Consensus Recommendations for the Management of Androgenetic Alopecia in Egypt: A Modified Delphi Study

Male pattern androgenetic alopecia is a chronic, progressive condition with significant social and psychological impact. Few preliminary researches have been done on the role of low-level laser therapy as a treatment modality for male pattern hair loss. This is a randomized, controlled, single-observer blinded clinical trial conducted from November 2019 to October 2021 at the East Avenue Medical Center Dermatology Out-Patient Department on the use of low-level laser therapy and topical minoxidil for the treatment of androgenetic alopecia. Twenty-four male adults with Norwood Hamilton Hair Loss Scale of IIa to V were randomly assigned into 2 groups: a control group (monotherapy with topical minoxidil 5%) and a treatment group (678 nm helmet-type low-level laser therapy and topical minoxidil 5%). A statistically significant higher increase in hair density was observed in the treatment group (14.58 and 15.08 for the right and left sides, respectively) compared to the control (5.83 on the right and 5.50 on the left, respectively, p=.000 <.05). In addition, the investigator’s global photographic assessment and patient satisfaction were also significantly higher. Both treatments were well tolerated. The results of this study show that 678 nm helmet-type low-level laser therapy is an effective adjunctive treatment modality to topical minoxidil 5% solution for the treatment of male androgenetic alopecia.

Plantar fasciitis (PF) is a common cause of heel pain among the general population. The lack of standard practice guideline in Singapore presents challenges in education and clinical practice for this painful condition. These consensus statements and guideline were developed to streamline and improve the management of PF, covering key aspects such as diagnosis, investigations, risk factors, treatment modalities, monitoring and return to work/play. A multidisciplinary expert panel consisting of 6 sports physicians, 2 orthopaedic surgeons, 2 podiatrists and 1 physiotherapist from SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC) was convened based on their clinical and academic experience with PF. The Grading of Recommen-dations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of the evidence and subsequently prepare a set of clinical recommen-dations pertaining to the manage-ment of PF. A modified Delphi process was used to reach consensus. Eighteen consensus statements were developed to cover key components of PF management, from initial diagnosis to treatment modalities and finally, clinical progression. They were subsequently consolidated under a proposed treatment pathway guideline for PF. The SDSC consensus statements and guideline provide concise recommendations for the management of PF in Singapore.

BackgroundThis consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies.MethodsWe conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level. We aimed to provide consensus statements for current developments and priorities for future developments.ResultsTwenty-five experts from a variety of fields with experience in acute pain management were invited to join a review panel, of whom 23 completed a modified Delphi survey of policies designed to improve the safety and quality of opioids prescribing for acute pain in the secondary care setting. Strong agreement, defined as consistent among> 75% of panellists, was observed for ten statements.ConclusionsUsing a modified Delphi study, we found agreement among a multidisciplinary panel, including patient representation, on prioritisation of policies for system-level interventions, to improve governance, pain management, patient/consumers care, safety and engagement.

The Translational Science Benefit Model (TSBM) was developed to broadly capture systematic measures of health and societal benefits from scientific research, beyond traditional outcome measures. We aimed to develop a systematic process for the application of the TSBM and to then provide an example of a novel application of the TSBM to an ongoing Return-to-Learn (RTL) after youth concussion project involving partnerships with community stakeholders. We invited investigators, project advisory board, and participants of the RTL project to participate in a modified Delphi process. We first generated a list of potential translational benefits using the indicators of the TSBM as guideposts. We then prioritized the benefits on an adapted Eisenhower matrix. We invited 35 concussion care or research experts to participate, yielding 20 ranked translational benefits. Six of these recommendations were ranked high priority, six were regarded as investments, and eight were ranked as either low yield or low priority. This study found that activities such as education and training of stakeholders, development of policy and consensus statements, and innovation in dissemination, were perceived as higher priority than other activities. Our approach using a modified Delphi process and incorporating the TSBM can be replicated to generate and prioritize potential benefits to society from research studies.

Microneedle technology integrated with diverse therapeutic modalities for hair regrowth in alopecia

Graduating pediatric residents need practical knowledge to recognize, provide initial management, and appropriately triage patients with childhood rheumatologic diseases (cRDs). The pediatric rheumatology workforce shortage and lack of focused American Board of Pediatrics rheumatology content specifications lead to challenges in the adequate education of trainees. The purpose of this study was to define essential knowledge areas in rheumatology for pediatric residents. A literature search was performed to identify resources pertinent to resident education in pediatric rheumatology. Results were used to inform items on a survey asking, "How important is it for graduating pediatric residents to demonstrate competency in each of these rheumatology-related activities?" Stakeholders in rheumatology-related pediatric resident education were invited to participate in a modified Delphi process. Subsequent surveys were created iteratively based on their responses. Twenty-one panelists from diverse geographic regions and specialties completed 2 rounds of surveys with a 100% completion rate. Analysis yielded 107 items: those rated by >70% of respondents as "Very Important" were categorized as Essential (n = 54, 47.7%), and those rated by >70% of respondents as either "Very Important" or "Somewhat Important" were categorized as Recommended (n = 55, 52.3%). Broad content specifications are insufficient to prepare graduating pediatric residents to address cRDs in practice. Given the pediatric rheumatology workforce shortage, access to an expanded, standardized list of critical rheumatology-related competencies is essential to better prepare graduating pediatric residents to evaluate patients with cRDs. These competencies should drive curriculum design to enhance pediatric resident education.

