Benefits of BV-AVD (Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) versus ABVD (doxorubicin hydrochloride, bleomycin sulfate, vinblastine sulfate, dacarbazine) in patients with advanced-stage Hodgkin's lymphoma: an analysis of the ECHELON 1 trial by the GATLA group using the Delphi Method.

INTRODUCTION: The BV-AVD (Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) combination for first-line treatment of advanced stage Hodgkin's lymphoma has been approved by regulatory authorities and included in international guidelines. However, several factors influence its incorporation as standard of care. MATERIALS AND METHODS: A group of experts from different institutions was identified and, using the Delphi method, an analysis of the results of the ECHELON 1 trial for the indication of BV-AVD over ABVD (doxorubicin hydrochloride, bleomycin sulfate, vinblastine sulfate, dacarbazine) in patients with Hodgkin's lymphoma Stages III and IV in Argentina was done. The clinical and academic experience of the authors and the context of the Argentine healthcare system were considered. RESULTS AND DISCUSSION: Seven statements on general aspects of the management of Hodgkin's lymphoma and nine on specific aspects related to the use of BV-AVD over ABVD reached a consensus of agreement. There was a strong expert consensus in favor of indicating BV-AVD in the presence of extranodal disease or pulmonary disease. Moderate to severe neuropathy, pregnancy and drug allergy were considered absolute contraindications to prescribe BV. CONCLUSIONS: The authors agreed that BV-AVD could be considered a new treatment option in high-risk patients. However health system-dependent factors (such as high cost, lack of availability, reimbursement difficulties, irregular delivery, and issues with granulocyte-colony stimulating factor availability) could pose limitations for this prescription. While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool for hematologists in different parts of the world.

Extended half-life recombinant factor VIII treatment of hemophilia A in Brazil: an expert consensus statement

Introduction Treatment of hemophilia A in Brazil is offered to all patients at no cost. However, several unmet medical needs exist. Method In this study, we applied the Delphi method to discuss with seven hemophilia A specialists the challenges that patients and the health system face regarding hemophilia A treatment and opportunities for improvement. Results A consensus was obtained regarding the number of weekly infusions and patient adherence to treatment. The bleeding profile, unfavourable pharmacokinetics (PKs), low adherence and high daily activity were patient profiles that would benefit from using the extended half-life (EHL) recombinant factor VIII (rFVIII). The advantages of treatment with the EHL rFVIII were the lower number of infusions per week, which could increase patient adherence and decrease the risk of bleeds, due to a more constant plasma level, a lower value. Additionally, the EHL rFVIII could improve quality of life, especially in patients with high daily activity, such as adolescents and young adults. The panelists mentioned that EHL rFVIII, if available, could be offered first to the priority group (adolescents between 12 and 19 years old), followed by adults (20 to 64 years old) and elderly people (over 65 years old). Conclusion In summary, the EHL rFVIII offers the optimal prophylaxis by decreasing the dose frequency, increasing the treatment adherence and improving the QoL, without compromising safety and efficacy.

Identificação de itens essenciais na elaboração de um laudo de tomografia computadorizada de feixe cônico com aplicação na endodontia: um estudo delphi / Identification of essential items in cone beam computed tomography report with applications in endodontics: a delphi study

A imagem tomográfica é importante na determinação do diagnóstico e do plano de tratamento em diversos casos clínicos na endodontia. Em decorrência do crescente aumento na solicitação de exames de tomografia computadorizada de feixe cônico (TCFC), a necessidade de um sistema de interpretação e descrição dos achados imaginológicos tornou-se imprescindível. O objetivo desse estudo foi identificar as informações consideradas essenciais pelo cirurgião- dentista solicitante em um laudo tomográfico para a prática clínica na endodontia. Foi realizado um estudo de consenso e-Delphi com um painel de 12 especialistas em Endodontia que participaram de duas rodadas de perguntas on-line, respondidas de maneira sequencial e individual. Os profissionais foram questionados acerca de quais informações eles consideravam importantes em um laudo tomográfico para auxílio no diagnóstico e no planejamento do tratamento em diferentes situações clínicas. As informações obtidas foram categorizadas por dois radiologistas experientes, e os itens assinalados por 80% ou mais dos endodontistas após a segunda rodada de pesquisa foram considerados essenciais em um laudo tomográfico. A identificação de alterações, bem como a descrição de sua localização, e a seleção de imagens em diferentes planos ortogonais que as ilustrem, foram itens considerados essenciais pelos especialistas em um laudo tomográfico. O laudo imaginológico é o principal instrumento de comunicação entre o radiologista e o dentista solicitante, e deve conter todas as informações necessárias ao clínico, descritas de forma clara e concisa, de maneira a oferecer o melhor atendimento ao paciente.

