One additional author (EJL) participated in the panel meeting but did not vote. Table 1 Panel Member Qualifications The consensus process was managed by a professional facilitator (David Kovick, JD, Consensus Building Institute, Cambridge, MA). Competing interests of all participants were disclosed prior to decision-making. One author (EJL) created an initial

“straw man” draft algorithm, which was distributed to all panelists. The draft algorithm identified key decision points in the treatment process, posed questions about best treatment practices, and served as a starting point for discussion. Initial modifications to the “straw man” were processed #selleckchem keyword# using a modified Inhibitors,research,lifescience,medical Delphi methodology, through which panelists provided substantive

feedback through the facilitator. The revised algorithm was presented to the panel in a 90-minute webinar, where facilitated discussion was used to identify initial areas of consensus and prioritize issues requiring further discussion. A second round of modified Delphi revisions was then completed. Final algorithm development took place Inhibitors,research,lifescience,medical during a 1.5-day in-person meeting held in Denver, Colorado, in May, 2010, which was governed by a structured consensus-building process. In resolving points of divergence among panel members, the panel relied upon published data (where available), supported by the collective experience of panel members. Consensus was defined as unanimous agreement of all panel members. After minor text revisions, the final algorithm was sent to panelists electronically for a conclusive vote. In order to provide the panel members with a complete Inhibitors,research,lifescience,medical literature base, research staff performed a structured literature search to identify articles relevant to the treatment of crotaline snakebite in the United States, using the search

strategy in Table Inhibitors,research,lifescience,medical ​Table2.2. Two researchers reviewed the titles and abstracts of all articles to identify those which might contain original data about (a) the management of crotaline snakebite with the current (ovine Fab) antivenom or (b) the management of crotaline snakebite without antivenom. In the event of disagreement, PD184352 (CI-1040) the article was pulled and reviewed. Full text copies of the 42 articles containing original data relevant to the key questions identified in preliminary panel deliberations were obtained and provided for panel members’ use during deliberations. Table 2 Search Strategy Recurrence of one or more venom effects (local pain and swelling and/or hematologic abnormalities such as coagulopathy and thrombocytopenia) following successful initial treatment with antivenom is a known problem in the management of venomous snakebite. Early issue identification revealed that prevention and treatment of these recurrence phenomena was a topic with some disagreement. Four data sources were utilized to inform the panel discussion of this issue.