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ObjectivesTo define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.MethodsNon-systematic literature synthesis, expert Delphi consensus process and expert panel conference.ResultsCarious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.ConclusionsComprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.Clinical relevanceCarious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

The prioritization of clinical practice guideline (CPG) efforts is particularly challenging for rare genetic neurodevelopmental disorders given the large number of (ultra)rare conditions and limited resources. We aimed to establish criteria for the priority-setting of CPG topics within the European Reference Network (ERN) Intellectual disability, TeleHealth, Autism, and Congenital Anomalies (ITHACA) based on stakeholder input. Sets of priority-setting criteria for etiology-specific CPGs and shared health topic CPGs (across etiologies) were generated using a 2-phase consensus process. The first phase consisted of initial criteria generation, internal feedback from the ERN ITHACA Executive Committee and Patient Advisory Board, and stakeholder input through an open survey. The second phase consisted of a 2-round modified Delphi and consensus meeting with an expert panel consisting of patient advocates, clinicians, and methodologists. The final sets of priority-setting criteria included absence of existing guidance, high burden for affected individuals and families, and specific health risks requiring adaptation from usual care. In addition, complexity and treatment availability were included for etiology-specific CPGs and common occurrence and societal burden were included for CPGs for shared health topics. Availability and interest of clinical experts and patient organizations were considered required to produce CPGs; shared health topics addressed through dedicated CPGs need to be universal across etiologies. Aligning with stakeholder perspectives in priority-setting is required to allocate scarce resources to the development of high-priority CPGs for rare conditions. Priority-setting criteria specific to the rare condition context were identified. CPG development was considered a particular priority important for complex conditions and/or health care and where care is nonstandard. Practice variation was not selected as a priority-setting criterion. [Display omitted] •We established priority-setting criteria for European rare condition guidelines.•Complexity and need to deviate from usual care indicated guideline priority.•Practice variation and feasibility of implementation were not selected.•Priority-setting is shaped by the context and goals of guideline development.

Background Disaster resilience is an essential personal characteristics of health rescue workers to respond to disasters in an effective manner, and maintain a state of adaptation after deployment. It is essential for disaster managers to recruit, assess, and prepare healthcare rescuers with this characteristic. A specific tool for measuring the disaster resilience of healthcare rescuers has yet to be devised. Objective The purpose of this study was to establish the content validity of a tool for measuring the disaster resilience of disaster rescue workers. Methods A modified Delphi approach was employed. Experts in disaster work and research were invited to rate the domains and items of a prototype tool for measuring disaster resilience in healthcare rescue workers. The panel of experts rated the relevance of the items using a 4-point Likert scale. The median and interquartile range, as well as the level of agreement, were calculated for each item using the Kendall coefficient W, to assess the consensus of the experts. The content validity index (CVI) was calculated to assess the content validity of this tool. Results A total of 22 and 21 experts were involved in the first and second rounds of this modified Delphi study (response rate of 91.7 and 95.5%), respectively. After two rounds of expert query, an eight-domain and 27-item disaster resilience measuring tool was established. The median range of all of the included items was 3.50 to 4.00 and the interquartile range was 0.00 to 1.00, and all items achieved ≥85% agreement. The Kendall coordination coefficient W was 0.21 and 0.33 in the first and second rounds, respectively, with P  < 0.01. The I-CVI ranged from 0.85 to 1.0, while the S-CVI/UA and S-CVI /Ave were 0.69 and 0.97, respectively. Conclusion Consensus was reached on a disaster resilience measuring tool covering 27 items. The content validity of this tool for measuring the disaster resilience of healthcare rescuers was excellent. This tool is validated and ready to be tested in a pilot study to assess its psychometric properties.

Background Delirium is frequently unrecognised, and healthcare professionals lack knowledge and confidence in recognition and management of the condition. Increased delirium education within pre-registration healthcare profession curricula may help to address this. A modified Delphi approach was utilised to develop a set of education priorities associated with delirium education for healthcare profession students. Methods An initial list of 72 education priorities were identified from a literature review, stakeholder focus groups, and a review of available clinical guidelines. Priorities were grouped into eight domains ‘assessment and diagnosis’, ‘aetiology and risk factors’, ‘pathophysiology’, ‘treatment of delirium’, ‘prevention’, ‘delirium and dementia’, ‘impact on people with delirium, informal caregivers and family’ and ‘health promotion and public education’. Academic experts and healthcare professionals were invited to rank each priority and each domain across two rounds. Round one consisted of a survey including the list of 72 potential education priorities which participants were asked to rank from one (not a priority) to five (essential priority). Items which did not reach consensus criteria following round one were re-distributed as round two of the survey and participants were asked to repeat this exercise for the shorter list of items. Additionally, in round two, participants were asked to rank the eight domains from most important to least important. Results Eighty participants completed round one of the Delphi survey and 55 (68.75%) also completed round two. Following round one, 41 priorities were considered highly relevant and therefore met the criteria to be included in the final set of education priorities. An additional four items reached these criteria following round two and so the final set consists of 45 items. Priorities related to prevention, diagnosis, and treatment were consistently ranked highly whereas priorities related to pathophysiology and health promotion were consistently ranked lowest. Discussion This Delphi study identified areas of education viewed as the highest priorities for healthcare profession students’ delirium education, drawn from a range of academics and healthcare professionals. The final set may help to inform the development of delirium education reflecting these priorities.