The tomographic image is crucial for determining diagnosis and treatment plans in various clinical cases in endodontics. Due to the increasing demand for cone-beam computed tomography (CBCT) scans, the need for a system to interpret and describe imaging findings has become essential. The objective of this study was to identify the information considered essential by the requesting dentist in a tomographic report for clinical practice in endodontics. A consensus e-Delphi study was conducted with a panel of 12 endodontic specialists who participated in two rounds of online sequential and individual questioning. The professionals were asked about the key information they deemed important in a tomographic report to assist in diagnosis and treatment planning across different clinical scenarios. The gathered information was categorized by two experienced radiologists, and items endorsed by 80% or more of the endodontists after the second round were deemed essential in a tomographic report. Identification of abnormalities, along with their precise location description, and the selection of images illustrating them in different orthogonal planes were considered essential items by the specialists in a tomographic report. The imaging report serves as the primary communication tool between the radiologist and the requesting dentist, and should contain all necessary information for the clinician, presented clearly and concisely, to ensure optimal patient care.

A circular waste bioeconomy development model in the Ecuadorian fishery industry: the impact of government strategy on supply chain integration and smart operations.

This study develops a set of measures to address the interrelationship among circular waste-based bioeconomy (CWBE) attributes, including those of government strategy, digital collaboration, supply chain integration, smart operations, and a green supply chain, to build a circular bioeconomy that feeds fish waste back into the economy. CWBE development is a potential solution to the problem of waste reuse in the fish supply chain; however, this potential remains untapped, and prior studies have failed to provide the criteria to guide its practices. Such an analytical framework requires qualitative assessment, which is subject to uncertainty due to the linguistic preferences of decision makers. Hence, this study adopts the fuzzy Delphi method to obtain a valid set of attributes. A fuzzy decision-making trial and evaluation was applied to address the attribute relationships and determine the driving criteria of CWBE development. The results showed that government strategies play a causal role in CWBE development and drive digital collaboration, smart operations, and supply chain integration. The findings also indicated that smart manufacturing technology, organizational policies, market enhancement, supply chain analytics, and operational innovation are drivers of waste integration from fisheries into the circular economy through waste-based bioeconomy processes.

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique.

Background: Diagnosis, classification, and treatment of allergic rhinitis (AR) varies considerably despite the availability of treatment guidelines. Objectives: We aimed to carry out a two-part modified Delphi panel study to elucidate global expert management of AR in real life. Methods: The modified Delphi panel study was composed of two ten-minute online questionnaires sent to global AR experts, aiming to identify areas of consensus (defined as >75% respondent agreement) on aspects of their real-world daily practice related to AR diagnosis, classification, and pharmacotherapy. A workshop discussion with respondents held after the first-round questionnaire informed the development of the second-round questionnaire. Results: Eighteen experts (from 7 countries across 3 continents) completed both questionnaires in September-October 2021 and January 2022, respectively. The majority of respondents agreed that diagnosis of AR is best confirmed using a mixture of observation and testing (n = 15) and collaborating with colleagues across other specialties (n = 14). Experts agreed that severity (n = 18), upper/lower respiratory tract involvement (n = 15) and symptom frequency (n = 14) are important factors when classifying AR, however consensus was not reached on which classification tool should be used. Although there were mixed opinions on the preferred pharmacotherapy treatment in the presented case studies, respondents largely agreed on which treatments require less monitoring (intranasal corticosteroid therapies [INCS]) and when treatments should be stepped down (≤3 months). Although opinions varied across respondents, some respondents considered as-needed INCS treatment and surgery to be viable treatment options. Conclusion: We identified clear differences between real-world practice and treatment guidelines related to the management of AR. Furthermore, we recognized differences among physicians concerning their clinical practice in the pharmacological treatment of AR. These findings highlight the need for greater research into the management of AR and further indicate there is still a major gap between treatment guidelines and daily practice, even among specialists, suggesting a need for local guideline adaptation and implementation plans.

Recomendaciones de expertos acerca del uso de teduglutide en pacientes pediátricos con sindrome de intestino corto / Expert recommendations on the use of teduglutide in pediatric patients with short bowel syndrome

Resumen El síndrome de intestino corto es una entidad de baja incidencia en los pacientes pediátricos, pero se asocia con elevadas tasas de morbimortalidad. El abordaje de estos pacientes por un equipo interdisciplinario de expertos enfocados en la rehabilitación intestinal mejora los resultados a corto y a largo plazo. Entre los recursos disponibles para el tratamiento se incluye el teduglutide, un análogo del péptido similar al glucagón tipo 2 (GLP-2) elaborado mediante técnicas recombinantes. Por medio de la aplicación del método Delphi, a partir de la evidencia disponible y de la experiencia de los autores, se proponen recomendaciones para el uso de teduglutide, dirigidas a los profesionales de la salud que tratan a los pacientes pediátricos con síndrome de intestino corto, así como a las autoridades sanitarias.

Abstract Short bowel syndrome is a low-incidence disorder among pediatric patients, but it is associated with high morbidity and mortality rates. Management of these patients by an interdisciplinary team of experts focused on intestinal rehabilitation improves short- and long-term outcomes. Available resources for treatment include teduglutide, a glucagon-like peptide type 2 (GLP-2) analog made by recombinant techniques. Considering the available evi dence and the authors' experience, Delphi-based recommendations for the use of teduglutide are suggested for healthcare professionals who treat pediatric patients with short bowel syndrome, as well as for health authorities.

Factors that favor or hinder the acquisition of a digital culture in large organizations in Chile.

Organizational culture is often perceived as a valuable strategic asset supporting business transformation and the exploitation of digital technologies. Still, it can also be the source of inertia that impedes change. The research question proposed is What factors favor or hinder the acquisition of digital culture in large organizations in Chile? The aim is to rank factors that promote a digital culture based on the perception of executives using the Delphi method. The expert panel was selected with strategic criteria, considering practical knowledge, up-to-date experience on the subject, and having high decision-making positions in large companies in Chile. The main statistics used are media, maximum, minimum, and average range, along with the search for consensus determined by the interquartile range and Kendall's W concordance coefficient. Results show a high level of agreement on the importance of digital strategy and digital leadership factors when favoring a digital culture in large companies in Chile. However, large companies in Chile must pay attention to the conservative triad of elements that characterize Chilean work culture that considers the belief that changes are exclusively possible when commanded by the strategic apex, a hierarchical work culture that prevents collaborative work, and the rejection of disruptive change. These factors and cultural characteristics will likely hinder any attempt to succeed in a digital transformation plan.

[Expert recommendations on the use of teduglutide in pediatric patients with short bowel syndrome]. / Recomendaciones de expertos acerca del uso de teduglutide en pacientes pediátricos con síndrome de intestino corto.

Short bowel syndrome is a low-incidence disorder among pediatric patients, but it is associated with high morbidity and mortality rates. Management of these patients by an interdisciplinary team of experts focused on intestinal rehabilitation improves short- and long-term outcomes. Available resources for treatment include teduglutide, a glucagon-like peptide type 2 (GLP-2) analog made by recombinant techniques. Considering the available evidence and the authors' experience, Delphi-based recommendations for the use of teduglutide are suggested for healthcare professionals who treat pediatric patients with short bowel syndrome, as well as for health authorities.

El síndrome de intestino corto es una entidad de baja incidencia en los pacientes pediátricos, pero se asocia con elevadas tasas de morbimortalidad. El abordaje de estos pacientes por un equipo interdisciplinario de expertos enfocados en la rehabilitación intestinal mejora los resultados a corto y a largo plazo. Entre los recursos disponibles para el tratamiento se incluye el teduglutide, un análogo del péptido similar al glucagón tipo 2 (GLP-2) elaborado mediante técnicas recombinantes. Por medio de la aplicación del método Delphi, a partir de la evidencia disponible y de la experiencia de los autores, se proponen recomendaciones para el uso de teduglutide, dirigidas a los profesionales de la salud que tratan a los pacientes pediátricos con síndrome de intestino corto, así como a las autoridades sanitarias.

How to Advance Palliative Care Research in South America? Findings From a Delphi Study.

CONTEXT: Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved. OBJECTIVES: To develop a set of recommendations to advance PC research in SA. METHODS: Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%. RESULTS: 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant. CONCLUSION: Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region.

How, When, & Where temporary hospitals fit in turbulent times: A hybrid MADM optimization in the middle east.

Governments have been challenged to provide temporary hospitals and other types of facilities to face the COVID-19 pandemic. This research proposes a novel multi-attribute decision-making (MADM) model to help determine how, when, and where these temporary facilities should be installed based on a set of critical success factors (CSFs) mapped in an uncertain environment. We portray the available facilities for temporary hospitals based on the CSFs that must be considered to make critical decisions regarding the optimal position based on the government's strategic decision-making process, thus indirectly providing better services and maximizing resources. In relation to earlier work, this research builds upon hybrid Pythagorean fuzzy numbers to find weights in Best-Worst Methods and rank temporary facilities based on evaluation by an area-based method for ranking. Policy implications and future directions are derived.

A Delphi consensus panel about clinical management of early-stage EGFR-mutated non-small cell lung cancer (NSCLC) in Spain: a Delphi consensus panel study.

PURPOSE: This Delphi panel study assessed the level of consensus between medical oncologists on the clinical management of patients with early-stage EGFR-mutated non-small cell lung cancer (NSCLC). METHODS: A modified two-round Delphi approach was used. A scientific committee comprised of medical oncologists developed an online questionnaire. Delphi panel experts rated their level of agreement with each questionnaire statement on a 9-point Likert scale. The questionnaire included 36 statements from 3 domains (clinical management of early-stage NSCLC: 15 statements; role of adjuvant therapy in early-stage NSCLC: 9 statements; and role of adjuvant therapy in early-stage NSCLC with sensitizing EGFR mutation: 12 statements). RESULTS: In round 1, consensus was reached for 24/36 statements (66.7%). Nine statements that did not achieve consensus after the first round were evaluated in round 2, and none of them reached consensus. Overall, 84.4% of the panelists agreed that EGFR mutation testing should be done after surgery. Consensus was not achieved on whether the implementation of EGFR mutation testing in resected early-stage NSCLC could limit the use of adjuvant osimertinib. The panelists recognized the rationale for the use of osimertinib in the adjuvant scenario (88%) and 72% agreed that it may change the treatment paradigm in stage IB-IIIA EGFR-mutated NSCLC. Consensus was not reached on the inconvenience of prolonged duration of osimertinib. CONCLUSIONS: This Delphi study provides valuable insights into relevant questions in the management of early-stage EGFR-mutated NSCLC. However, specific issues remain unresolved. The expert consensus emphasizes the role of adjuvant treatment with osimertinib in this scenario.