IntroductionIn the Kingdom of Saudi Arabia, there is a lack of up-to-date clinical guidelines on the treatment of early-stage or metastatic breast cancer (BC) that are relevant to local resource and financial constraints. Therefore, we aimed to develop consensus statements to provide practical guidance for general oncologists on BC management in the Kingdom that support fair and rational decision-making across institutions.MethodsA panel of medical oncologist experts from the Kingdom of Saudi Arabia was convened. Based on a pragmatic literature review, 35 statements were drafted by two of the participating oncologist experts (S. Alaklabi and M. Alzahrani) that focused on clinical scenarios with lacking/contradictory data while taking into account healthcare resource availability. A modified Delphi process was used (consensus threshold was ≥ 70%); the first round of voting was online and second-round voting was conducted in-person.ResultsTwenty-six panelists voted on each statement in Round 1 and 19 to 23 panelists (not all voted on every statement) voted in Round 2. Consensus was reached on 13 of 20 statements for early BC and on seven of 15 statements for metastatic BC (MBC). Statements on early BC defined the use of adjuvant cyclin-dependent kinase-4/6 inhibitors, neoadjuvant hormonal therapy duration (statements S6–7), and the management of triple-negative BC, where there is residual disease or pathologic complete response is not achieved after neoadjuvant chemoimmunotherapy. Statements on MBC defined the use of trastuzumab deruxtecan in patients with hormone receptor-positive human epidermal growth factor receptor 2 (HER2)-low disease or in patients with HER2+ MBC and brain metastases/leptomeningeal disease, and the use of sacituzumab govitecan in hormone receptor-positive/negative HER2-low MBC. Antibody–drug conjugate sequencing and oligoprogression were also covered.ConclusionThe consensus statements provide expert guidance for medical oncologists, and it is hoped these statements will help unify clinical practice across the Kingdom.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40487-025-00404-9.

Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

Panel stacking is a threat to consensus statement validity

Androgenic alopecia, also known as seborrheic alopecia, is the most common hair loss disorder in dermatology clinics, mainly characterized by hair follicle miniaturization and progressive hair loss. The etiology and pathogenesis of androgenic alopecia are not clear, but may be related to heredity and androgen metabolism. Currently, minoxidil and finasteride are the only two drugs approved by the U.S. Food and Drug Administration (FDA) for AGA treatment, other treatments include oral minoxidil, hair transplantation, low energy laser therapy (LLLT), platelet-rich plasma (PRP), Chinese medicine microneedles, and combination therapy. With the development of medicine and science, we have ushered in the era of biologics and targeted therapy. In recent years, a variety of signaling pathways for androgenic alopecia have been found, which may provide a basis for targeted therapy for androgenic alopecia.

Objectives This modified Delphi study of vascular interventional radiologists sought to achieve consensus statements on the optimal imaging strategy and definitions of important imaging diagnostic features in women with pelvic vein incompetence. Method The UK-based interventional radiologists with the experience of investigating and treating pelvic vein incompetence responded to up to three rounds of online questionnaires. Results Three consensus statements emerged from 27 responders: (1) catheter venography is the ‘gold standard’ investigation for the diagnosis of pelvic vein incompetence; (2) pelvic vein incompetence should be defined as ‘retrograde flow along the ovarian or internal iliac veins’; (3) pelvic varices should be defined as ‘tortuous, often dilated, vulval, adnexal, para-uterine veins arising from incompetent internal iliac or ovarian veins.’ Conclusion This study achieved consensus statements on imaging diagnosis in women with suspected pelvic vein incompetence. These can be used to minimise heterogeneity of research protocols, and represent baseline positions which can, themselves, be tested.

Continuous efforts have been made to optimise treatment approaches for renal cell carcinoma (RCC), including locally advanced (la)RCC and metastatic (m)RCC. To update their joint consensus statements on the management of la/mRCC, the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology convened a series of Delphi meetings. A panel of six urologists and eight clinical oncologists was formed, addressing five areas: (i) surgical and (neo)adjuvant treatment in laRCC; (ii) first-line management of clear cell mRCC; (iii) second- and later-line treatment of clear cell mRCC; (iv) management of mRCCs with sarcomatoid features or non-clear cell histology; and (v) management of oligometastatic RCC. Consensus statements were drafted based on an extensive literature review and panel discussions. A consensus statement was established only if ≥ 80% of the panellists selected 'accept completely' or 'accept with some reservation' from a five-point Likert scale through anonymous voting. A total of 42 consensus statements were accepted. Compared with the previous version, this set of consensus statements asserted the use of adjuvant therapy for laRCC and the use of immunotherapy-based combination therapy across different types of mRCC; multiple new areas were also added, including active surveillance in mRCC patients with very favourable prognosis, a novel therapeutic agent for mRCC (belzutifan), and the definitions and management of oligometastatic/oligoprogressive RCC. While several research gaps remain to be addressed, this set of consensus statements reflects contemporary approaches for la/mRCC management, offering practical references for clinicians in Hong Kong and the Asia-Pacific region.

[Translated article] Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Hair Disorders Group of the Spanish Academy of Dermatology and Venererology (AEDV)

To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration