Expert consensus document: European Consensus Statement on congenital hypogonadotropic hypogonadism-pathogenesis, diagnosis and treatment.

Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by the deficient production, secretion or action of gonadotropin-releasing hormone (GnRH), which is the master hormone regulating the reproductive axis. CHH is clinically and genetically heterogeneous, with >25 different causal genes identified to date. Clinically, the disorder is characterized by an absence of puberty and infertility. The association of CHH with a defective sense of smell (anosmia or hyposmia), which is found in ∼50% of patients with CHH is termed Kallmann syndrome and results from incomplete embryonic migration of GnRH-synthesizing neurons. CHH can be challenging to diagnose, particularly when attempting to differentiate it from constitutional delay of puberty. A timely diagnosis and treatment to induce puberty can be beneficial for sexual, bone and metabolic health, and might help minimize some of the psychological effects of CHH. In most cases, fertility can be induced using specialized treatment regimens and several predictors of outcome have been identified. Patients typically require lifelong treatment, yet ∼10-20% of patients exhibit a spontaneous recovery of reproductive function. This Consensus Statement summarizes approaches for the diagnosis and treatment of CHH and discusses important unanswered questions in the field.

Practical guidance and considerations for transitioning patients from oxcarbazepine or carbamazepine to eslicarbazepine acetate--Expert opinion.

There is currently a lack of guidance on methodology and special considerations for transitioning patients from oxcarbazepine (OXC) or carbamazepine (CBZ) to eslicarbazepine acetate (ESL), if deemed clinically necessary. An advisory panel of epilepsy experts was convened to share their experience on the use of adjunctive ESL in clinical practice and to provide practical recommendations to help address this gap. When changing over from OXC to ESL, an OXC:ESL dose ratio of 1:1 should be employed to calculate the ESL target dose, and the changeover can take place overnight. No changes to comedication are required. Since CBZ has a different mechanism of action to ESL and is a stronger inducer of cytochrome P450 (CYP) enzymes, the transitioning of patients from CBZ to ESL requires careful consideration on a patient-by-patient basis. In general, a CBZ:ESL dose ratio of 1:1.3 should be employed to calculate the ESL target dose, and patients should be transitioned over a minimum period of 1-2weeks. Special considerations include adjustment of titration schedule and target dose in elderly patients and those with hepatic or renal impairment and potential adjustment of comedications metabolized by CYP enzymes. In summary, due to structural distinctions between ESL, OXC, and CBZ, which affect mechanism of action and tolerability, there are clinical situations in which it may be appropriate to consider transitioning patients from OXC or CBZ to ESL. Changing patients over from OXC to ESL is generally more straightforward than transitioning patients from CBZ to ESL, which requires careful consideration.

Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.

Quality of Qualitative Research in the Health Sciences : Analysis of the Common Criteria Present in 58 Assessment Guidelines by Expert Users

The number of qualitative research methods has grown substantially over the last twenty years, both in social sciences and, more recently, in the health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. The latters include many discrepancies though, both in their vocabulary and construction. Many expert evaluators decry the absence of consensual and reliable evaluation tools. The authors present the results of an evaluation of 58 existing guidelines in 4 major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology / psychiatry, research methods and organization) by expert users (article reviewers, experts allocating funds, editors, etc.). The results propose a toolbox containing 12 consensual criteria with the definitions given by expert users. They also indicate in which disciplinary field each type of criteria is known to be more or less essential. Nevertheless, the authors highlight the limitations of the criteria comparability, as soon as one focuses on their specific definitions. They conclude that each criterion in the toolbox must be explained to come to broader consensus and identify definitions that are consensual to all the fields examined and easily operational.

The Making of Experimental Economics: Witness Seminar on the Emergence of a Field

This book is the transcript of a witness seminar on the history of experimental economics, in which eleven high-profile experimental economists participated, including Nobel Laureates Vernon Smith, Reinhard Selten and Alvin Roth. The witness seminar was constructed along four different topics: skills, community, laboratory, and funding. The transcript is preceded by an introduction explaining the method of the witness seminar and its specific set-up and resuming its results. The participants' contribution and their lively discussion provide a wealth of insights into the emergence of experimental economics as a field of research.