Valoración de una metodología para integrar software educativo en la asignatura Rehabilitación estomatológica / Assessment of a methodology to integrate educational software in Stomatological Rehabilitation Subject

Introducción: Al elaborar una metodología resulta importante obtener los criterios de expertos antes de su aplicación. En un periodo precedente a esta investigación se elaboró una metodología con etapas y procedimientos para el desarrollo de software educativo. Objetivo: Valorar la pertinencia de la metodología para la integración de software educativo en el proceso de enseñanza-aprendizaje de las asignaturas Rehabilitación I y II de Estomatología. Método: Se realizó una investigación pedagógica en la Universidad de Ciencias Médicas de Holguín. Para valorar la pertinencia de la metodología se aplicó el método Delphi, a partir del cual, mediante una encuesta aplicada a 17 expertos seleccionados por su alto coeficiente de competencia en la temática, se pudo llegar a un consenso sobre el tema explorado. Resultados: La aplicación del cuestionario reveló que la mayoría de los expertos consideró cada indicador de la dimensión validez como muy adecuado, solo uno evaluó el indicador etapas de la metodología como adecuado y los procedimientos de la etapa dos como bastante adecuados. Para la dimensión viabilidad casi la totalidad consideró muy adecuados los indicadores factibilidad de aplicación y posibilidad de generalización; esta última fue evaluada por un experto como adecuada. Al comparar los resultados de los siete indicadores con los puntos de corte se aprecia que los expertos en su conjunto los definen como muy adecuados. Conclusiones: La pertinencia de la metodología se constató con el criterio consensuado de los expertos, quienes consideraron muy adecuados los aspectos valorados, y realizaron aportes que permitieron perfeccionarla antes de su implementación. Sobre estas bases no fue necesaria una segunda etapa de aplicación del método(AU)

Introduction: When developing a methodology, it is important to obtain the criteria of experts before its application. In a period preceding this research, a methodology with stages and procedures was defined for the development of educational software. Objective: To assess the relevance of the methodology for the integration of educational software in the teaching-learning process of the subjects Rehabilitation I and II of Stomatology. Method: A pedagogical research was carried out at the University Of Medical Sciences Of Holguín. To assess the relevance of the methodology, the Delphi method was applied, from which, through a survey applied to 17 experts selected for their high coefficient of competence in the subject, a consensus could be reached on the explored topic. Results: The application of the questionnaire revealed that most of the experts considered each indicator of the validity dimension as very adequate; only one evaluated the indicator stages of the methodology as adequate and the procedures of stage two as quite adequate. For the feasibility dimension, almost all considered the feasibility of application and possibility of generalization indicators to be very adequate; the latter was evaluated by an expert as adequate. When comparing the results of the seven indicators with the cut-off points, it can be seen that the experts as a whole define them as very adequate. Conclusions: The relevance of the methodology was verified with the agreed criteria of the experts, who considered the aspects evaluated to be very adequate, and made contributions that allowed it to be perfected before its implementation. On these bases, a second stage of application of the method was not necessary(AU)

Validación de un manual sobre la elaboración de una estrategia didáctica para potenciar el nivel de información sobre la COVID-19 en estudiantes de Medicina / Validation of a manual to design a didactic strategy for enhancing the level of information on COVID-19 in the medical students / Validação de um manual sobre o desenvolvimento de uma estratégia didática para aumentar o nível de informação sobre COVID-19 em estudantes de Medicina

RESUMEN Introducción: Las estrategias didácticas, en su conjunto, demandan establecer una relación dialógica, constante y triangular entre educadores, educandos y metodologías, aunque el educando ignore o no las metodologías que utiliza el docente para tal fin. Objetivo: validar un manual para el diseño y elaboración de una estrategia didáctica para potenciar el nivel de información sobre COVID-19 en estudiantes de Medicina. Método: Se elaboró un manual sobre el diseño de una estrategia didáctica empleada para incrementar el conocimiento de los estudiantes de Medicina del segundo año de la Universidad de Ciencias Médicas de Sancti Spíritus, Cuba, sobre los signos, síntomas y métodos de prevención de la COVID-19 durante el inicio de la pandemia en el país. Treinta expertos nacionales en ciencias de la educación médica emitieron sus dictámenes sobre la pertinencia de la estrategia didáctica y del manual sobre su diseño, y fueron analizados por el método Delphi. El éxito de la aplicación de la estrategia didáctica se valoró mediante la aplicación de exámenes a la población del estudio antes y después de la introducción de la estrategia didáctica en el período 2021-2022. Resultados: El consenso general de los expertos fue de Muy de acuerdo para los fundamentos que sustentan la estrategia didáctica para la educación médica superior y la calidad del manual propuesto. Conclusiones: Tanto la estrategia educativa como el manual sobre su elaboración fueron validadas por los expertos para su aplicación en la educación médica superior y, particularmente, para la detección y contención de la COVID-19.

ABSTRACT Introduction: Didactic strategies, as a whole, demand the establishment of a dialogical, constant and triangular relationship between educators, learners and methodologies, even though the learner is unaware or not of the methodologies used by the professor for purpose required. Objective: To validate a manual for designing and elaborating a didactic strategy to enhance the information level for medical students concerning COVID-19. Method: A manual based on a didactic strategy structural design was elaborated with the porpuse of increase the knowledge for the second year medical students at the Universidad de Ciencias Médicas de Sancti Spíritus, Cuba, on the signs, symptoms of COVID-19 and the prevention methods used at the beginning of the pandemic in the country. Thirty national experts in medical education sciences gave their opinions on the relevance of the didactic strategy and about the structural design of the manual, which were analyzed by the Delphi method. The success of the strategy implementation was assessed implementing tests to the studied population before and after the introduction of the didactic strategy in the period 2021- 2022. Results: The experts' opinion concerning the fundamentals underpinning the didactic strategy for higher medical education and the quality of the proposed manual was highly favorable in general consensus. Conclusions: Both the educational strategy and the elaboration of the manual were validated by the experts for its application in higher medical education and in particularly for the detection and containment of COVID-19.

RESUMO Introdução: As estratégias didáticas, como um todo, demandam estabelecer uma relação dialógica, constante e triangular entre educadores, educandos e metodologias, independentemente de o educando ignorar ou não as metodologias utilizadas pelo professor para esse fim. Objetivo: Submeter um manual para a concepção e desenvolvimento de uma estratégia didática para melhorar o nível de informação sobre COVID-19 em estudantes de medicina para validação. Método: Foi elaborado um manual sobre o desenho de uma estratégia didática utilizada para aumentar o conhecimento dos alunos do segundo ano de Medicina da Universidad de Ciencias Médicas de Sancti Spíritus, Cuba, sobre os sinais, sintomas e métodos de prevenção da COVID. -19 durante o início da pandemia no país. Trinta especialistas nacionais em ciências da educação médica emitiram suas opiniões sobre a relevância da estratégia didática e do manual sobre seu desenho, e foram analisados pelo método Delphi. O sucesso da aplicação da estratégia didática foi avaliado por meio da aplicação de testes à população do estudo antes e após a introdução da estratégia didática no período 2021-2022. Resultados: O consenso geral dos especialistas foi Fortemente concordante para os fundamentos que sustentam a estratégia didática para a formação médica superior e a qualidade do manual proposto. Conclusões: Tanto a estratégia educativa como o manual sobre a sua elaboração foram validados por especialistas para a sua aplicação no ensino superior médico e, em particular, para a deteção e contenção da COVID-19.

Proposal for a Tool for Assessing Access to Water in Rural Communities: a Case Study in the Brazilian Semi-arid.

This paper proposes a Water Access Index (WAI). Using this tool, decision-makers can identify and prioritize areas that need state intervention to develop actions to guarantee rural population access to water. Thus, was carried out is a case study, rural communities in the semi-arid region of Brazil to validate the suggested method. The WAI is based on a combined method of multicriteria decision analysis (MCDA), Geographic Information System (GIS), cluster analysis (CA) using Ward's agglomeration method and participation of rural inhabitants. The data for calculating the WAI were obtained by conducting interviews following a script of themes in the structured questionnaire closed to 370 residents of the communities evaluated. To calculate the WAI, weightings were used, in which the scores of the indicators and the weights of the dimensions were determined and analyzed using the Delphi method, what found to be a valid method for calculating the dimensions and indicators weights. Due to difficulty of rural population to have water access and suffer from drought, the proposed model showed appropriate to conduct a robust and well-structured decision-making. The main contributions were the study in region suffering from drought and difficulty in water access, as well as the combination of MCDA, SIG, CA and participation of rural inhabitants methods to aid in this problem. For use in other areas, researchers need to conduct public and specialized consultations to adjust the dimension weights, so the WAI method can estimate the water access situation and generate maps anywhere in the world for decision-making.

Perfil de competencia del cirujano general en Venezuela. Estudio delphi / Competency profile of the surgeon. general in Venezuela. Delphi Study

