Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

2020 ◽  
pp. 135245852095231 ◽  
Author(s):  
Agostino Riva ◽  
Valeria Barcella ◽  
Simone V Benatti ◽  
Marco Capobianco ◽  
Ruggero Capra ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Seasonal Influenza ◽  
Careful Consideration ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Disease Modifying Drugs ◽  
Risks And Benefits ◽  
Modified Delphi ◽  
Increased Risk ◽  
Evidence Based Decision Making

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

Developing a Fracture Risk Clinical Assessment Protocol for Long-Term Care: A Modified Delphi Consensus Process

2020 ◽  
Author(s):  
Caitlin McArthur ◽  
Loretta Hillier ◽  
George Ioannidis ◽  
Jonathan D. Adachi ◽  
Lora Giangregorio ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Clinical Assessment ◽  
Long Term Care ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Term Care ◽  
Assessment Protocol ◽  
Modified Delphi

scholarly journals Home therapy for inherited bleeding disorders in South Africa: Results of a modified Delphi consensus process

2019 ◽  
Vol 109 (9) ◽  
pp. 639
Author(s):  
J N Mahlangu ◽  
Y Naidoo ◽  
Y Goga ◽  
M Vaithlingum ◽  
J Joubert ◽  
...  
Keyword(s):  
South Africa ◽  
Bleeding Disorders ◽  
Home Therapy ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Modified Delphi

Disease-modifying drugs for multiple sclerosis and infection risk: a cohort study

2018 ◽  
Vol 89 (10) ◽  
pp. 1050-1056 ◽  
Author(s):  
José Maria Andreas Wijnands ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
John David Fisk ◽  
Charity Evans ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
First Generation ◽  
Second Generation ◽  
Population Based ◽  
Infection Risk ◽  
Disease Modifying Drugs ◽  
Drug Classes ◽  
Increased Risk ◽  
Disease Modifying ◽  
Status Index

ObjectiveLittle is known about disease-modifying treatments (DMTs) for multiple sclerosis (MS) and infection risk in clinical practice. We examined the association between DMTs and infection-related medical encounters.MethodsUsing population-based administrative data from British Columbia, Canada, we identified MS cases and followed them from their first demyelinating event (1996–2013) until emigration, death or study end (December 2013). Associations between DMT exposure (by DMT generation or class) and infection-related physician or hospital claims were assessed using recurrent time-to-events models, adjusted for age, sex, socioeconomic status, index year and comorbidity count. Results were reported as adjusted HRs (aHRs).ResultsOf 6793 MS cases, followed for 8.5 years (mean), 1716 (25.3%) were DMT exposed. Relative to no DMT, exposure to any first-generation DMT (beta-interferon or glatiramer acetate) was not associated with infection-related physician claims (aHR: 0.96; 95% CI 0.89 to 1.02), nor was exposure to these drug classes when assessed separately. Exposure to any second-generation DMT (oral DMT or natalizumab) was associated with an increased hazard of an infection-related physician claim (aHR: 1.47; 95% CI 1.16 to 1.85); when assessed individually, the association was significant for natalizumab (aHR: 1.59; 95% CI 1.19 to 2.11) but not the oral DMTs (aHR: 1.17; 95% CI 0.88 to 1.56). While no DMTs were associated with infection-related hospital claims, these hospitalisations were also uncommon.ConclusionExposure to first-generation DMTs was not associated with an altered infection risk. However, exposure to the second-generation DMTs was, with natalizumab associated with a 59% increased risk of an infection-related physician claim. Continued pharmacovigilance is warranted, including an investigation of the DMT-associated infection burden on patient outcomes.

Quality Indicators for Non-Small Cell Lung Cancer Operations With Use of a Modified Delphi Consensus Process

2014 ◽  
Vol 98 (1) ◽  
pp. 183-190 ◽  
Author(s):  
Gail Darling ◽  
Richard Malthaner ◽  
John Dickie ◽  
Leigh McKnight ◽  
Cindy Nhan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Quality Indicators ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Modified Delphi

scholarly journals Developing a Scoring Guide for the Appraisal of Guidelines for Research and Evaluation II Instrument in Korea: A Modified Delphi Consensus Process

2013 ◽  
Vol 28 (2) ◽  
pp. 190 ◽  
Author(s):  
You Kyoung Lee ◽  
Ein Soon Shin ◽  
Jae-Yong Shim ◽  
Kyung Joon Min ◽  
Jun-Mo Kim ◽  
...  
Keyword(s):  
Delphi Consensus ◽  
Consensus Process ◽  
Modified Delphi

Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

2015 ◽  
Vol 9 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Gabor D. Kelen ◽  
Lauren Sauer ◽  
Eben Clattenburg ◽  
Mithya Lewis-Newby ◽  
James Fackler
Keyword(s):  
Classification System ◽  
Early Discharge ◽  
Likert Scale ◽  
Risk Tolerance ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Surge Capacity ◽  
Hospital Capacity ◽  
Modified Delphi ◽  
Pediatric Inpatient

AbstractBackgroundCritically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of “reverse triage,” with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.MethodsWe conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.ResultsPanelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1–2%); 7% (5–10%), 18% (10–20%), 46% (20–65%), and 72% (50–90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).ConclusionsThe classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events. (Disaster Med Public Health Preparedness. 2015;9:283-290)

Depression in Multiple Sclerosis: A Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L. Paixão ◽  
M.J. Avelino
Keyword(s):  
Multiple Sclerosis ◽  
Side Effects ◽  
Interferon Β ◽  
Psychological Disturbance ◽  
Disease Modifying Drugs ◽  
Loss Of Self ◽  
Duration Of Illness ◽  
Increased Risk ◽  
Demyelinating Lesions

