Search Results (1,016)

Background: The rapid advancement of artificial intelligence (AI) in healthcare has opened new opportunities, yet the clinical validation of AI tools in dentistry remains limited. Objectives: This study aimed to assess the performance of ChatGPT in generating accurate and complete responses to academic dental questions across multiple specialties, comparing the capabilities of GPT-4 and GPT-3.5 models. Methodology: A panel of academic specialists from eight dental specialties collaboratively developed 48 clinical questions, classified by consensus as easy, medium, or hard, and as requiring either binary (yes/no) or descriptive responses. Each question was sequentially entered into both GPT-4 and GPT-3.5 models, with instructions to provide guideline-based answers. The AI-generated responses were independently evaluated by the specialists for accuracy (6-point Likert scale) and completeness (3-point Likert scale). Descriptive and inferential statistics were applied, including Mann–Whitney U and Kruskal–Wallis tests, with significance set at p < 0.05. Results: GPT-4 consistently outperformed GPT-3.5 in both evaluation domains. The median accuracy score was 6.0 for GPT-4 and 5.0 for GPT-3.5 (p = 0.02), while the median completeness score was 3.0 for GPT-4 and 2.0 for GPT-3.5 (p < 0.001). GPT-4 demonstrated significantly higher overall accuracy (5.29 ± 1.1) and completeness (2.44 ± 0.71) compared to GPT-3.5 (4.5 ± 1.7 and 1.69 ± 0.62, respectively; p = 0.024 and <0.001). When stratified by specialty, notable improvements with GPT-4 were observed in Periodontology, Endodontics, Implantology, and Oral Surgery, particularly in completeness scores. Conclusions: In academic dental settings, GPT-4 provided more accurate and complete responses than GPT-3.5. Despite both models showing potential, their clinical application should remain supervised by human experts. Full article

Accessing the built environment poses many challenges for people with disabilities, severely affecting their independence and quality of life. A panel of experts with a lived experience of disabilities co-designed a survey capturing the challenges in New Zealand’s public places. There were 319 survey respondents with impairments related to mobility (66.5%), vision (18.8%), hearing (5.0%), sensory processing and cognition (8.8%). They perceived sports stadiums as the least accessible venue, followed by bars, boutique shops and public toilets. The most accessible venues were supermarkets, libraries and shopping malls. The type of disability affected the main accessibility challenges. Significant outdoor barriers included uneven and cluttered paths, inadequate provision of curb cuts, seating and accessible parking spaces, and obscure wayfinding. Entrance barriers included heavy doors, complex access control, remote ramps and narrow, obscure entrances. Interior problems included cluttered paths and poor signage. The top priorities for improvement were simplifying layouts, keeping paths clear, and providing clear, inclusive signage, communication and assistance for people with varying impairments. Providing lower counters, better colour contrast, hearing loop facilities and better control of lighting and acoustics also improve accessibility. This research contributes novel experiential data from people with disabilities that is critical to achieving an inclusive built environment. Full article

Background: Evidence of the real-world management of dedifferentiated liposarcoma (DDLPS) is limited by the patient size and coding. The objective of this study is to generate consensus expert opinion on locally advanced or metastatic DDLPS diagnosis, treatment, and unmet needs. Methods: A three-round Delphi consensus panel was conducted with 9 DDLPS clinical experts from November to December 2023. Expert panelists were recruited across academic specialty and traditional settings and US regions. The Delphi panel included two rounds of surveys followed by a consensus building workshop. Surveys contained multiple-choice and free response questions, and statements for level of agreement rating. Panelists rated each statement for level of agreement on a 9-point Likert scale. Statements with ≥75% of scores ≥ 7 achieved consensus, and those that did not achieve consensus agreement were modified or removed from subsequent testing. A virtual workshop was held to discuss areas which did not achieve consensus and refine previously agreed upon statements. Results: In total 25 consensus statements were developed by the Delphi panel. Survey 1 achieved 7 consensus statements across the areas of burden, treatment, and unmet needs of DDLPS. Survey 2 generated an additional 10 consensus statements. During the workshop, eight more statements achieved consensus, and four statements were refined for enhanced clarity and precision. The study findings are limited by the number of Delphi panel participants and consensus statements may not be fully representative of clinician perspectives across the US. Conclusions: Consensus areas identified by the Delphi panel help better understand the decision factors for surgical and non-surgical treatments and anticipated utilization. These results could be used to inform both drug development programs as well as care delivery challenges for liposarcoma patients. Full article