Construir el Perfil del Cirujano General en Venezuela. Método: Estudio cuantitativo, constructivista, con aplicación del método Delphi para la construcción del consenso. Fases: revisión de la literatura, redacción de propuestas, rondas itinerantes de consulta a expertos, adecuación del modelo según la interacción con participantes.Resultados : Población: 30 expertos miembros del Consejo Nacional de la Sociedad Venezolana de Cirugía y profesores de Postgrado de Cirugía General. Aprobación de 100% de las competencias de segundo nivel en la segunda ronda itinerante. En relación a las habilidades prácticas se obtuvo aprobación en 98,2% de las propuestas. El número de años de formación de postgrado y el número de intervenciones al momento del egreso, propuesta por los participantes, no obtuvo consenso. La fiabilidad del instrumento mediante el Alpha Cronbach fue de 0,98.Conclusiones : El Perfil de Competencia Profesional del Cirujano General en Venezuela fue creado por consenso describiendo la necesidad de un Cirujano General quien de respuestas éticas, inclusivas, con sentido de responsabilidad humana y social, capacidad de autoevaluación y cumplimiento de normativas internacionales adaptadas a la realidad local y ajustadas al medio de trabajo. De igual manera, se identificaron las habilidades prácticas que deben ser dominadas por el egresado para dar respuesta a la asistencia médica institucional. Consideramos que este perfil de competencia debe servir de referente para el diseño de los nuevos currículos por competencia profesional de nuestros postgrados a nivel nacional que permitan la formación del especialista que atienda y responda a la necesidades de nuestra población(AU)

Build the Profile of the General Surgeon in Venezuela. Method: Quantitative, constructivist study, with application of the Delphi method for prospective consensus. Phases: review of the literature, writing of proposals, itinerant consultation rounds with experts, adaptation of the model according to the interaction with participants. Results: Population: 30 expert members of the National Council of the Venezuelan Society of Surgery and Postgraduate professors of General Surgery. 100% of the level II competitions were approved in the first and second rounds. In relation to practical skills, approval was obtained in 98.2% of the proposals. In relation to the number of years of postgraduate training and the number of interventions at the time of graduation, proposed by the participants, no consensus was obtained. The reliability of the instrument using the Alpha Cronbach was 0.98.Conclusions : The Professional Competence Profile of the General Surgeon in Venezuela was created by consensus describing the need for a Surgeon General who, with ethical, inclusive responses, with a sense of human and social responsibility, self-assessment capacity and compliance with international regulations adapted to the local reality, and adjusted to the work environment. Similarly, the practical skills that must be mastered by the graduate to respond to institutional medical care were identified. We believe that this profile of competence should serve as a reference for the design of the new curricula for professional competence of our postgraduate courses at the national level that allow the training of the specialist who attends and responds to the needs of our population(AU)

Extended half-life recombinant factor VIII treatment of hemophilia A in Brazil: an expert consensus statement.

INTRODUCTION: Treatment of hemophilia A in Brazil is offered to all patients at no cost. However, several unmet medical needs exist. METHOD: In this study, we applied the Delphi method to discuss with seven hemophilia A specialists the challenges that patients and the health system face regarding hemophilia A treatment and opportunities for improvement. RESULTS: A consensus was obtained regarding the number of weekly infusions and patient adherence to treatment. The bleeding profile, unfavourable pharmacokinetics (PKs), low adherence and high daily activity were patient profiles that would benefit from using the extended half-life (EHL) recombinant factor VIII (rFVIII). The advantages of treatment with the EHL rFVIII were the lower number of infusions per week, which could increase patient adherence and decrease the risk of bleeds, due to a more constant plasma level, a lower value. Additionally, the EHL rFVIII could improve quality of life, especially in patients with high daily activity, such as adolescents and young adults. The panelists mentioned that EHL rFVIII, if available, could be offered first to the priority group (adolescents between 12 and 19 years old), followed by adults (20 to 64 years old) and elderly people (over 65 years old). CONCLUSION: In summary, the EHL rFVIII offers the optimal prophylaxis by decreasing the dose frequency, increasing the treatment adherence and improving the QoL, without compromising safety and efficacy.

Trajetória da Política Nacional de Educação Permanente em Saúde no Brasil / Trajectory of the National Policy of Permanent Education in Health in Brazil / Trayectoria de la Política Nacional de Educación Permanente en Salud en Brasil

Resumo A Política Nacional de Educação Permanente em Saúde estabelece como pressuposto a centralidade nos processos de trabalho para nortear as atividades de qualificação dos trabalhadores da saúde. O presente estudo tem por objetivo discutir a trajetória de institucionalização da Política Nacional de Educação Permanente em Saúde de acordo com a percepção dos atores representativos dessa política pública (gestores federais, gestores estaduais e municipais, e pesquisadores), considerando os 16 anos de sua institucionalização até o ano deste estudo (2004-2020). Trata-se de pesquisa qualitativa, com a aplicação do método Delphi. Os resultados obtidos mostraram que a Política se encontra frágil quanto à sua implantação. No que se refere aos impactos, constatou-se que ela oportunizou o estreitamento da relação entre os serviços de saúde e as instituições de ensino, e promoveu mudanças significativas nos processos de trabalho em equipe, independentemente da sua composição.

Abstract The Brazilian National Policy of Permanent Education in Health establishes as an assumption the centrality in the work processes to guide the qualification activities of health workers. The present study aims to discuss the trajectory of institutionalization of the National Policy of Permanent Education in Health according to the perception of the representative actors of this public policy (federal managers, state and municipal managers, and researchers), considering the 16 years of its institutionalization until the year of this study (2004-2020). This is a qualitative research, with the application of the Delphi method. The results showed that the policy is fragile regarding its implementation. Regarding the impacts, it was found that it facilitated the strengthening of the relationship between health services and educational institutions, and promoted significant changes in teamwork processes, regardless of their composition.

