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BACKGROUND: Transfemoral transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for patients with severe aortic stenosis who are at elevated surgical risk. Despite widespread use, optimal periprocedural anaesthetic management remains highly variable, and evidence-based guidance is lacking. METHODS: An interdisciplinary panel of Italian experts in anaesthesiology, cardiology, and cardiac surgery conducted a systematic review of the literature and used the RAND/UCLA Appropriateness Method to evaluate 1032 clinical scenarios across a range of risk profiles and comorbid conditions. Ratings were conducted over three rounds, including a moderated in-person meeting to refine and discuss appropriateness scores. RESULTS: A minimally invasive approach, local anaesthesia alone, and conscious sedation were judged appropriate across most clinical scenarios. Invasive monitoring, such as placement of an additional arterial catheter or a central venous catheter, was recommended only in selected high-risk patients. Several approaches or interventions were consistently rated inappropriate across all evaluated scenarios, including nurse-administered anaesthesia, pulmonary artery catheterisation, and cardiac output monitoring using pulse wave analysis. Other approaches, such as general anaesthesia and deep sedation, were considered inappropriate in most cases but retained uncertainty in select clinical contexts. Several recommendations were rated as necessary to define a minimum standard of care. CONCLUSIONS: This Italian consensus statement provides practical, expert-driven recommendations to standardise anaesthetic care for transfemoral TAVI. While many recommendations reached strong consensus, areas of uncertainty remain, underscoring the need for further clinical research. Patient-centred, individualised decision-making remains essential, guided by institutional experience and procedural complexity.
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Cytomegalovirus (CMV) is an increasingly recognized complication of chimeric antigen receptor T-cell (CAR-T) and bispecific antibody (BsAb) therapies for hematologic malignancies, driven by therapy-related immunosuppression and cumulative exposure to lymphodepleting or steroid regimens. Given China's high adult CMV IgG seroprevalence (>90%), baseline risk, interpretation of low-level DNAemia, and operational thresholds differ from low-seroprevalence settings, requiring context-specific guidance. This China-adapted, evidence-graded consensus was developed by a multidisciplinary panel from major centers using a modified Delphi process and Oxford Centre for Evidence-Based Medicine levels to translate international guidance into a high-seroprevalence setting. Recommendations prioritize early risk stratification and pragmatic surveillance. We advise routine CMV monitoring by real-time quantitative PCR during the first 30 days after therapy, with risk-adapted extension thereafter. Interpretation and treatment triggers are anchored to WHO-traceable IU/mL and specified by specimen matrix to support comparability across assays. Consideration of prophylaxis is proposed for well-defined high-risk subgroups, acknowledging the need for prospective validation. Syndrome-based diagnostic and treatment algorithms are provided for tissue-invasive disease, including CMV pneumonia and encephalitis, with guidance on antiviral induction, step-down, and monitoring for virologic response and drug toxicity. This consensus explicitly adapts international recommendations to China's epidemiology, assay practice, and drug accessibility. By standardizing prevention, surveillance, and management in CAR T-cell and BsAb recipients, this consensus aims to lower non-relapse mortality and improve long-term outcomes. Priority research needs include harmonized viral-load thresholds, validation of risk-adapted prophylaxis strategies, and studies that clarify the significance of low-level DNAemia in this population.
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Objectives: The use of genomic testing for patients with anterior skull base malignancies has grown dramatically. There are no clear guidelines on indications for testing. As the literature on the subject is still in early stages, there is a need for expert consensus. We conducted a modified Delphi expert consensus process with high-volume North American cranial base surgical programs. Design Setting Participants: A modified Delphi consensus approach was used, following the method laid out by the American Academy of Otolaryngology-Head and Neck Surgery, and included 13 high-volume care centers. An otolaryngologist was appointed at each location to serve as the institutional representative. Main Outcome Measures: Participant responses to Delphi surveys were tabulated to determine consensus. Results: Thirteen teams responded comprising 23 otolaryngologists and 10 neurosurgeons. Overall, 11 of 12 institutions reported genomic testing to be fairly or easily available at their location, and 22 of 38 initial statements achieved consensus. Statements achieving consensus focused on primary and recurrent rare tumors without possibility of margin-negative resection, those with family history of anterior skull base malignancies, or rare tumors with distant metastasis. Statements regarding routine genomic sequencing or for primary tumors and cost of care did not achieve consensus. Conclusion: Expert multidisciplinary teams agreed on several appropriate settings for genomic sequencing in patients with anterior skull base malignancies, including recurrence, distant metastasis, and the inability to achieve a margin-negative resection. Further research is needed to explicitly clarify the role of genomic sequencing in this rare disease group.
