de náilon na hemostasia preventiva: efeito da estação do ano, método de contenção e técnica cirúrgica

v. 10, n. 1, p. 261-270, jan./mar. 2009.

O método cooperação dos amigos do cinema

v. 12, n. 2, p. 203-223, jul./dez. 2014.

A.·. 418: um método de sistematização da concepção musical interpretativa

Este trabalho consiste numa proposta metodológica, denominada A∴418, que visa abordar a actividade especulativa dos performers no que diz respeito às suas concepções interpretativas dos discursos musicais. Foram identificados dois factores inerentes a esta actividade – as concepções expressiva e técnica – como estando na base da configuração final deste processo. O A∴418 resulta de um processo de aplicação de técnicas de análise musical vocacionadas para o estudo da interpretação musical, são elas a Análise da Intenção Musical Interpretativa (direccionada para a concepção expressiva da narrativa sonora) e a Análise Técnica da Intenção Musical Interpretativa (direccionada para a concepção técnico-instrumental do discurso musical). A sistematização deste processo metodológico conduz à produção de uma partitura final, revista pelo músico-instrumentista, na qual acrescem ao discurso original do compositor indicações que reflectem a concepção técnicoexpressiva produzida pelo performer que interpreta a obra musical. Esta metodologia foi demonstrada através da sua aplicação à concepção musical interpretativa do Concerto para Violoncelo em La menor, RV 418, de Antonio Vivaldi, tendo em conta as demandas específicas deste instrumento musical e a leitura idiossincrática que o autor fez desta obra musical em concreto.

Para uma sistematização do método transcricional guitarrístico

O presente trabalho apresenta um levantamento de processos transcricionais usados por músicos, desde compositores do período barroco até músicos contemporâneos. Este conjunto de técnicas permite encontrar alternativas às eventuais problemáticas levantadas durante a transcrição e simultaneamente, processos para manter inalterada a significação proposta pelo compositor. Seguidamente, apresenta-se um conjunto de obras transcritas com apoio nas técnicas anteriormente observadas.

Quantificação de mercúrio em águas de consumo: validação do método na Luságua

Para o ser humano, a água sempre foi um recurso essencial ao longo da sua evolução. Hoje em dia, com todo o avanço tecnológico, a água é um bem muito vulnerável às diversas atividades antropogénicas. Entre os muitos contaminantes que podem afetar a qualidade da água para consumo humano, os metais causam grande preocupação devido à sua elevada toxicidade. O mercúrio é um dos contaminantes que deve ser devidamente controlado devido ao seu elevado grau de toxicidade. Este Estágio foi realizado no Laboratório Luságua e o seu principal objetivo foi avaliar se era possível baixar o limite de quantificação da técnica existente na empresa para quantificar o mercúrio em águas de consumo e validar o método através do cálculo de vários parâmetros de controlo de qualidade. Foi ainda feita a comparação entre a técnica de quantificação de mercúrio existente na Luságua (CV-AAS) e a existente na Universidade de Aveiro (CVAFS) para avaliar se havia uma mais-valia para a Luságua se adquirisse um novo equipamento para analisar o mercúrio em águas. Os parâmetros de validação avaliados nos dois métodos derem resultados semelhantes, não identificando a necessidade atual de substituir o equipamento existente na Luságua, até porque se conseguiu baixar o limite de quantificação, atingindo assim o objetivo estabelecido no início para este Estágio.

Tarea 4-Método de demostración condicional (2ª parte)

4ª tarea del curso de Lógica 2, semestre 2009-2, referente al Método de la demostración condicional.

Análise custo benefício de gestões alternativas do paúl de Lagos pelo método dos preços hedónicos/contigenciais com recursos a análise ANOVA sic: valorização do paul de Lagos

Dissertação mest., Gestão e Conservação da Natureza, Universidade do Algarve, 2009