Introduction Competency-based medical education is gaining momentum globally, emphasizing demonstrable skills and knowledge. However, the Syrian neonatology fellowship program remains largely grounded in a traditional, time-based model and faces significant challenges due to the ongoing conflict in Syria. This study aims to identify and prioritize core competencies for Syrian neonatology fellowship curricula to establish a foundation for a standardized national curriculum. Methods A mixed-methods approach was utilized, incorporating a literature review, focus group discussions, and a modified Delphi technique involving three survey rounds. This process engaged a panel of 135 Syrian healthcare professionals with expertise in neonatal care. Participants evaluated a preliminary list of 120 competencies derived from a literature review and focus group discussions using a 5-point Likert scale. A consensus threshold of 75% agreement was applied to determine the final competency list. Results Expert consensus identified 135 competencies, categorized as 38 (28.1%) knowledge, 80 (59.3%) skills, and 17 (12.6%) attitudes. A weighted ranking system determined that 89 (65.9%) of these competencies are essential for successful neonatology fellowship training in Syria. Prioritized competencies emphasized foundational clinical skills, infection control, and teamwork, reflecting the resource limitations and collaborative needs of the Syrian healthcare system. Conclusion This study establishes a comprehensive set of core competencies for neonatology fellowship training in Syria. These findings provide a framework for developing contemporary, evidence-based curriculum aligned with international standards while adapting to local resource constraints. They represent a crucial step in standardizing neonatology fellowship training and advancing neonatal care in Syria.

Objectives The systemic vasculitides are multiorgan diseases where early diagnosis and treatment can significantly improve outcomes. Robust nomenclature reduces diagnostic delay. However, key aspects of current nomenclature are widely perceived to be out of date, these include disease definitions, classification and diagnostic criteria. Therefore, the aim of the present work was to identify deficiencies and provide contemporary points to consider for the development of future definitions and criteria in systemic vasculitis. Methods The expert panel identified areas of concern within existing definitions/criteria. Consequently, a systematic literature review was undertaken looking to address these deficiencies and produce ‘points to consider’ in accordance with standardised European League Against Rheumatism (EULAR) operating procedures. In the absence of evidence, expert consensus was used. Results There was unanimous consensus for re-evaluating existing definitions and developing new criteria. A total of 17 points to consider were proposed, covering 6 main areas: biopsy, laboratory testing, diagnostic radiology, nosology, definitions and research agenda. Suggestions to improve and expand current definitions were described including the incorporation of anti-neutrophil cytoplasm antibody and aetiological factors, where known. The importance of biopsy in diagnosis and exclusion of mimics was highlighted, while equally emphasising its problems. Thus, the role of alternative diagnostic tools such as MRI, ultrasound and surrogate markers were also discussed. Finally, structures to develop future criteria were considered. Conclusions Limitations in current classification criteria and definitions for vasculitis have been identified and suggestions provided for improvement. Additionally it is proposed that, in combination with the updated evidence, these should form the basis of future attempts to develop and validate revised criteria and definitions of vasculitis.

•To date, no specific guideline exists for the reporting of high quality clinical case reports in homeopathy.•Homeopathic clinical case reporting (HOM-CASE) guideline items were identified, as an extension to the CARE clinical case reporting guideline.•The HOM-CASE guideline extension can help to improve the quality and reliability of clinical case reports in homeopathy. Develop a criteria catalog serving as a guideline for authors to improve the quality of reporting clinical case reports in homeopathy. An online Delphi process was initiated with a panel of 19 homeopathic experts from Europe, the USA and India. Homeopathy specific item selection took place in three rounds of adjusting. The selected items can be used as an extension of the CARE clinical case reporting guideline. Eight homeopathy specific ‘core’ items were selected from a list of 31 suggested items; (1) the clinical history from a homeopathic perspective; (2) the type of homeopathy; detailed description of the medication—(3) nomenclature, (4) manufacture, (5) galenic form+dosage; outcomes—(6) objective evidence if available, (7) occurrence homeopathic aggravation, (8) assessment possible causal attribution of changes to the homeopathic treatment. A further 4 items were recommended for consideration as optional items when case reports are used for specific, in particular educational, purposes. The 8 core items can be used, merged into 6 items, as a homeopathy specific (HOM-CASE) extension to the CARE clinical case reporting guideline items 6, 9 and 10. Use of the HOM-CASE guideline extension will contribute to transparent and accurate reporting and can significantly improve the quality and reliability of clinical case reports in homeopathy.