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INTRODUCTION: Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAA and GDAA) are rare but life-threatening vascular lesions. Many are associated with median arcuate ligament syndrome (MALS), a condition associated with increased retrograde collateral flow due to celiac artery compression. Although endovascular treatment is the first-line approach for PDAA and GDAA, the role and timing of median arcuate ligament (MAL) release remain unclear. METHODS: This consensus statement was developed through the Anatomy on the Border Expert Consensus Meeting, organized by the Japanese Society for Endoscopic Surgery. Among multiple clinical questions (CQs) addressed by the working group, this statement focuses on CQ3: the appropriate timing of MAL release in patients with PDAA or GDAA associated with MALS. Consensus statements were developed based on a literature review, a nationwide survey, expert panel discussions, and a modified Delphi voting process. RESULTS: Although evidence remains limited, MAL release may improve antegrade visceral perfusion, prevent ischemic complications, reduce retrograde hemodynamic stress and recurrence risk, and facilitate vascular access for future interventions. Based on current evidence and expert input, the committee developed and approved three consensus statements: MAL release could be considered before endovascular treatment in clinically stable cases; Endovascular treatment should be performed first in ruptured cases, with careful attention to end-organ ischemia; Elective MAL release is suggested after aneurysm treatment to reduce the risk of recurrence. CONCLUSION: These consensus statements support individualized surgical decision-making for patients with PDAA or GDAA associated with MALS, where evidence is limited and clinical practice varies.
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Aneurisma , Artéria Celíaca , Duodeno , Artéria Gástrica , Síndrome do Ligamento Arqueado Mediano , Pâncreas , Estômago , Humanos , Aneurisma/cirurgia , Aneurisma/etiologia , Aneurisma/complicações , Artéria Celíaca/cirurgia , Consenso , Duodeno/irrigação sanguínea , Artéria Gástrica/cirurgia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Síndrome do Ligamento Arqueado Mediano/complicações , Pâncreas/irrigação sanguínea , Estômago/irrigação sanguínea , Fatores de TempoRESUMO
Colorectal cancer (CRC) is the second most frequently diagnosed cancer worldwide and represents a major challenge for public health. Despite advances in molecular profiling, important gaps remain in our understanding of tumorigenesis and the regulatory mechanisms underlying CRC progression. The most widely adopted classification system is the Consensus Molecular Subtypes (CMS), which stratifies CRC into four biologically distinct subtypes. We investigated the role of A-to-I RNA editing across CMS subtypes in a cohort of 100 CRC patients at various disease stages. Bulk RNA-seq data were analyzed using REDItools to detect editing events, focusing on both recoding sites and edits within repetitive elements, such as Alu sequences. Furthermore, expression levels of the ADAR enzyme family were assessed, and deconvolution analyses were performed on single-cell RNA-seq data from an independent cohort of stage II CRC patients to characterize editing activity within the tumor microenvironment (TME). Competitive endogenous RNA (ceRNA) networks, specific to each CMS subtype, were constructed based on editing events in repetitive elements. A multivariate Cox proportional hazards model was applied to evaluate associations with overall survival (OS). We observed statistically significant differences in ADARB1 expression across CMS subtypes. Single-cell RNA-seq data revealed subtype-specific distribution patterns of ADAR enzymes within the TME. Analysis of editing events showed subtype-specific signatures in both known cancer-related genes (e.g., COPA, CADPS, IGFBP7) and novel candidates (ZNF552, RALGPS1). Editing in repetitive elements informed the construction of distinct ceRNA networks for each CMS subtype, suggesting different post-transcriptional regulatory mechanisms. Survival analysis identified three variables significantly associated with OS, independent of CMS classification and clinical stage: ADARB1 expression, and editing events in NOP14-AS1 (chr4:2960236; p = 0.036; HR = 0.0069), previously linked to 5-FU sensitivity, and ST7-AS2 (chr4:117120557). This study underscores the biological relevance of RNA editing in CRC, highlighting its impact on chemoresistance, the tumor microenvironment, and subtype-specific gene regulation. Our findings suggest that RNA editing represents a critical post-transcriptional regulatory layer in CRC and holds potential as a biomarker and therapeutic target.
