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Gauvreau CL, Schreyer L, Gibson PJ, Koo A, Ungar WJ, Regier D, Chan K, Hayeems R, Gibson J, Palmer A, Peacock S, Denburg AE. Development of a Value Assessment Framework for Pediatric Health Technologies Using Multicriteria Decision Analysis: Expanding the Value Lens for Funding Decision Making. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:879-888. [PMID: 38548179 DOI: 10.1016/j.jval.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES A health technology assessment (HTA) does not systematically account for the circumstances and needs of children and youth. To supplement HTA processes, we aimed to develop a child-tailored value assessment framework using a multicriteria decision analysis approach. METHODS We constructed a multicriteria-decision-analysis-based model in multiple phases to create the Comprehensive Assessment of Technologies for Child Health (CATCH) framework. Using a modified Delphi process with stakeholders having broad disciplinary and geographic variation (N = 23), we refined previously generated criteria and developed rank-based weights. We established a criterion-pertinent scoring rubric for assessing incremental benefits of new drugs. Three clinicians independently assessed comprehension by pilotscoring 9 drugs. We then validated CATCH for 2 childhood cancer therapies through structured deliberation with an expert panel (N = 10), obtaining individual scores, consensus scores, and verbal feedback. Analyses included descriptive statistics, thematic analysis, exploratory disagreement indices, and sensitivity analysis. RESULTS The modified Delphi process yielded 10 criteria, based on absolute importance/relevance and agreed importance (median disagreement indices = 0.34): Effectiveness, Child-specific Health-related Quality of Life, Disease Severity, Unmet Need, Therapeutic Safety, Equity, Family Impacts, Life-course Development, Rarity, and Fair Share of Life. Pilot scoring resulted in adjusted criteria definitions and more precise score-scaling guidelines. Validation panelists endorsed the framework's key modifiers of value. Modes of their individual prescores aligned closely with deliberative consensus scores. CONCLUSIONS We iteratively developed a value assessment framework that captures dimensions of child-specific health and nonhealth gains. CATCH could improve the richness and relevance of HTA decision making for children in Canada and comparable health systems.
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Affiliation(s)
- Cindy L Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada
| | - Leighton Schreyer
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul J Gibson
- McMaster Children's Hospital, Hamilton, ON, Canada; Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Alicia Koo
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dean Regier
- BC Cancer Research Institute, Vancouver, BC, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robin Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Antonia Palmer
- Ac4orn: Advocacy for Canadian Childhood Cancer Research Network, Toronto, ON, Canada
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Avram E Denburg
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Nguyen TA, Brito JP, Singh Ospina N. Defining inappropriate thyroid biopsy?-Proposed definition based on clinical evidence and stakeholder engagement. Endocrine 2024; 85:146-151. [PMID: 38407695 PMCID: PMC11246802 DOI: 10.1007/s12020-024-03727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Identify factors that can be used to assess the appropriateness of a thyroid biopsy and propose a pathway to define inappropriate thyroid biopsies in practice. METHODS We identified factors utilized in clinical guidelines and existing literature to determine the clinical indications for a thyroid biopsy. Subsequently, we assembled a multidisciplinary panel of experts, including patients, clinicians, researchers, and quality experts, to integrate these factors and develop a pathway for assessing the appropriateness of thyroid biopsies. RESULTS Through literature review and stakeholder engagement, we identified multiple factors to determine if a thyroid biopsy is necessary: ultrasound risk assessment, presence of compressive symptoms and/or clinical suspicion of high-risk thyroid cancer, life expectancy, comorbidity burden, surgical risk, personal risk factors for thyroid cancer, thyroid function levels, local resources and medical expertise and patient values and preferences. We proposed a multiple-tier classification for the appropriateness of thyroid biopsy that begins with ultrasound findings (e.g., size, thyroid cancer risk) and encompasses the evaluation of additional patient-specific factors. CONCLUSION Assessment of the appropriateness of a thyroid biopsy is possible. Although, thyroid nodule ultrasound risk assessment is a pivotal factor for this assessment, additional factors should be considered (e.g., life expectancy, personal risk factors for thyroid cancer, patient preferences). Yet, additional efforts are needed to operationalize the objective implementation of these factors in clinical practice.