Resumen La Política Nacional de Educación Permanente en Salud de Brasil establece como presupuesto la centralidad en los procesos de trabajo para orientar las actividades de calificación de los trabajadores de la salud. El presente estudio tiene como objetivo discutir la trayectoria de institucionalización de la Política Nacional de Educación Permanente en Salud según la percepción de los representantes de esa política pública (gestores federales, gestores estatales y municipales e investigadores), considerando los 16 años de su institucionalización hasta el año de este estudio (2004-2020). Se trata de una investigación cualitativa, con la aplicación del método Delphi. Los resultados obtenidos mostraron que la política es frágil en cuanto a su implementación. En lo que se refiere a los impactos, se constató que brindó una oportunidad para fortalecer la relación entre los servicios de salud y las instituciones educativas, y promovió cambios significativos en los procesos de trabajo en equipo, independientemente de su composición.

Validation of instrument to comply institutional measures on tuberculosis infection control / Validación del instrumento para el cumplimiento de las medidas institucionales de control de la infección por tuberculosis / Validação do instrumento de conformidadedas medidas institucionais de controle de infecções por tuberculosenos prestadores de serviços de saúde / Validation de linstrument de respect des mesures institutionnelles de luttecontrelinfectiontuberculeusedans les établissements de santé

Abstract Objective To evaluate the validity and reliability of an instrument that inspect compliance with institutional tuberculosis infection control measures of Healthcare Providers in the city of Cali, Colombia. Materials and Methods Across-sectional study (psychometric type, instrument validation). The development of instrument considered sections from the Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas and Evaluation Control Tools for Hospital-Acquired Infections. The construction of the final instrument was carried out with the support of seven experts according to Delphi method, obtaining an instrument comprising three domains and a final number of 65 questions; each item was evaluated, usefulness, format, and validity of the instrument. Contents were assessed with the Aiken coefficient and reliability with Bangdiwala concordance coefficient. Rversion3.2.0 application was used. Results The instrument was concocted by 65 items referring to questions regarding administrative, environmental and respiratory measures. It holds acceptable psychometric properties, including good internal structure and suitable reliability. Conclusions A valid and reliable instrument was obtained to evaluate compliance with institutional measures on tuberculosis infection control in Healthcare Institutions in the city of Cali.

Resumen Objetivo Evaluar la validez y confiabilidad de un instrumento que inspecciona el cumplimiento de las medidas institucionales de control de infecciones para la tuberculosis en las Instituciones Prestadoras de Salud de la ciudad de Cali, Colombia. Materiales y Métodos El estudio fue de corte transversal (tipo psicométrico, validación de un instrumento). El desarrollo del instrumento consider secciones de las Guidelines for the preventing of transmission of Mycobacteriumtuberculosis in health care settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas y Evaluation Control Tools for Hospital-Acquired Infections. La construcción del instrumento final se realizó con el apoyo de 7 expertos según la metodología Delphi, obteniéndose un instrumento constituido por tres dominios y con un número final de 65 preguntas; donde se evaluó cada uno de los ítems, la utilidad, el formato y la validez del instrumento. Se evaluó el contenido con el coeficiente de Aiken y la confiabilidad con el coeficiente de concordancia de Bangdiwala. Se utilizó el aplicativo R versión3.2.0. Resultados El instrumento quedó conformado por 65 ítems que se refieren a preguntas relacionadas con las medidas administrativas, ambientales y respiratorias. Cuenta con las propiedades psicométricas aceptables, entre ellas, una buena estructura interna y una adecuada confiabilidad. Conclusiones Se obtuvo un instrumento válido y confiable para evaluar el cumplimiento de las medidas institucionales de control de infecciones para la tuberculosis en las Instituciones de Salud de la ciudad de Cali.

Resumo Objetivo Avaliar a validade e a confiabilidade de um instrumento que inspeciona o cumprimento de medidas institucionais de controle de infecção por tuberculosenasinstituições de saúde da cidade de Cali. Colombia. Materiais e métodos O estudofoi transversal (tipo psicométrico, validação de um instrumento). O desenvolvimento do instrumentoconsiderouseções dasGuidelines for the preventing of transmission of Mycobacterium tuberculosis in health care settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas e Evaluation Control Tools for Hospital-Acquired Infections.Aconstruçãodoinstrumentofinalfoirealizadacom o apoio de 7 especialistas, conforme a metodologia Delphi, obtendoum instrumento composto por trêsdomínios e comum número final de 65 perguntas; onde cada um dos itens, a utilidade, o formato e a validade do instrumento foram avaliados. O conteúdofoi avaliado com o coeficiente de Aiken e a confiabilidadecom o coeficiente de concordância de Bangdiwala. O aplicativo R versão 3.2.0 foiusado. Resultados O instrumento foi composto por 65 itens que se referem a questões relacionadas a medidas administrativas, ambientais e respiratórias. Possui propriedades psicométricas aceitáveis, incluindo boa estrutura interna e confiabilidade adequada. Conclusões Foiobtidoum instrumento válido e confiável para avaliar o cumprimento das medidas institucionais de controle de infecção por tuberculose nasinstituições de saúde da cidade de Cali.