In resorts, service quality refers to the overall level of guest satisfaction during their stay. This includes a variety of factors, such as the friendliness and helpfulness of the staff, the cleanliness and condition of the rooms and common areas, the availability of amenities and activities, the efficiency of check-in and check-out procedures, and the resort’s overall atmosphere. To address above gap, this study aims to develop contextual service quality (SERVQUAL) instrument for resorts to obtain the consensus benchmark to measure the service quality of Nepali tourist standard resorts. The SERVQUQL is a measuring tool of service quality of different organizational settings, more importantly, in the hospitality and service sector. Therefore, to contextualize and align to SERVQUAL, the Modified Delphi Technique (MDT) was used to develop this instrument based on SERVQUAL theory. The instrument development was performed among 10 anonymous experts and stakeholders who have experience, knowledge, and expertise in the area of the hospitality and leisure industries. The findings identified that one more key construct is essential to realize the service quality of the tourist standard resorts. To carry out the mutual consensus among the experts and stakeholders, the interquartile range (IQR) value was taken from three points Likert scale to conduct the MDT from the second stage until the mutual consensus of experts and stakeholders. The IQR value was taken from each set of questions which was evaluated by the exports to obtain a consensus benchmark on the contextualized SERVQUQL construct and items. The data were presented using Microsoft Excel. In the final stage, 29 question statements out of 31 were found to have a high consensus benchmark among the experts and stakeholders. Therefore, 29 items from six constructs were accepted and included in the actual questionnaire to measure the service quality of Nepali tourist standard resorts. Our findings contribute to the SERVQUAL theory, practice, and future research.

The number of centenarians worldwide is expected to increase dramatically, reaching 3.4 million by 2050 and >25 million by 2100. Despite these projections, depression remains a prevalent yet underdiagnosed and undertreated condition among this population that carries significant health risks. This study aimed to identify and achieve consensus on the most representative signs and symptoms of depression in near-centenarians and centenarians (aged ≥95 years) through an e-Delphi study with an international and interdisciplinary panel of experts. Ultimately, the outcomes of this study might help create a screening instrument that is specifically designed for this unique population. A modified e-Delphi study was carried out to achieve expert consensus on depressive symptoms in near-centenarians and centenarians. A panel of 28 international experts was recruited. Consensus was defined as 70% agreement on the relevance of each item. Data were collected through a web-based questionnaire over 3 rounds. Experts rated 104 items that were divided into 24 dimensions and 80 criteria to identify the most representative signs and symptoms of depression in this age group. The panel consisted of experts from various countries, including physicians with experience in old age psychiatry or geriatrics as well as nurses and psychologists. The response rate remained consistent over the rounds (20/28, 71% to 21/28, 75%). In total, 4 new dimensions and 8 new criteria were proposed by the experts, and consensus was reached on 86% (24/28) of the dimensions and 80% (70/88) of the criteria. The most consensual potentially relevant dimensions were lack of hope (21/21, 100%), loss of interest (27/28, 96%), lack of reactivity to pleasant events (27/28, 96%), depressed mood (26/28, 93%), and previous episodes of depression or diagnosed depression (19/21, 90%). In addition, the most consensual potentially relevant criteria were despondency, gloom, and despair (25/25, 100%); depressed (27/27, 100%); lack of reactivity to pleasant events or circumstances (28/28, 100%); suicidal ideation (28/28, 100%); suicide attempt(s) (28/28, 100%); ruminations (27/28, 96%); recurrent thoughts of death or suicide (27/28, 96%); feelings of worthlessness (25/26, 96%); critical life events (20/21, 95%); anhedonia (20/21, 95%); loss of interest in activities (26/28, 93%); loss of pleasure in activities (26/28, 93%); and sadness (24/26, 92%). Moreover, when assessing depression in very old age, the duration, number, frequency, and severity of signs and symptoms should also be considered, as evidenced by the high expert agreement. The classification of most elements as relevant highlights the importance of a multidimensional approach for optimal depression screening among individuals of very old age. This study offers a first step toward improving depression assessment in near-centenarians and centenarians. The development of a more adapted screening tool could improve early detection and intervention, enhancing the quality of mental health care for this population.