Background/Objectives: Musculoskeletal disorders causing chronic pain are increasingly prevalent due to factors such as injury, overuse, and aging, leading to interest in porcine collagen injections as a potential therapeutic and conservative option. Despite promising results, evidence-based information on this treatment is scarce. To address this gap, the authors conducted an eDelphi consensus among expert Italian physicians in musculoskeletal pain to gather their perspectives on collagen injections. Methods: A Steering Committee and a Panel of 23 physicians developed the statements list (36) including the modalities, safety, and efficacy of intra- and extra-articular collagen injections. Panelists rated their agreement with each statement on a 5-point Likert scale (5 means “Strong Agreement”). Consensus was defined as when at least 75% of the panelists voted with a score of ≥4/5 after two rounds of votes. The weighted average (WA) was calculated for each statement. As control, we elaborated a Hypothetical Parametric Distribution (HPD WA equal to 3.00), where the percent of panelists is equally distributed along each Likert Scale Value (LSV). The maximum WA for 75% of the consensus is established at 3.75. Indeed, the combination of 75% having WA > 3.75 was defined as “Strong Agreement”. While, if the consensus was under 75%, the WA vs. HPD comparison was performed using the Wilcoxon Test. Significant differences among the distribution of LSVs judged the statement as “Low Level of Agreement”. Disagreement was evaluated when the WA was under the PHD. Results: The consensus was reached “Strong Agreement” after twin rounds in 29 out of 36 (8.55%). In 5 out of 36 statements (13.89%), the panelists reached the “Low Level of Agreement” by statistical tests. In the remaining two statements, there was a “Consensus of Disagreement”. All panelists unanimously agreed on crucial points, such as contraindications, non-contraindication based solely on comorbidity, and the importance of monitoring collagen’s effectiveness. Unanimous agreement was reached on recommending ultrasound guidance and associating collagen injections with therapeutic exercise and physical modalities. Substantial consensus (concordance > 90%) supported collagen injections for osteoarthritis, chondropathy, and degenerative tendinopathies, emphasizing intra- and peri-articular treatment, even simultaneously. However, areas with limited evidence, such as the combination of collagen with other injectable drugs, treatment of myofascial syndrome, and injection frequency, showed disagreement. The potential of intra-tendinous porcine collagen injections for tendon regeneration yielded mixed results. Conclusions: Clinicians experts in musculoskeletal pain agree on using collagen injections to treat pain originating from joints (e.g., osteoarthritis) and periarticular (e.g., tendinopathies). Full article

Cities play a vital role in creating wealth and ensuring the well-being of all their inhabitants. However, major international efforts aimed at fostering fairer, healthier, and a more sustainable world have been compromised by the widespread effects of the COVID-19 pandemic. The objective of this research is to determine key priorities for addressing the pandemic’s impact in both the present and in a future urban context. Therefore, this study applies the Delphi method to a panel of 24 experts in order to identify the most and least important targets from Sustainable Development Goal 11 for post-COVID-19 sustainable urban planning in Cuenca, Ecuador. Out of the twelve targets, only five were prioritized, including “Target 11.1 Affordable housing”, Target 11.3 Sustainable Urbanization”, “Target 11.9 Implement policies for inclusion and property rights”, and “Target 6.3 Improve water quality”. These findings can serve as a foundation for future public policies and strategies for sustainable urban planning of the city. Full article