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Ultrasonography, especially Transvaginal sonography (TVS) is an effective, non-invasive and reliable investigation for the diagnosis of adenomyosis. The Morphological Uterus Sonographic Assessment group consensus terminology provides a standardised lexicon for the description of myometrial lesions and has been recently revised to include direct and indirect features of adenomyosis on sonography. In this article, we aim to provide a simplified framework for the practical application of the MUSA group consensus terminology in the ultrasonographic evaluation of adenomyosis, aiding in accurate diagnosis and informed decision-making.
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Treatment success after urethral reconstruction remains poorly standardized, resulting in heterogeneous outcome reporting and limited comparability across studies. To address this gap, we aimed to establish a consensus-based, reproducible definition of surgical success through the development of a novel outcome framework: the stricture-fecta. A two-round Delphi process was conducted under the auspices of the European Association of Urology (EAU) Young Academic Urologists-Trauma and Reconstructive Urology Working Party. A total of 113 international experts in urethral reconstruction were invited to assess the potential outcome criteria using a 9-point Likert scale. Consensus was defined as a rating of 7-9 by ≥70% and 1-3 by ≤15% of respondents. Eighty-seven (77%) experts completed round 1, and 65 (75%) participated in round 2. The final consensus identified three core criteria: (1) freedom from stricture retreatment; (2) no significant impact on continence or sexual function, assessed with validated instruments; and (3) patient satisfaction. The stricture-fecta represents a step toward standardized outcome reporting in urethral reconstruction, akin to the trifecta metrics in urological oncology. Its adoption may improve data quality, facilitate multicenter collaboration, and support more transparent, patient-centered evaluations of surgical success. Patient summary: This study developed a clear and simple way to measure success after surgery to fix narrowing of the urethra, a condition that affects urination and quality of life. Experts agreed that success means no need for further treatment, and no negative effects on bladder control or sexual function, and that patients feel satisfied with the results. The use of this approach will help doctors compare outcomes better and improve care for patients undergoing urethral surgery.
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The therapeutic landscape for renal cell carcinoma (RCC) and urinary tract cancer (UTC) has transformed dramatically, creating complexity in treatment selection and sequencing. The 2025 Advanced Urologic Cancer Consensus Conference was convened to establish evidence-based expert consensus recommendations for optimal management. A multidisciplinary panel of 51 experts participated in a modified Delphi process addressing questions developed through iterative consensus-building covering RCC and UTC management. Voting occurred before and after the conference, and analyses focused on postmeeting responses. Consensus was defined as ≥75% agreement, with strong consensus as >90%. Strong consensus was found on the use of adjuvant pembrolizumab for higher risk RCC (pathologic T2 [pT2], grade 4; pT3-pT4, any grade; pTXN1; or fully resected metastatic disease) and on neoadjuvant therapy before cystectomy for localized UTC. There was strong consensus on the use of enfortumab vedotin plus pembrolizumab as frontline therapy for metastatic UTC and the use of platinum-based chemotherapy postprogression in biomarker-negative UTC. For RCC, there was consensus on the role of single-agent vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy after progression on frontline immune checkpoint inhibitor/vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy or dual immune checkpoint inhibitor therapy. However, there was a lack of consensus on other critical areas in the management of RCC and UTC. The 2025 Advanced Urologic Cancer Consensus Conference provides evidence-informed guidance for complex clinical scenarios while identifying critical research priorities. The group recognizes that the lack of consensus across multiple areas highlights the need for improved patient selection and prospective studies enabling optimal combination and sequencing approaches. This iterative annual process will address evolving treatment paradigms to optimize outcomes.
