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      Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

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          Abstract

          Purpose

          In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon.

          Methods

          To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society’s Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists’ agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated.

          Results

          Strong consensus (≥ 80% of panelists rating their agreement as 6–7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5–7 on the Likert-type scale), consensus was achieved for 88% (31/35) items.

          Conclusions

          We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing’s disease, represent areas where further research is needed.

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          Most cited references 37

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          Acromegaly: an endocrine society clinical practice guideline.

          The aim was to formulate clinical practice guidelines for acromegaly.
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            Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline.

            The objective is to formulate clinical practice guidelines for treating Cushing's syndrome.
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              Research guidelines for the Delphi survey technique.

              Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.
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                Author and article information

                Contributors
                ntritos@mgh.harvard.edu
                pkfazeli@pitt.edu
                a.mccormack@garvan.org.au
                smalleagil@gmail.com
                mercepin@gmail.com
                mirjam.christ-crain@unibas.ch
                frara.stefano@hsr.it
                labadzha@gmail.com
                aioachi@emory.edu
                i_shimon@netvisin.net.il
                takahash@naramed-u.ac.jp
                mg299@medschl.cam.ac.uk
                fleseriu@ohsu.edu
                Journal
                Pituitary
                Pituitary
                Pituitary
                Springer US (New York )
                1386-341X
                1573-7403
                20 July 2021
                20 July 2021
                : 1-10
                Affiliations
                [1 ]GRID grid.38142.3c, ISNI 000000041936754X, Massachusetts General Hospital/Harvard Medical School, ; Boston, MA USA
                [2 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, University of Pittsburgh School of Medicine, ; Pittsburgh, PA USA
                [3 ]GRID grid.415306.5, ISNI 0000 0000 9983 6924, Garvan Institute of Medical Research, ; Darlinghurst, Australia
                [4 ]Hospital Militar Central, Buenos Aires, Argentina
                [5 ]GRID grid.11630.35, ISNI 0000000121657640, Hospital de Clinicas, Facultad de Medicina, , Universidad de la Republica, ; Montevideo, Uruguay
                [6 ]GRID grid.410567.1, University Hospital Basel, ; Basel, Switzerland
                [7 ]GRID grid.15496.3f, Università Vita-Salute San Raffaele, ; Milano, Italy
                [8 ]GRID grid.50956.3f, ISNI 0000 0001 2152 9905, Cedars-Sinai Medical Center, ; Los Angeles, CA USA
                [9 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Emory University School of Medicine, ; Atlanta, GA USA
                [10 ]GRID grid.413156.4, ISNI 0000 0004 0575 344X, Rabin Medical Center, ; Petah Tikva, Israel
                [11 ]GRID grid.410814.8, ISNI 0000 0004 0372 782X, Nara Medical University, ; Nara, Japan
                [12 ]GRID grid.120073.7, ISNI 0000 0004 0622 5016, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, , Addenbrooke’s Hospital, ; Box 289, Cambridge, CB2 0QQ UK
                [13 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Oregon Health & Science University, ; Portland, OR USA
                Article
                1170
                10.1007/s11102-021-01170-3
                8294287
                34283370
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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