Wildlife rescue centres face considerable challenges in promoting animal welfare and enhancing the care and housing conditions of animals under professional supervision. These challenges are further compounded by the diversity of species admitted, each with distinct specific needs. In Colombia and other Latin American countries, primates are among the most frequently rescued and behaviourally complex mammalian taxa, requiring particular attention. In response, this study aimed to assess the content validity of proposed animal welfare indicators for Cebus albifrons through a Delphi consultation process and to develop two species-specific assessment protocols: a daily-use tool for keepers and a comprehensive protocol for professional audits. A panel of 23 experts in primate care and rehabilitation participated in two consultation rounds to evaluate and prioritise the indicators based on their content validity, perceived reliability, and practicality. Indicators were classified as either animal-based (direct measures) or resource- and management-based (indirect measures). After each round, experts received summarised feedback to refine their responses and facilitate consensus building. Of the 39 initially proposed indicators, 28 were validated for inclusion in the extended protocol and 10 selected for the daily-use checklist. Among these, 20 indicators in the extended protocol and 6 in the daily protocol were resource- or management-based—such as adequate food provision, physical enrichment, and habitat dimensions—highlighting their practical applicability and relevance in identifying welfare issues and risk factors. Although these indirect indicators were more numerous, the top-ranked indicators in both protocols were animal-based, including signs of pain, affiliative behaviours, and abnormal repetitive behaviours. These are essential for accurately reflecting the animals’ welfare state and are therefore critical components of welfare assessment in captive non-human primates. This study demonstrates that welfare assessment tools can be effectively tailored to the specific needs of wildlife rescue centres, providing a robust foundation for enhancing welfare practices. These protocols not only offer practical approaches for assessing welfare but also underscore the importance of embedding animal welfare as a priority alongside conservation efforts. Future research should aim to refine these tools further, assess their implementation, and evaluate inter- and intra-observer reliability to ensure consistency across different settings. Full article

Background/Objectives: Acne vulgaris is a prevalent dermatological condition, yet clear, region-specific management guidelines, particularly for India’s diverse population, remain limited. Effective acne management extends beyond pharmacologic therapy, emphasizing proper skincare, patient education, and adherence strategies. This consensus aims to provide tailored, evidence-based recommendations for optimizing acne treatment in the Indian context. Methods: A panel of 14 dermatology experts with ≥15 years of experience reviewed literature, real-world clinical practices, and patient-centric factors relevant to acne management in India. Using a modified Delphi process with two virtual voting rounds, 61 statements across seven clinical domains were evaluated. Consensus was defined as ≥75% agreement. Results: Topical retinoids remain the first-line therapy, with combination regimens (benzoyl peroxide or topical antibiotics) preferred to enhance efficacy and minimize antibiotic resistance. Hormonal therapies, including combined oral contraceptives and spironolactone, are recommended for females with resistant acne. Guidance includes individualized treatment plans, baseline investigations, and selection of appropriate topical and systemic agents. Special considerations for pregnancy and lactation prioritize maternal and fetal safety. Conclusions: This expert consensus provides practical, evidence-based recommendations for acne management in India, integrating pharmacological and non-pharmacological approaches. The tailored guidance supports individualized care, antibiotic stewardship, and improved treatment adherence, aiming to enhance patient outcomes nationwide. Full article

Hand hygiene is a key measure to prevent healthcare-associated infections (HAIs), yet compliance remains low in Sub-Saharan Africa (SSA), due to limited resources, insufficient training, and behavioral challenges. Simulation-based education offers a promising approach to enhance technical and non-technical skills in safe learning environments, promoting behavioral change and patient safety. This study aimed to develop and pilot a contextually adapted hand hygiene simulation-based learning scenario for nursing students in SSA. Grounded in the Medical Research Council (MRC) Framework and Design-Based Research principles, a multidisciplinary team from European and African higher education institutions (HEIs) co-created this scenario, integrating international and regional hand hygiene guidelines. Two iterative pilot cycles were conducted with expert panels, educators, and students. Data from structured observation and post-simulation questionnaires were analyzed using descriptive statistics. The results confirm the scenario’s feasibility, relevance, and educational value. The participants rated highly the clarity of learning objectives (M = 5.0, SD = 0.0) and preparatory materials (M = 4.6, SD = 0.548), reporting increased knowledge/skills and confidence and emphasizing the importance of clear roles, structured facilitation, and real-time feedback. These findings suggest that integrating simulation in health curricula could strengthen HAI prevention and control in SSA. Further research is needed to evaluate long-term outcomes and the potential for wider implementation. Full article

