{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:23:46Z","timestamp":1793283826532,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Cryptoglandular anal fistula is a disorder with an incidence of around 1 per 5,000 people per year in European countries. Many studies have been conducted to evaluate the effectiveness of interventions for anal fistula. However, there is considerable heterogeneity in the outcomes assessed and reported in these studies. This limits research quality and complicates evidence synthesis. A solution for heterogeneity in outcome reporting is the development of a Core Outcome Set (COS). This paper describes the protocol for the development of a European COS for Anal Fistula (AFCOS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The first step will be a systematic review of the literature to identify potential outcomes that may be included in the COS. Patient interviews will be conducted in The United Kingdom and The Netherlands to ensure that both clinician\u2010important and patient\u2010important outcomes are captured. The outcomes will be categorized using the COMET taxonomy and taken forward to a Delphi consensus exercise. In up to three web\u2010based Delphi surveys the outcomes will be prioritized by patients, clinicians (surgeons, gastroenterologists, and radiologists), and (clinical) researchers. The responses will be summarized and reported anonymously in subsequent round(s) facilitating convergence to a consensus opinion. The final COS will be decided during a face\u2010to\u2010face consensus meeting with patients, clinicians, and (clinical) researchers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This study protocol describes the development of a European COS for anal fistula to improve research quality, evidence synthesis, and patient care.<\/jats:p><\/jats:sec>","DOI":"10.1177\/2050640620907570","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T04:45:37Z","timestamp":1583815537000},"page":"220-226","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["The development of a cryptoglandular Anal Fistula Core Outcome Set (AFCOS): an international Delphi study protocol"],"prefix":"10.1002","volume":"8","author":[{"given":"A.J.H.M.","family":"Machielsen","sequence":"first","affiliation":[{"name":"Department of Surgery and Colorectal Surgery Maastricht University Medical Centre\u00fe Maastricht The Netherlands"},{"name":"Faculty of Health Medicine &amp; Life Sciences Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Robin Phillips Fistula Research Unit St Mark\u2019s Hospital London The United Kingdom"},{"name":"Department of Surgery and Cancer Imperial College London London The United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.L.","family":"Kimman","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment Maastricht University Medical Centre\u00fe Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Sahnan","sequence":"additional","affiliation":[{"name":"Robin Phillips Fistula Research Unit St Mark\u2019s Hospital London The United Kingdom"},{"name":"Department of Surgery and Cancer Imperial College London London The United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.O.","family":"Adegbola","sequence":"additional","affiliation":[{"name":"Robin Phillips Fistula Research Unit St Mark\u2019s Hospital London The United Kingdom"},{"name":"Department of Surgery and Cancer Imperial College London London The United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kleijnen","sequence":"additional","affiliation":[{"name":"Department of Family Practice Care and Public Health Research Institute Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.J.","family":"Vaizey","sequence":"additional","affiliation":[{"name":"Robin Phillips Fistula Research Unit St Mark\u2019s Hospital London The United Kingdom"},{"name":"Department of Surgery and Cancer Imperial College London London The United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Grossi","sequence":"additional","affiliation":[{"name":"4th Surgery Unit Treviso Hospital Treviso Italy"},{"name":"University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.J.","family":"Tozer","sequence":"additional","affiliation":[{"name":"Robin Phillips Fistula Research Unit St Mark\u2019s Hospital London The United Kingdom"},{"name":"Department of Surgery and Cancer Imperial College London London The United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.O.","family":"Breukink","sequence":"additional","affiliation":[{"name":"Department of Surgery and Colorectal Surgery Maastricht University Medical Centre\u00fe Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3]]},"reference":[{"issue":"5224","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1136\/bmj.1.5224.463","article-title":"Pathogenesis and treatment of fistula\u2010in\u2010ano","volume":"1","author":"Parks AG.","year":"1961","journal-title":"British Medical Journal"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-007-0334-7"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v7.i14.1795"},{"issue":"13","key":"e_1_2_14_5_1","first-page":"1857","article-title":"Natural history of anorectal sepsis","volume":"104","author":"Sahnan K","year":"2017","journal-title":"British Medical Journal"},{"issue":"28","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.3748\/wjg.v17.i28.3286","article-title":"Current management of cryptoglandular fistula\u2010in\u2010ano","volume":"17","author":"Bleier JIS","year":"2011","journal-title":"World Journal of Gastroenterology"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0035-1570392","article-title":"Management of complex anal fistulas","volume":"29","author":"Bubbers EJ","year":"2016","journal-title":"Clinics in Colon and Rectal Surgery"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000885"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c365"},{"key":"e_1_2_14_10_1","first-page":"Mr000035","article-title":"Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions","volume":"10","author":"Page MJ","year":"2014","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9876.00197"},{"key":"e_1_2_14_12_1","unstructured":"COMET: Core Outcome Measures in Effectiveness Trials. 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