Introduction:Depression is the predominant psychological disturbance in Multiple Sclerosis (MS) with lifetime prevalence around 50% and annual prevalence of 20%. Depression is commoner during relapses and may exacerbate fatigue and cognitive dysfunction. The aetiology of depression is multifactorial and likely associated with psychological stress, focal demyelinating lesions and immune dysfunction. There is no correlation between age, gender, duration of illness and sex. Unlike it was believed for the treatment with interferon β, recent side effects data from clinical trials have failed to confirm that this medication is associated with an increased risk of depression in patients with MS. Treating depression improves quality of life and improves adherence to disease-modifying drugs. Treatment with pharmacotherapy is particularly challenging given the somatic symptoms overlap between MS and depression and the increased burden of their side effects.Aims:To demonstrate the relationship between depression and MS.Methods:We report a case of depression in a 32 year old woman with MS, treated twice with bolus of metilprednisolone, taking interferon β at present. Her psychopathological symptoms have been sadness, terminal insomnia, anorexia, fatigue, social isolation, anhedonia, increased worry, pessimism, loss of self-esteem and suicidal ideation (not structured). The pharmacotherapy used to treat the depression was firstly fluoxetine and lately venlafaxine.Results:There has been an improvement on the patient's symptoms related both to the depression and to the MS.Conclusions:This case demonstrates once more, the complex relationship between those two clinical entities.

Establishing gold standards for System-Level Measures: a modified Delphi consensus process

2018 ◽  
Vol 31 (3) ◽  
pp. 205-211
Author(s):  
Fiona Doolan-Noble ◽  
Stuart Barson ◽  
M Lyndon ◽  
F Cullinane ◽  
J Gray ◽  
...  
Keyword(s):  
System Level ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Modified Delphi ◽  
Gold Standards

scholarly journals Study of Optimal Perimetric Testing In Children (OPTIC): developing consensus and setting research priorities for perimetry in the management of children with glaucoma

Eye ◽  
2021 ◽  
Author(s):  
Dipesh E. Patel ◽  
Phillippa M. Cumberland ◽  
Bronwen C. Walters ◽  
Joseph Abbott ◽  
John Brookes ◽  
...  
Keyword(s):  
Visual Field ◽  
Research Priorities ◽  
Healthcare Setting ◽  
Evidence Based ◽  
Limited Evidence ◽  
Delphi Consensus ◽  
Test Quality ◽  
Consensus Process ◽  
Reliability Indices ◽  
Modified Delphi

Abstract Background Perimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research. Methods Experts were invited to participate in a modified Delphi consensus process. Panel selection was based on clinical experience of managing children with glaucoma and UK-based training to minimise diversity of view due to healthcare setting. Questionnaires were delivered electronically, and analysed to establish ‘agreement’. Divergence of opinions was investigated and resolved where possible through further iterations. Results 7/9 experts invited agreed to participate. Consensus (≥5/7 (71%) in agreement) was achieved for 21/26 (80.8%) items in 2 rounds, generating recommendations to start perimetry from approximately 7 years of age (IQR: 6.75–7.25), and use qualitative methods in conjunction with automated reliability indices to assess test quality. There was a lack of agreement about defining progressive visual field (VF) loss and methods for implementing perimetry longitudinally. Panel members highlighted the importance of informing decisions based upon individual circumstances—from gauging maturity/capability when selecting tests and interpreting outcomes, to accounting for specific clinical features (e.g. poor IOP control and/or suspected progressive VF loss) when making decisions about frequency of testing. Conclusions There is commonality of expert views in relation to implementing perimetry and interpreting test quality in the management of children with glaucoma. However, there remains a lack of agreement about defining progressive VF loss, and utilising perimetry over an individuals’ lifetime, highlighting the need for further research.

Guidance on COVID-19 Vaccination in Hidradenitis Suppurativa Patients: A Modified Delphi Consensus of Experts

2022 ◽  
pp. 1-4
Author(s):  
Jonathan W. Rick ◽  
Devea R. De ◽  
Terri Shih ◽  
Afsaneh Alavi ◽  
Joslyn S. Kirby ◽  
...  
Keyword(s):  
Hidradenitis Suppurativa ◽  
General Surgeon ◽  
Delphi Consensus ◽  
The Core ◽  
Modified Delphi ◽  
Increased Risk ◽  
The Us ◽  
Survey Results ◽  
Attending Physician ◽  
New Evidence

<b><i>Introduction:</i></b> Hidradenitis suppurativa (HS) patients may be at increased risk of COVID-19 infection and complications from their medications and comorbidities. There is a lack of expert consensus on recommendations for the COVID-19 vaccine for HS patients. Herein, we aim to provide expert-driven consensus recommendations regarding COVID-19 vaccinations in HS patients. <b><i>Methods:</i></b> A modified Delphi consensus survey developed by a core committee of 7 dermatologist HS experts consisting of 4 demographic questions and 12 practice statements was distributed to the US HS Foundation-sponsored provider listserv. Participants were attending physician HS experts. Survey results were to be reviewed by the core group and revised and resubmitted until consensus (≥70% agreement) was achieved. <b><i>Results:</i></b> Among the 33 survey participants, there were 30 (87%) dermatologists, 1 general surgeon, 1 plastic surgeon, and 1 rheumatologist. Consensus for all 12 statements on vaccine counseling and HS treatment counseling was achieved after the first round. <b><i>Discussion/Conclusion:</i></b> For now, this consensus can serve as a resource for clinicians discussing COVID-19 vaccination with their HS patients. These recommendations will need to be updated as new evidence on COVID-19 emerges.

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