SARS-CoV-2 infection can be followed by prolonged symptoms, signs and sequelae, collectively known under the term Long COVID. Hundreds of millions are estimated to suffer from Long COVID. Long COVID, therefore, is a public health crisis that deserves the utmost urgency from all relevant stakeholders, from policymakers to advocacy groups, researchers and healthcare providers. The development of effective definitions and guidelines for Long COVID is crucial to support patients and carers. In this review, I address the following two case definitions of Long COVID developed in the US as a case study for a broader discussion on the sequelae of SARS-CoV-2 infection: the U.S. Government (USG) working definition for Long COVID and the NASEM definition published in 2024. In the first part of this review, I provide a critical appraisal of the USG in light of research, pathophysiology and lived experience, building upon my intervention as a patient expert on a National Academies of Sciences, Engineering, and Medicine (NASEM) panel for defining Long COVID, which examined the USG. In the second part, I raise some pressing concerns to address when approaching Long COVID as a disease entity and as a concept, which I originally submitted to NASEM. In the third part, I offer a critical appraisal of the NASEM definition, the most recent benchmark for Long COVID in the US. The review highlights the importance of broad, expansive and inclusive definitions for Long COVID, accounting for the disease’s heterogeneous, fluctuating and multi-system manifestations. Clinical case definitions for Long COVID must retain their focus on the broader spectrum and scope of the disease entity, while incorporating feedback from people with lived experience, advocates and patient-researchers. Full article

Intubated critically ill patients are susceptible to secretion accumulation because of compromised airway clearance. Various airway clearance interventions are employed to prevent complications arising from mucus retention. This Delphi study aims to collect global opinions in an international expert panel of ICU professionals on the usefulness of these various airway clearance interventions. A steering committee performed a literature search informing the formulation of statements. Statements are grouped into two distinct parts: (1) Humidification and Nebulization, and (2) Suctioning and Mucus mobilization techniques. For each part, a diverse panel of 30–40 experts will be selected, with concerted effort to involve experts from various medical specialties involved in airway clearance methods. Multiple choice questions (MCQs) or 7-point Likert-scale statements will be used in the iterative Delphi rounds to reach consensus on various airway clearance interventions. Rounds will continue until stability is achieved for all statements. Consensus will be deemed achieved when a choice in MCQs or a Likert-scale statement achieves ≥75% agreement or disagreement. Starting from the second round of the Delphi process, stability will be assessed using non-parametric χ² tests or Kruskal–Wallis tests. Stability will be defined by a p-value of ≥0.05. Full article

In the realm of educational assessment, the integration of artificial intelligence (AI) offers a promising pathway for the development of robust evaluations. This study explores the application of AI chatbots in crafting and validating examinations tailored to road geometric design, while adhering to the principles of Bloom’s Taxonomy. Utilizing Gemini AI Studio, three distinct exam versions were generated, covering eight crucial topics within road geometric design. A panel of expert chatbots, including Chat GPT 3.5, Claude 3, Sonet, Copilot, Perplexity, and You, assessed the validity of the exam content. These chatbots achieved scores of 9.17 or higher, establishing their proficiency as experts. Subsequent evaluations focused on relevance and wording, revealing high scores for both metrics, indicating the adequacy of the assessment tools. The two remaining versions were administered to student groups enrolled in the Road Construction II course at the Universidad Técnica Particular de Loja. Only 1.2% of students reached Bloom’s Taxonomy level 3, with many questions deemed easy, leading to varying trends in cognitive levels. Comparative analysis of student scores revealed significant discrepancies between a previous “classic” exam. While AI shows potential in crafting valid assessments aligned with Bloom’s Taxonomy, greater human involvement is necessary to ensure high-quality instrument generation. Full article

The strategic transformation of increasing data volumes into managerial decisions is critical for organisational performance and sustainability; yet, it faces hurdles like poor data quality, technological deficiencies, and skill gaps. This study investigates the causal interdependencies among key factors influencing data-driven decision-making within data-driven organisations. Utilising the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method, a robust structural and Multi-Attribute Decision-Making (MADM) technique, expert judgments from five management-level professionals were analysed to construct direct and total-relation matrices. The results classify Data Analytics Literacy (DAL) and Business-Strategy Alignment (BSA) as primary causal factors, while Data Quality (DQ), Data Infrastructure & Technology (DIT), and Data Culture & Governance (DCG) emerge as effect factors. These findings provide a structured framework for prioritising managerial interventions, suggesting that strengthening foundational elements (DAL and BSA) will significantly enhance analytical capabilities and strategic alignment. A limitation is the small, expert-based sample, indicating the potential for future validation with larger, more diverse panels or Fuzzy-DEMATEL applications. Full article

Folate receptor alpha (FRα) is a high-affinity folate transporter overexpressed in various epithelial malignancies, particularly high-grade serous ovarian carcinoma. Given its restricted expression in normal tissues and accessibility in tumors, FRα is an emerging therapeutic target. Immunohistochemistry (IHC) is the standard method for FRα assessment; however, interpretation is semi-quantitative and prone to interobserver variability. This study aimed to evaluate interobserver agreement among 12 pathologists in the IHC assessment of FRα in ovarian cancer, focusing on internal control adequacy, staining intensity, and the percentage of FRα-positive tumor cells. Thirty-seven high-grade serous ovarian carcinoma cases were stained using the VENTANA FOLR1 (FOLR1-2.1) RxDx Assay. A reference panel of four expert pathologists established consensus diagnoses. Twelve pathologists independently assessed the slides, recording internal control adequacy, staining intensity (positive vs. negative), and percentage of FRα-positive tumor cells. Interobserver agreement was measured using Fleiss’ kappa and intraclass correlation coefficient (ICC). Agreement on internal control adequacy was almost perfect (κ = 0.84). Substantial agreement was observed for staining intensity (κ = 0.76), while percentage estimation showed almost perfect concordance (ICC = 0.89). Discrepancies were primarily confined to borderline cases (65–85% positivity) and tumors with intermediate staining, reflecting interpretive challenges near clinical decision thresholds. Pathologists demonstrated high reproducibility in FRα IHC assessment, particularly in estimating percentage positivity and control adequacy. These findings support the clinical utility of FRα IHC but underscore the need for standardized scoring criteria and potential integration of digital tools to enhance consistency, especially in borderline cases. Full article

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

Background: Cognitive decline is a growing public health concern in Latin America, driven by rapid aging, widespread micronutrient inadequacies, and socioeconomic disparities. Despite the recognized importance of nutrition, many older adults struggle to meet daily dietary micronutrients requirements, increasing the risk of mild cognitive impairment (MCI). This study aimed to establish expert consensus on the role of Multivitamin and Mineral supplements (MVMs) in promoting cognitive healthy aging among older adults in Latin America. Methods: A panel of nine experts in geriatrics, neurology, and nutrition applied a modified Delphi methodology to generate consensus statements. The panel reviewed the literature, engaged in expert discussions, and used structured voting to develop consensus statements. Results: Consensus was reached on 14 statements. Experts agreed that cognitive aging in Latin America is influenced by neurobiological, lifestyle, and socioeconomic factors, including widespread micronutrient inadequacies (vitamins B-complex, C, D, E, and minerals such as zinc, magnesium, chromium, copper, iron and selenium), which were identified as critical for global cognitive function and brain structures, yet commonly inadequate in the elderly. While a balanced diet remains essential, MVMs can be recommended as a complementary strategy to bridge nutritional gaps. Supporting evidence, including the COSMOS-Mind trials, demonstrate that MVM use improves memory and global cognition, and reduces cognitive aging by up to 2 years in older adults. Conclusions: MVMs offer a promising, accessible adjunct for cognitive healthy aging in Latin America’s elderly population, particularly where dietary challenges persist. Region-specific guidelines, public health initiatives, and targeted research are warranted to optimize outcomes and reduce health inequities. Full article