Résumé Objectif Évaluer la validité et la fiabilité d'un instrument qui inspecte le respect des mesures institutionnelles de contrôle des infections de la tuberculose dans les établissements de santé de la ville de Cali. Matériels et méthodes L'étude était transversale (type psychométrique, validation d'un instrument). L'élaboration de l'instrument a examiné des sections des Lignes directrices pour la prévention de la transmission de Mycobacterium tuberculosis dans les établissements de santé (CDC), des Lignes directrices pour la mise en œuvre de la lutte contre les infections de la tuberculose dans les Amériques et des outils de contrôle de l'évaluation des infections nosocomiales. La construction de l'instrument final a été réalisée avec le soutien de 7 experts selon la méthodologie Delphi, obtenant un instrument composé de trois domaines et avec un nombre final de 65 questions; où chacun des éléments, l'utilité, le format et la validité de l'instrument ont été évalués. Le contenu a été évalué avec le coefficient Aiken et la fiabilité avec le coefficient de concordance Bangdiwala. L'application R version 3.2.0 a été utilisée. Résultats L'instrument était composé de 65 éléments qui renvoient à des questions liées aux mesures administratives, environnementales et respiratoires. Il a des propriétés psychométriques acceptables, y compris une bonne structure interne et une fiabilité adéquate. Conclusions Un instrument valide et fiable a été obtenu pour évaluer le respect desmesures institutionnelles de contrôle des infections de la tuberculose dans les établissements de santé de la ville de Cali.

Networks for studies on reproductive and perinatal health: Searching for a consensus.

OBJECTIVE: To address the essential characteristics of a network and aspects related to network sustainability. METHOD: A descriptive study based on a two-round Delphi survey was conducted from 2016 to 2018. Researchers participating in maternal and perinatal health networks were identified by searching PubMed for network-based publications and invited to complete a two-round Delphi questionnaire by email. RESULTS: Among 529 eligible researchers identified, 54 (10.2%) and 46 (8.7%) responses were received in the first and second rounds, respectively. A consensus on 13 of 21 [OK] questions, and 5 of 10 questions was achieved in the first and second rounds, respectively. The results indicated that a responsible leader is required, and both coordinators and members have a role in decision-making within the network. Good communication and periodic face-to-face meetings are key factors in sustainability and motivation. Rules for secure access to the network database and definition of authorship of scientific papers are essential. Mentioning the name of the network in publications is important for strengthening its activities and the obtainment of funds. CONCLUSION: Although operational characteristics of the network may differ according to setting and collaborators, homogeneous and essential network characteristics were identified.

Validación de un cuestionario sobre factores de riesgo para defectos congénitos / Validation of a questionnaire about risk factors for congenital defects

Introducción: Los defectos congénitos constituyen la primera causa de muerte infantil en los países desarrollados y la segunda en muchos países en vías de desarrollo. Objetivo: Validar un cuestionario sobre factores de riesgo para defectos congénitos relacionados con la deficiencia de ácido fólico. Métodos: El proceso de validación se basó en un proceso dinámico de retroalimentación y toma de decisiones cambiante, de acuerdo al criterio de expertos, para lo que se utilizó el método Delphi, el cual constó de tres etapas: selección de los expertos, análisis y validación de cada uno de los ítems por parte de los expertos y su posterior reevaluación y, por último, la realización de un estudio piloto. En el proceso de validación del cuestionario se calculó el coeficiente de concordancia de Kendall y Friedman con el objetivo de determinar concordancia o similitudes de las respuestas de los evaluadores respectivamente. Resultados: Se seleccionaron 18 expertos con altos niveles de competencia de acuerdo al cálculo de los coeficientes de conocimiento y argumentación. En la segunda versión del cuestionario existió similitud en las respuestas de los expertos a favor de la categoría superior de muy bien, así como concordancia en el nivel de respuesta de los expertos. Conclusiones: El cuestionario diseñado dispone de niveles óptimos de validez de contenido y factibilidad para identificar los factores de riesgo para defectos congénitos sensibles a la deficiencia de ácido fólico(AU)

Introduction: Congenital defects are the leading cause of child mortality in developed countries and the second in many developing countries. Objective: Validate a questionnaire about risk factors for congenital defects related to folic acid deficiency. Methods: Validation was based on a dynamic process of feedback and changing decision-making geared by expert criteria for which use was made of the Delphi method in three stages: selection of experts, analysis and validation of each item by the experts and further re-evaluation, and conduct of a pilot study. Kendall and Friedman's coefficient of concordance was estimated to determine the agreement or similarities between the answers provided by the evaluators. Results: Eighteen highly-qualified experts were selected based on the knowledge and argumentation coefficients estimated. In the second version of the questionnaire the answers provided by experts coincided in awarding the higher category of 'very good', and there was concordance in the experts' response level. Conclusions: The questionnaire designed is characterized by optimal levels of content validity and feasibility to identify risk factors for congenital defects related to folic acid deficiency(AU)