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Carcinoma de Células Renais , Neoplasias Renais , Neoplasias Urológicas , Humanos , Anticorpos Monoclonais Humanizados/uso terapêutico , Carcinoma de Células Renais/terapia , Carcinoma de Células Renais/patologia , Consenso , Neoplasias Renais/terapia , Neoplasias Renais/patologia , Terapia Neoadjuvante/métodos , Neoplasias Urológicas/terapia , Neoplasias Urológicas/patologiaRESUMO
AIMS: In April of 2025, the Wake Forest Institute for Regenerative Medicine hosted a Global Consensus meeting on IC/BPS in Winston-Salem, NC. The goal of this meeting was to establish global consensus regarding diagnostic criteria, phenotyping, treatment outcome assessment, and etiopathology in interstitial cystitis/bladder pain syndrome (IC/BPS). Our sub-committee was tasked with developing a consensus document on patient phenotyping in IC/BPS. METHODS: Narrative review. RESULTS: Patients with IC/BPS populate broad groups that have been characterized as having a bladder-focused disease phenotype (bladder-centric), a widespread pain and symptoms phenotype (systemic), or by other variable phenotypes including those with myofascial pelvic pain. In this review, we discuss the published evidence supporting each of these patient phenotypic groups. CONCLUSIONS: Future clinical trials and treatment development in IC/BPS should include patient phenotyping efforts with, at minimum, a focus on stratification into bladder-centric vs systemic and efforts to refine discriminative thresholds (cut-off points) that may influence differential treatment outcomes. It is important to continue to investigate the importance of patient phenotypes on treatment strategy selection, outcomes, and our understanding of the underlying pathophysiology for this disease spectrum. CLINICAL TRIAL REGISTRATION: N/A.
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Cistite Intersticial , Dor Pélvica , Humanos , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Cistite Intersticial/fisiopatologia , Fenótipo , Dor Pélvica/diagnóstico , Dor Pélvica/terapia , Dor Pélvica/fisiopatologia , Bexiga Urinária/fisiopatologia , ConsensoRESUMO
BACKGROUND: Unless greater awareness inspires action, lung cancer will become the next global public health emergency. Despite improvements in screening, diagnosis, and treatments, more must be done because global incidence continues to increase. Concerted action must address the burden both between and within countries. Inequalities result from the uneven distribution of resources while inequities result from differences in prevention, screening, diagnosis, and treatment. METHOD: Participants in the 9th International Lung Cancer Network conference (Athens, June 2023) received an advanced draft of the declaration with a confidentiality notice by email upon completion of online registration. They were invited to provide comments and suggestions up to seven days before the meeting. All contributions were reviewed by the authors and incorporated into the final version circulated the day before the meeting began. Although not a formal Delphi-style process, this approach prioritized inclusivity, transparency, and broad endorsement. Outreach extended beyond onsite attendees, ensuring diverse perspectives and representation. This process complements methodological consensus approaches by uniting stakeholders around shared policy goals. RESULTS: At the 9th International Lung Cancer Network conference, participants were invited to sign the final declaration, and 785 did so. Since then, 20 organizations worldwide have formally endorsed the Consensus Statement, and support continues to grow. The inclusive design has fostered broad and sustained backing, underscoring the value of the Statement as a unifying policy declaration advancing shared principles. CONCLUSION: The Consensus Statement, Bridging the Gap in the Diagnosis and Management of Lung Cancer, reinforces five unifying principles: improve and expand prevention; focus on early detection; ensure equitable and sustainable access to treatment; build partnerships and promote investment; and, combat stigma, recognizing it as a social determinant of public health.