Le raisonnement clinique de l'infirmier (ère) expert(e) lors de l'évaluation de la douleur chez les patients ventilés, sédatés et non communicants aux soins intensifs

Problématique : La douleur aux soins intensifs adultes est un problème majeur auquel l'équipe soignante est confrontée quotidiennement. Elle nécessite un traitement adéquat et, pour ce faire, une évaluation systématique et précise est requise. Les patients hospitalisés aux soins intensifs sont vulnérables de par leurs pathologies et les multiples stimulations douloureuses auxquelles ils sont exposés. L'évaluation de la douleur est rendue complexe par le fait qu'ils ne peuvent pas la communiquer verbalement. L'utilisation d'échelles d'évaluation de la douleur est recommandée, mais les scores obtenus doivent être interprétés et contextualisés. Evaluer la douleur chez ce type de patient demande aux infirmières des connaissances et compétences élevées, à même d'être mobilisées lors d'un processus complexe lié au raisonnement clinique. But : l'objectif de cette étude descriptive observationnelle est de décrire les indicateurs influençant le raisonnement clinique de l'infirmière1 experte lors de l'évaluation de la douleur chez les patients ventilés, sédatés et non communicants aux soins intensifs. Les résultats produisent une meilleure compréhension de l'évaluation et de la gestion de la douleur en pratique et, finalement, participent à l'amélioration de la qualité de son évaluation et de sa gestion. Méthode : un échantillon de convenance de sept infirmières expertes travaillant dans une unité de soins intensifs d'un hôpital universitaire de Suisse Romande a été constitué pour cette étude. Les données ont été récoltées en situation réelle lors de l'évaluation de la douleur de sept patients en utilisant la méthode du think aloud, par une observation non participative et par un entretien semistructuré. Les données ont été analysées en utilisant une méthode d'analyse de contenu déductive sur la base d'un modèle de raisonnement clinique, comprenant les suivantes: le contexte, la situation du patient, la génération d'hypothèses, les actions infirmières et l'évaluation de l'action. Résultats : la moyenne d'expérience des infirmières participantes est de 15 ans (ÉT 4.5) en soins et de 7.85 ans (ÉT 3.1) en soins intensifs. Sept patients étaient ventilés, sédatés et non communicants ayant une moyenne de score APACHE II2 de 19. Les résultats montrent que les infirmières se basent principalement sur des indicateurs physiologiques pour évaluer la douleur. Elles cherchent à prévenir la douleur pour le patient. Elles se réfèrent régulièrement à des situations déjà vécues (pattern). Elles mobilisent leurs connaissances pour pondérer l'agitation liée à la douleur ou à d'autres causes en générant des hypothèses, puis réalisent un test antalgique pour confirmer ou infirmer l'hypothèse retenue. Conclusion : le contexte clinique joue un rôle important dans le raisonnement clinique de l'infirmière et la gestion de la douleur. Pour faciliter cette tâche, l'évaluation de la douleur doit être combinée avec l'évaluation de la situation clinique du patient et du niveau de sédation des patients de soins intensifs.

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

OBJECTIVE: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. DESIGN: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. SETTING: International group of countries participating to OECD projects. PARTICIPANTS: Members of the OECD HCQI expert group. RESULTS: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. CONCLUSIONS: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.

Bias in dissemination of clinical research findings: structured OPEN framework of what, who and why, based on literature review and expert consensus.

OBJECTIVE: The aim of this study is to review highly cited articles that focus on non-publication of studies, and to develop a consistent and comprehensive approach to defining (non-) dissemination of research findings. SETTING: We performed a scoping review of definitions of the term 'publication bias' in highly cited publications. PARTICIPANTS: Ideas and experiences of a core group of authors were collected in a draft document, which was complemented by the findings from our literature search. INTERVENTIONS: The draft document including findings from the literature search was circulated to an international group of experts and revised until no additional ideas emerged and consensus was reached. PRIMARY OUTCOMES: We propose a new approach to the comprehensive conceptualisation of (non-) dissemination of research. SECONDARY OUTCOMES: Our 'What, Who and Why?' approach includes issues that need to be considered when disseminating research findings (What?), the different players who should assume responsibility during the various stages of conducting a clinical trial and disseminating clinical trial documents (Who?), and motivations that might lead the various players to disseminate findings selectively, thereby introducing bias in the dissemination process (Why?). CONCLUSIONS: Our comprehensive framework of (non-) dissemination of research findings, based on the results of a scoping literature search and expert consensus will facilitate the development of future policies and guidelines regarding the multifaceted issue of selective publication, historically referred to as 'publication bias'.

Le raisonnement clinique de l'infirmier(ère) expert(e) lors de l'évaluation de la douleur chez l'enfant ventilé et non communicant, sous analgésie et sédation, aux soins intensifs de pédiatrie

Dans le contexte des soins intensifs pédiatriques, la douleur est une préoccupation majeure et quotidienne pour l'équipe soignante. Les patients sont vulnérables de par leur condition et les multiples stimulations douloureuses auxquelles ils sont exposés. En dépit des données probantes démontrant l'importance d'une évaluation de la douleur, le traitement de celle-ci reste non optimal dans cette population vulnérable. Une douleur inadéquatement traitée peut causer de nombreuses complications à moyen et à long terme. L'évaluation de la douleur chez le patient ventilé et non communicant représente un défi important, rendu complexe par l'utilisation concomitante de médicaments sédatifs et analgésiques qui peuvent masquer ou altérer les comportements de la douleur. Il existe des outils d'évaluation adaptés à cette population vulnérable, mais l'interprétation des scores reste difficile. L'évaluation de la douleur demande aux infirmières des connaissances et compétences élevées à même d'être mobilisées lors d'un processus complexe lié au raisonnement clinique. Le but de cette étude descriptive et observationnelle est de déterminer les indicateurs utilisés par les infirmières expertes des soins intensifs de pédiatrie lors de l'évaluation de la douleur chez le patient ventilé et non communicant, sous analgésie et sédation. Un échantillon de convenance de dix infirmières expertes travaillant dans une unité de soins intensifs pédiatriques d'un hôpital universitaire de Suisse romande a participé à cette étude. Les données ont été récoltées par l'enregistrement de la verbalisation du raisonnement clinique au lit du patient, complété par une observation non participante et un entretien semi-structuré. Le développement d'un cadre théorique constitué d'un modèle de raisonnement clinique expert et d'une modélisation du décodage de la douleur a permis de réaliser une analyse de contenu des enregistrements. Les résultats montrent une utilisation importante des indicateurs physiologiques, en lien avec la stabilité clinique du patient qui est un critère essentiel pour la prise de décision lors de la gestion de la douleur. La difficulté à discriminer l'agitation résultant de la douleur ou d'autres causes est également omniprésente. Les expertes anticipent et préviennent la survenue de la douleur en s'appuyant sur leurs connaissances et les situations de patient déjà rencontrées. Le contexte clinique influence de manière prépondérante le raisonnement clinique et les indicateurs utilisés lors de l'évaluation et la gestion de la douleur. Celle-ci doit être évaluée de manière combinée avec la stabilité clinique du patient et son niveau de sédation. De futures recherches sont nécessaires pour confirmer ces résultats réalisés avec un échantillon de petite taille et un devis observationnel.

Improving the effectiveness of supply chain development work – an expert role perspective

This study focuses to the intersection of three sets of activities in a company: expert work, development work and supply chain management, SCM. Experts and expert work represent a set of individuals whose efficiency and impact this study is intended to improve, while development work defines the set of organizational activities to focus on. SCM as an expertise area acts as the platform on which this study is built. The study has two aims. Firstly, it aims to derive a model helping an SCM expert to increase the effectiveness of expert work in development tasks by understanding the encountered organizational situations and processes better, reflecting his/her past and future actions to organizational processes and selecting and adjusting the processes and contents of his/her work accordingly. Secondly, it aims to develop applicable approaches and methods to understand, evaluate and manage the organizational processes and situations in development work. The integrative model on approaches and methods to improve the effectiveness of development processes is split to two aggregate dimensions: technical performance of the developed solution and consumption of resources of the development process. Six potential approaches and methods aiming at helping in the management of organizational dimensions are presented in enclosed publications. The approaches focus on three subtasks of development work: decision making, implementation and change, and knowledge accumulation. The approaches and methods have been tested in case studies representing typical development processes in the area of supply chain management. As a result, four suggestions are presented. Firstly, SCM experts are advised to consider the SCM development work to be consisting of development processes. Secondly, inside these processes they should identify and evaluate the risk of difficult decision-making related to organizational factors. Thirdly, they are prompted for an active role in implementation and change, supporting the implementation through whole process. Finally, the development should be seen in a holistic view, taking into account the stage of knowledge and organizational issues related to it, and adopt a knowledge development strategy.

Talent, expert o les dues coses

De vegades és difícil distingir els conceptes d’individu amb talent i individu expert. Sens dubte, això és degut a que els individus que assoleixen l’èxit en l’esport, la música, el teatre, la literatura, etc. mostren ambdues condicions: una si es vol innata, el talent, i una altra adquirida, la de ser expert. També, de vegades, desitjaríem que els talents treballessin per a ser experts, aspecte que els elevaria a un grau superior d’excel·lència. En el present article es realitza una posada al dia d’ambdós conceptes amb l’objectiu d’establir una base adequada sobre la que sostenir amb més solidesa les decisions i actuacions del formador. També es presenten algunes nocions sobre el seguiment i control dels nois que gaudeixen en les canteres esportives sempre amb l’orientació bàsica de formar individus complerts amb un rendiment òptim.

Witness is presence : reading Stanley Hauerwas in a Nordic setting

I en postsekulär situation har förutsättningarna för att förstå och kommunicera en kristen tradition förändrats. De etablerade religionerna kan inte längre anta att de har monopol på den ”religiösa marknaden”. Ett centralt påstående i denna studie är att en postsekulär situation, som kännetecknas av minskande medlemskap i etablerade kyrkor och en ny synlighet av alternativa religiösa uttryck, medför ett behov av att reflektera över alternativa förståelser av kristenheten i sin kontext. Denna studie frågar hur man kan meningsfullt kommunicera en kristen tradition i en postsekulär situation. Traditionellt uttryckt: hur kan man förstå kristet vittnesbörd i vår situation? Det är till denna problematik som denna studie hävdar att Stanley Hauerwas ecklesiologi tillför ett viktigt perspektiv. Hauerwas ses som ett kritiskt korrektiv till vissa synsätt som ofta möter hos Nordiska, i denna studie främst finska och svenska, lutherska teologer. Det perspektiv som utvecklas i denna studie anses vara relevant eftersom kristna kyrkor i en postsekulär situation inte längre kan anta en makt- eller majoritetsposition. Därmed uppstår ett behov av att fråga sig hur man kan förstå kristenhet som en gemenskap i en minoritetsposition som bär vittnesbörd utan samhällelig makt. Denna studie hävdar att förkroppsligande av kristna övertygelser intar en central roll i en meningsfull postsekulär förståelse av vittnesbörd.

A feature-based object-oriented expert system to model and support product design

In this paper a computer program to model and support product design is presented. The product is represented through a hierarchical structure that allows the user to navigate across the product’s components, and it aims at facilitating each step of the detail design process. A graphical interface was also developed, which shows visually to the user the contents of the product structure. Features are used as building blocks for the parts that compose the product, and object-oriented methodology was used as a means to implement the product structure. Finally, an expert system was also implemented, whose knowledge base rules help the user design a product that meets design and manufacturing requirements.

Fuzzy expert system in the prediction of neonatal resuscitation

In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.