METHODS: We invited 138 potentially eligible participants to take part in the Delphi survey from a representative spread of expertise and geography. We employed a Likert scale with comments for our 32-item proposal in round 1, and a dichotomous scale with comments for our 29-item proposal in round 2. Threshold for agreement was set at ≥ 80% for both rounds.
RESULTS: Forty-seven potentially eligible participants responded to our invitation, 38 completed the first round and 36 completed the second. N = 23 (72%) items achieved ≥ 80% in round 1, and 100% of items in round 2. Three items were dropped or merged following round 1. A third Delphi round was not required to obtain consensus.
CONCLUSIONS: This Delphi expert consensus proposes a 29-item checklist specific to the reporting of nutrition RCTs and will inform further development of guidance through forthcoming consensus meetings.
STUDY DESIGN AND SETTING: We used a descriptive qualitative study design. We employed purposive and snowball sampling techniques to recruit guideline developers from LMICs and World Health Organization offices to participate in online, semistructured interviews. Data were analysed using a thematic approach with NVivo 20 software. Ethics approval was granted by Monash University.
RESULTS: We interviewed 18 participants from LMICs (Colombia, India, Iran, Indonesia, Argentina, and Malaysia) and WHO offices (including headquarters, regional offices, and country offices). Two main themes emerged, along with six associated subthemes. The main themes were as follows: (1) People in LMICs want living guidelines and (2) Resource limitations and their implications for living guidelines in LMICs.
CONCLUSION: Our research identified that guideline developers in LMICs have a strong desire to both develop and use living guidelines, but are currently limited by important barriers. Initiatives to support development, adaptation, and use of living guidelines in LMICs may help overcome barriers and meet the need for living guidelines in LMICs. It is also essential to design strategies that overcome identified barriers to developing, adapting, and implementing living guidelines, such as a lack of resources, delays in updates, and limited accessibility.
PLAIN LANGUAGE SUMMARY: This study looked at how living (continuously updated) approaches can be used to develop, adapt, and use clinical guidelines in settings with limited resources, and explored the pros and cons of each. The findings revealed a strong need to develop and use living guidelines in low-resource settings despite challenges, such as resource scarcity, delays in updating, and limited access to these guidelines. Overall, the findings revealed that living guidelines were worthwhile in LMICs despite all of the related challenges.
METHODS: A systematic literature search was conducted across major databases, including PubMed, EMBASE, and the Cochrane Library, to identify relevant randomized controlled trials (RCTs) evaluating the efficacy and safety of ibrexafungerp in the treatment of VVC. Following rigorous methodology, data extraction, risk of bias assessment using Cochrane's RoB 2 tool, and meta-analysis were conducted.
RESULTS: Four RCTs were included in the analyses. The ibrexafungerp regimen utilized across the studies were 300 mg administered twice daily for one day. Meta-analysis revealed that ibrexafungerp was associated with significantly higher clinical cure rates compared to placebo in patients with VVC (pooled odds ratio (OR) 2.32; 95 % confidence interval (CI) 1.80 to 2.98). Complete symptom resolution was achieved in a greater proportion of participants receiving ibrexafungerp (pooled OR 2.76; 95 % CI 1.62 to 4.71). Analysis of treatment-emergent adverse events revealed a significant higher incidence of at least one treatment-emergent adverse event with ibrexafungerp compared to placebo (pooled OR 2.83; 95 % CI 2.06 to 3.88).
CONCLUSION: This study provides robust support for the efficacy of ibrexafungerp in the treatment of VVC. While the safety profile of ibrexafungerp appears favorable with mostly mild adverse events reported, decision-making in the clinical context should be guided by individual patient factors.
METHODS: A cross-sectional study involving 421 participants was conducted in Iraq from November 2023 to March 2024 across various cancer centers and oncology hospitals. A 41-item questionnaire covering eight domains-Risk Factors, Infections and Antibiotic Use, Mechanisms of Resistance, Impact on Drug Efficacy and Toxicity, Genetic Factors, Microbial Adaptation, Impact of Gut Microbiota, and Antimicrobial Stewardship-was developed. Content validity was evaluated by five experts. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to assess construct validity, while Item Response Theory (IRT) evaluated item performance. Reliability was measured using Cronbach's Alpha and Composite Reliability (CR).
KEY FINDINGS: The questionnaire showed strong content validity, with most items achieving a Content Validity Index (CVI) of ≥0.8. EFA identified eight factors, confirmed by CFA with acceptable model fit (CFI = 0.96, TLI = 0.95, RMSEA = 0.05). IRT indicated strong item discrimination and acceptable difficulty. Cronbach's Alpha was 0.88, with CR at 0.89.
CONCLUSION: This validated 41-item questionnaire provides a reliable tool for assessing oncologists' knowledge of bacterial resistance among cancer patients. It helps identify knowledge gaps and guide interventions to improve oncology practice outcomes.
METHODS: This was a retrospective study of children with CMT who had at least one pelvic radiograph between 2000 and 2020. Reimer's migration percentage, acetabular index and lateral center edge angle were used to identify hip dysplasia.
RESULTS: A total of 178 children were included with a median age of 6.4 (IQR 3.4-11.3) years at CMT diagnosis. First pelvic radiographs were performed at a median age of 8.0 (IQR 4.6-12.2) years and 64 (35.8%) had hip dysplasia, of which 20 normalized over time. Repeat radiographs were done in 96/178 children (53.9%), and six children with originally normal radiographs developed later radiographic hip dysplasia. At the time of last follow up, 50/178 children (28.1%) had hip dysplasia and 17/178 children (9.6%) required surgical intervention. The frequency of hip dysplasia in specific CMT subtypes was: 28/100 in CMT1A, 5/7 in Dejerine-Sottas disease, 3/10 in CMT2A, and 4/4 in TRPV4-related CMT.
INTERPRETATION: The prevalence of hip dysplasia in children with CMT in this cohort was estimated to be between 9.6% and 28.1%. Serial imaging is important to monitor outcomes into adulthood. Specific CMT subtypes were more likely to be associated with hip dysplasia.
METHODS: A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.
RESULTS: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.
CONCLUSION: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.
METHODS: MEDLINE and Embase (inception to 2023) were systematically searched for observational studies of adults with CKD conducted in Asia that reported the prevalence of anaemia or its treatment. Additional relevant unpublished data were obtained from national experts. Summary estimates of the prevalence of anaemia and its treatment were determined using a random-effects meta-analysis according to country and study-specific CKD inclusion criteria.
RESULTS: Eighty-six studies from 10 Asian countries reported data on 1 342 121 participants. The overall prevalence of anaemia in individuals with CKD was 42% (95% CI 33%-52%), with wide variation (12%-57% in studies including all CKD stages; 21%-96% in studies limited to individuals with kidney failure). Anaemia prevalence progressively increased with more advanced CKD (80% in Stage 5). Studies reporting data on anaemia treatment, particularly in early CKD, were limited. The prevalence of erythropoietin-stimulating agents (ESAs) and iron therapy was 40% (95% CI 24%-58%) and 21% (95% CI 14%-31%), respectively (ESA: 7%-29% in CKD, 63%-95% in kidney failure; iron: 6%-26% in CKD, 15%-88% in kidney failure).
CONCLUSION: Our findings indicate a significant, but widely varying, prevalence of anaemia and its treatment in people with CKD in Asia. Substantial variability in data availability and collection highlights the need for standardised reporting to facilitate the development of regionally relevant strategies for anaemia management in CKD.