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Saúde Global , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/prevenção & controle , Detecção Precoce de Câncer , Disparidades em Assistência à SaúdeRESUMO
BACKGROUND: Advanced practice radiation therapist (APRT) roles have expanded internationally to address cancer workforce shortages and improve service delivery. A Canadian consensus process previously established 20 standardized APRT clinical activities across five themes. This study evaluated the international applicability of these activities through expert consensus to establish a global framework for APRT practice. METHODS AND MATERIALS: A systematic three-round international Delphi consensus study was conducted following established quality framework recommendations. Expert panel members were recruited from an international Community of Practice using objective selection criteria ensuring recognized APRT expertise and diverse geographical representation. Participant anonymity was maintained throughout all rounds. Controlled feedback provided quantitative results and anonymized qualitative comments between rounds. Consensus threshold was defined a priori at 80% agreement, and activities were evaluated for inclusion in international APRT scope of practice across five themes: patient interactions, multidisciplinary consultation, virtual consultation, resource optimization, and technical activities. RESULTS: Twenty-three international experts were invited to take part in the study with response rates of 81% (Round 1), 89% (Round 2), and 89% (Round 3). Twenty clinical activities were systematically evaluated. Five activities achieved immediate Round 1 consensus: Planning Consultation (83%), Multidisciplinary Pre-treatment Consultation (83%), Care Coordination (96%), Patient Navigation (87%), and Technical Consultation (87%). Following iterative three-round evaluation, 16 of 20 activities (80%) achieved final international consensus for APRT practice inclusion. Four activities failed to reach consensus: Patient Education/Informed Consent (75%), Follow-up Consultation (78%), Clinical Examination (78%), and MR Applicator Assessment (65%). The validated framework demonstrates substantial global alignment while identifying specific jurisdictional variations in advanced practice acceptance. CONCLUSIONS: This study establishes international consensus on core APRT clinical activities, providing evidence-based foundations for standardized global APRT role development and implementation. These findings support healthcare systems in addressing workforce challenges through validated advanced practice frameworks while maintaining quality cancer care delivery.
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Neoplasias , Radioterapia (Especialidade) , Humanos , Técnica Delphi , Consenso , Neoplasias/radioterapiaRESUMO
The Dublin ISUP Consensus Conference covered the proceedings on the best practice recommendations on nonurachal glandular lesions of the urinary bladder, bladder diverticular cancers, and molecular features of bladder and urachal glandular lesions. The conference proceedings on urachal neoplasms (except for their molecular features) are published elsewhere. The rationale for convening this conference was the lack of structured and consented pathologic recommendations in these rare lesions. Consensus by participants was reached on the following statements: (1) intestinal metaplasia with dysplasia is considered to be a precursor to primary bladder adenocarcinoma; (2) dysplasia arising from cystitis glandularis should be reported in terms of focality (focal or nonfocal) and grade (low or high); (3) the term "adenocarcinoma" should only be used for carcinomas showing pure (nonurothelial) morphology and should not be used interchangeably in urothelial carcinoma with "glandular differentiation" because of the pathobiological differences and management implications; (4) the different histologic subtypes of bladder adenocarcinoma should be specified in the report; (5) immunohistochemistry has an ancillary role in the work up of bladder adenocarcinoma versus gastrointestinal or Müllerian-type adenocarcinomas; (6) lymphovascular invasion should be included as a parameter when reporting bladder adenocarcinoma; (7) representative or targeted sampling will be sufficient for bladder diverticulum resection specimens; and (8) molecular analysis in genomic profiling should be performed only in advanced or metastatic bladder and urachal adenocarcinomas for targetable therapy. This report on glandular (nonurachal) lesions of the bladder from the Dublin ISUP consensus conference will serve as a best practice recommendation and as a guide for future research on these relatively rare lesions.
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Adenocarcinoma , Divertículo , Neoplasias da Bexiga Urinária , Bexiga Urinária , Humanos , Adenocarcinoma/patologia , Consenso , Divertículo/patologia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
BACKGROUND: The combination of radiotherapy (RT) with targeted agents or immunotherapy may result in improved outcomes, but it can also increase toxicity. However, there is a paucity of high-quality toxicity data, leading to an absence of evidence-based guidelines. DESIGN: To address this, European Society for Medical Oncology (ESMO) and European SocieTy for Radiotherapy and Oncology (ESTRO) initiated a series of systematic reviews followed by a Delphi consensus process to develop multidisciplinary, evidence-based consensus statements regarding the safety of combining RT with such agents. The current publication describes the combination of RT with immune checkpoint inhibitors (ICIs), vascular endothelial growth factor (receptor) [VEGF(R)] inhibitors, or multitargeted tyrosine kinase inhibitors (TKIs). By systematically covering different drug classes and irradiated areas, 76 clinical scenarios were evaluated during two Delphi rounds with 20 international experts. Safety statements were developed for each scenario, based on the systematic literature reviews. RESULTS: A total of 5921 records were screened during the systematic literature review process for ICIs, VEGF(R) inhibitors, and multitargeted TKIs, and 159 reports were selected for inclusion in the final literature reviews and the database. During the two Delphi rounds, agreement was reached regarding the safety statements for 74 clinical scenarios. CONCLUSIONS: Generally, the expected toxicity of combining RT with ICIs is low, particularly for programmed death(-ligand) 1 inhibitors. For most combinations with VEGF(R) inhibitors and multitargeted TKIs, exercising caution is recommended. The evidence-based safety statements developed during this comprehensive project provide practical guidance on combining RT with targeted cancer therapies and immunotherapy.
