DEFINE Physicians: An International Delphi Survey to Identify Consensus in the Care of Patients with FSGS or Idiopathic Nephrotic Syndrome
Bibliographic record
Abstract
Background: The extent to which real-world practice aligns with guidelines for management of focal segmental glomerulosclerosis (FSGS) and pediatric idiopathic nephrotic syndrome (INS) is unknown. The DEFINE: Physicians project sought to describe physicians' opinions on the pathophysiology and optimal management of FSGS/INS in real-world settings. Methods: DEFINE: Physicians was a 2-round Delphi survey that recruited nephrologists from North America and Europe. A total of 22 FSGS/INS statements were scored using a 1-9 Likert scale (9=strongly agree). Consensus was defined as median and mean score ≥7, and ≥75% of participants scoring agreement (ie, score 7-9). Statements not achieving high consensus (≥90% agreement) in Round 1 were revised and retested in Round 2. Results: This study involved 207 adult and pediatric nephrologists. Median clinical experience was 18 (range 5-49) years; 103 participants (50%) worked in nonacademic settings. In Round 1, 21 statements met consensus criteria and 7 statements not achieving high consensus were revised or divided into multiple parts, creating 11 revised statements for testing in Round 2. In Round 2, 9 of 11 statements met at least moderate consensus. Round 1 statements with high consensus described prognostic significance of proteinuria and disease management (Figure 1). Controversial statements retested in Round 2 pertained to distinction between primary and secondary FSGS in adults, and to management of frequently relapsing INS in children (Figure 2).Figure 1Figure 2Conclusions: The level of consensus in this Delphi survey was high for statements on treatment decisions and the importance of proteinuria control. The main area where high consensus was not reached pertained to differentiation between primary and secondary FSGS and managing frequently relapsing INS in children, suggesting that these areas require further research. Funding: Commercial Support - Travere Therapeutics, Inc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.079 | 0.069 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.008 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".