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Quimiorradioterapia , Inibidores de Checkpoint Imunológico , Neoplasias , Inibidores de Proteínas Quinases , Receptores de Fatores de Crescimento do Endotélio Vascular , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Neoplasias/terapia , Neoplasias/imunologia , Neoplasias/tratamento farmacológico , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Técnica DelphiRESUMO
BACKGROUND: With the increasing use of minimally invasive surgery, understanding of the precise anatomy involved in median arcuate ligament syndrome (MALS) has advanced. However, surgical strategies and treatment principles for MALS remain unclear. METHODS: At the 37th Annual Meeting of the Japan Society for Endoscopic Surgery, an expert consensus conference titled "AOB Consensus Meeting" was held. Eleven experts in upper gastrointestinal, hepatobiliary-pancreatic, and vascular surgery discussed five clinical questions (CQs) regarding MALS. Systematic literature reviews were conducted, and draft consensus statements were developed. Evidence levels were assessed based on the MINDS guideline, and final consensus statements were established through a second-round Delphi voting process. RESULTS: Thirteen consensus statements were formulated across the five CQs, all achieving over 75% agreement among the experts. CONCLUSION: This consensus provides evidence- and experience-based recommendations for the diagnosis and surgical treatment of MALS. These consensus statements are expected to serve as a practical guide for specialists and surgeons, promoting the safe execution and appropriate global dissemination of MALS treatment.
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Artéria Celíaca , Síndrome do Ligamento Arqueado Mediano , Humanos , Síndrome do Ligamento Arqueado Mediano/cirurgia , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Consenso , Artéria Celíaca/cirurgia , Artéria Celíaca/anatomia & histologia , Técnica DelphiRESUMO
BACKGROUND CONTEXT: Spine surgery, like all major surgeries, carries the risk of adverse events and delayed recovery. Prehabilitation programs may mitigate negative prognostic factors to reduce complications and promote faster recovery postoperatively following spine surgery. There is no international consensus or recommendations regarding prehabilitation components in spine surgery. PURPOSE: This study aims to establish international consensus on important modalities of prehabilitation before spine surgery for patients appropriate for prehabilitation using a modified nominal group technique (NGT). STUDY DESIGN/SETTING: A modified NGT. PATIENT SAMPLE: This study used a modified NGT to establish consensus among 50 participants during the International Forum for Back and Neck Pain (ILBP Forum) 2023 and International Society for the Study of the Lumbar Spine (ISSLS) 2024 conference. OUTCOME MEASURES: The rank for each theme and component was computed as the mean of the ranking. We expressed the dispersion in ranking as a measure of consensus. METHODS: During the workshops participants consisting of clinicians and researchers ranked themes and components of a prehabilitation intervention for patients scheduled for spine surgery. The rank for each theme and component was calculated as the mean rank, the dispersion in rankings was used as a measure of consensus. RESULTS: Five main prehabilitation themes were identified and ranked from most to least important by the participants: education (consensus=0.65), psychological prehabilitation (consensus=0.56), physical prehabilitation (consensus=0.37), multidisciplinary prehabilitation (consensus=0.54) and lifestyle factors (consensus=0.53). Within themes, different prehabilitation components were identified and ranked by priority. CONCLUSIONS: The 5 themes identified by this NGT consensus process (education, psychological prehabilitation, physical prehabilitation, multidisciplinary prehabilitation and lifestyle factors) can help inform the design of innovative prehabilitation interventions for optimizing recovery from spine surgery.
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Cuidados Pré-Operatórios , Exercício Pré-Operatório , Coluna Vertebral , Humanos , Consenso , Coluna Vertebral/cirurgia , Cuidados Pré-Operatórios/métodosRESUMO
PURPOSE: The main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries. METHODS: A structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary 'agree/disagree' in the final third round. Levels of evidence were assigned to each statement using standardized A-E and GRADE grading systems based on the available data. RESULTS: High agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%-100%), whereas for 7 agreement was <80% (range 63%-74%). The highest levels of agreement were reached for imaging modalities, treatment of PCL tibial avulsions, and preservation of native PCL fibres in reconstruction techniques, whereas the greatest divergence was observed regarding the role of leg axis and slope analyses and indications for corrective osteotomies, use of augmentation in reconstruction and post-operative rehabilitation protocols. The available level of evidence across studies in the literature was predominantly low to moderate. Of the 31 statements, 17 were graded as expert opinion (E, GRADE: very low), 12 as case series (C; GRADE: low), and only 2 achieved higher levels of evidence (B2, GRADE: moderate). CONCLUSION: By providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes. STUDY DESIGN: Expert survey. LEVEL OF EVIDENCE: Level V.
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Traumatismos do Joelho , Ligamento Cruzado Posterior , Humanos , Técnica Delphi , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Feminino , Masculino , Pessoa de Meia-Idade , Traumatismos do Joelho/cirurgia , Alemanha , Sociedades Médicas , ConsensoRESUMO
BACKGROUND AND PURPOSE: External beam radiotherapy (EBRT) is a well-established and effective intervention for pain palliation in patients with bone metastases. Variability in trial endpoints, however, has limited comparability and synthesis of available evidence. To address this, the International Bone Metastases Consensus Working Party published endpoint guidelines in 2002 and updated them in 2012. This study aims to review, re-evaluate, and update the existing consensus to reflect contemporary clinical practice and technological advances. MATERIALS AND METHODS: A modified Delphi process was undertaken, informed by a systematic literature review and post-2012 guideline publications. An electronic survey was distributed to previous contributors and internationally recognized bone EBRT experts. In Phase I, statements achieving ≥ 75 % agreement were accepted. Items not reaching consensus were refined by the Working Party, discussed by a core panel of eight experts, and recirculated in Phase II. Descriptive statistics summarized response rates and agreement levels. RESULTS: Of 125 experts invited, 58 participated in Phase I, and 44 in Phase II. Consensus was achieved for 38 out of 49 statements (78%), including 18 new or revised items. Key recommendations addressed eligibility criteria for trial enrolment, standardized pain and analgesic assessments, specification of radiation techniques and dose schedules, follow-up intervals, assessment timing and modalities, and incorporation of cost-effectiveness analyses. CONCLUSION: This updated consensus provides a contemporary, standardized framework for EBRT trial design and reporting in bone metastases. Adoption will improve cross-study comparability and guide future research priorities. Regular updates are planned to ensure alignment with evolving clinical practice and technology.
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Neoplasias Ósseas , Dor do Câncer , Cuidados Paliativos , Humanos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Dor do Câncer/radioterapia , Ensaios Clínicos como Assunto , Consenso , Técnica Delphi , Determinação de Ponto Final , Cuidados Paliativos/métodosRESUMO
PURPOSE: The purpose of this article is to establish expert consensus on the rationale for, and components of, a global patient registry for interstitial cystitis/bladder pain syndrome (IC/BPS). Our goal is to highlight what a comprehensive international patient registry can add to the growing body of IC/BPS-focused research and summarize the committee's rationale for inclusion or exclusion of certain patient and diagnostic characteristics to identify sub-groups of patients who will benefit from targeted therapy. MATERIALS AND METHODS: An expert working group was formed from members of the Global Consensus on IC/BPS meeting. The working group consisted of four Urologists and a Urogynaecologist, and held a series of meetings in 2025 to achieve consensus on the benefits, hurdles and practical aspects of developing a global registry for IC/BPS. Literature search of the PubMed database was also performed where relevant, and all members agreed on the final proposals. RESULTS: The framework for an IC/BPS global registry was developed inclusive of male and female patients ages 18 years and older, who have symptoms of pain, pressure or discomfort related to the bladder, along with lower urinary tract symptoms, that have persisted for 3 or more months, in the absence of confusable disorders. A comprehensive list of patient data points including demographic, history-related, and comorbid conditions was developed. Additionally, validated questionnaires were identified for inclusion that assess domains of pain, urinary symptoms and quality of life. Consensus was reached regarding collecting data on prior treatment, cystoscopy findings and biopsy results where applicable. Lastly, importance was placed on patient-reported questionnaire data that can be input longitudinally by patients to lessen the burden of data collection by providers. Technical, legal and financial aspects were addressed as potential barriers. CONCLUSIONS: A global registry for IC/BPS would overcome the limitations of current regional registries by including large numbers of patients from varied geographical locations, allowing for more efficient recruitment of patients for clinical trials. Understanding epidemiological trends and global variation in practice would enable optimization of care and quality improvement worldwide.
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Cistite Intersticial , Sistema de Registros , Humanos , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Cistite Intersticial/epidemiologia , Cistite Intersticial/fisiopatologia , Feminino , Masculino , ConsensoRESUMO
Cardiac amyloidosis (CA) is an emerging iceberg among the cardiomyopathies with significant morbidity and mortality. The overlapping signs and symptoms with other cardiac pathologies warrant prompt identification of the clinical red flags and imaging red flags (iRF) for early detection and treatment of CA. Unluckily data suggests that these patients visit 4-5 physicians before being diagnosed with CA; this is mainly due to perception of rarity, overlapping symptomatology with other common cardiac conditions (hypertension, chronic renal failure, aortic stenosis, and hypertrophic cardiomyopathy), and inability of identification of clinical and iRF of CA by the practicing physicians in the routine outpatient department (OPD) working. Recently published multiregional expert consensus on multimodality correlative cardiac imaging by international societies has emphasized on specific clinical and imaging red flags (iRF) using ECG, echocardiogram, 99m Tc-based scintigraphy, and cardiac MR for robust diagnosis of CA. However, reading all these tedious guidelines and retaining their diagnostic practice points (DPPs) appears difficult in daily practice for practicing physicians and residents. Therefore, the current draft has condensed and highlighted the DPPs of recent 5 years of published data in the form of concise, printable tables and flow charts, enabling a physician in the OPD to flick through, teach, and direct the suspected patients for prompt and timely diagnostic testing to rule out CA.
Assuntos
Amiloidose , Cardiomiopatias , Imageamento Multimodal , Humanos , Amiloidose/diagnóstico por imagem , Imageamento Multimodal/métodos , Cardiomiopatias/diagnóstico por imagemRESUMO
BACKGROUND: Hereditary hearing loss is one of the most common disabling disorders in children and lacks effective pharmacological treatments. Recent breakthroughs in OTOF gene therapy clinical trials necessitate standardized frameworks to guide emerging therapies. This study aims to establish the first international consensus on the clinical application of gene therapy for hereditary hearing loss. METHODS: A modified Delphi process was conducted from March 2024 to March 2025, involving 46 multidisciplinary experts from several countries across otology, genetics, audiology, gene therapy, and hearing rehabilitation. After a systematic literature review, as well as integration of research and clinical expertise and experience, three iterative voting rounds (two anonymous surveys and one online consensus meeting) were performed. Statements required ≥75% agreement for inclusion. FINDINGS: From 9,093 publications, 69 were used to draft and support the consensus statements. A total of 30 statements relevant to six domains achieved consensus on gene therapy for hereditary hearing loss, including ethical review (1 statement), patient selection criteria (12 statements), diagnosis and preoperative evaluation (9 statements), gene therapy drug delivery (4 statements), follow-up (3 statements), and post-treatment auditory and speech rehabilitation (1 statement). CONCLUSIONS: This consensus provides the first globally endorsed framework for gene therapy in hereditary hearing loss. It standardizes clinical trial design and patient management, accelerating translation from research to practice while ensuring safety. The guidelines are immediately applicable to OTOF-related hearing loss and adaptable to other genetic forms. FUNDING: This work was supported by the National Natural Science Foundation of China, the German Research Foundation (DFG) via the Cluster of Excellence, and others.