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Affiliation(s)
- Thao A Nguyen
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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Kellams A, Kair L, Broomfield-Massey K, Harper KD, Bugg K, Stuebe A. Setting the Agenda for Patient-Centered Research in Infant and Young-Child Feeding: Results from the Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere. Breastfeed Med 2024. [PMID: 38938202 DOI: 10.1089/bfm.2023.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Background: Breastfeeding is critically important for optimal health of both birthing people and their infants. Shared, patient-centered goals of how health care team members, community groups, and families can help facilitate breastfeeding success are needed, as are ways to define and measure what breastfeeding success looks like from the patient's perspective. Methods: The Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere's collaborated in a multi-methods approach to identify breastfeeding priorities most important to parents. Results: We identified (1) Key components of a successful breastfeeding journey defined by parents and families, (2) Research priorities that will enable families to achieve breastfeeding. Conclusion: Dissemination of these findings can foster research efforts that are codesigned with birthing parents and families and reflect their priorities.
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Affiliation(s)
- Ann Kellams
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Laura Kair
- Department of Pediatrics, University of California Davis of medicine, Sacramento, California, USA
| | | | - Kimberly D Harper
- Collaborative for Maternal and Infant Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kimarie Bugg
- Reaching Our Sisters Everywhere (ROSE), Lithonia, Georgia, USA
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
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Perez-Beltran M, Roldán-Merino J, Russi ME, Rolandi MG, Colome Roura R, Sampaio F, Del Campo MD, Farres-Tarafa M, Pardos BH, Alda Díez JÁ. The Development and Content Validation of a Clinical Screening Scale to Identify Attention-Deficit Hyperactivity Disorder Cases Based on the Gender Perspective: An e-Delphi Study. Healthcare (Basel) 2024; 12:1282. [PMID: 38998817 PMCID: PMC11241727 DOI: 10.3390/healthcare12131282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD. OBJECTIVE The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD. METHODS The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content. RESULTS A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls. CONCLUSIONS To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.
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Affiliation(s)
- Meritxell Perez-Beltran
- School of Nursing, Campus Sant Joan de Déu de Barcelona-Fundació Privada, Calle Sant Benito Menni 18-20, Sant Boi de Llobregat, 08830 Barcelona, Spain
- Facultat de Psicología, University of Barcelona, Pg. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
- Neuropsychologist at Avan Neurology Center, Carrer Estrella, 10, Sabadell, 08201 Barcelona, Spain
| | - Juan Roldán-Merino
- School of Nursing, Campus Sant Joan de Déu de Barcelona-Fundació Privada, Calle Sant Benito Menni 18-20, Sant Boi de Llobregat, 08830 Barcelona, Spain
- Mental Health, Psychosocial and Complex Nursing Care Research Group (NURSEARCH), University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Maria Eugenia Russi
- Neuropediatrician in the Pediatric Neurology Service, Sant Joan de Déu Hospital, Pg. de Sant Joan de Déu, 2, 08950 Barcelona, Spain
| | - Maria Garau Rolandi
- Neurology Service and in the Learning Disorders Unit (UTAE), Sant Joan de Deu Hospital, 08950 Barcelona, Spain
- Psychology and Neurotherapy Centers, Carrer de Gresolet, 14, Sarrià-Sant Gervasi, 08034 Barcelona, Spain
| | - Roser Colome Roura
- Neurology Service and in the Learning Disorders Unit (UTAE), Sant Joan de Deu Hospital, 08950 Barcelona, Spain
| | - Francisco Sampaio
- Nursing School of Porto, Rua Dr. António Bernardino de Almeida, 830, 844, 856, 4200-072 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Marta Domínguez Del Campo
- Parc Sanitari Sant Joan de Déu-Research Center, Carrer del Camí Vell de la Colònia, 25, 08830 Barcelona, Spain
| | - Mariona Farres-Tarafa
- School of Nursing, Campus Sant Joan de Déu de Barcelona-Fundació Privada, Calle Sant Benito Menni 18-20, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Barbara Hurtado Pardos
- School of Nursing, Campus Sant Joan de Déu de Barcelona-Fundació Privada, Calle Sant Benito Menni 18-20, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - José Ángel Alda Díez
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Pg. de Sant Joan de Déu, 2, 08950 Barcelona, Spain
- Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 08830 Esplugues de Llobregat, Spain
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Tan WY, Nagabhyrava S, Ang-Olson O, Das P, Ladel L, Sailo B, He L, Sharma A, Ahuja N. Translation of Epigenetics in Cell-Free DNA Liquid Biopsy Technology and Precision Oncology. Curr Issues Mol Biol 2024; 46:6533-6565. [PMID: 39057032 PMCID: PMC11276574 DOI: 10.3390/cimb46070390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
Technological advancements in cell-free DNA (cfDNA) liquid biopsy have triggered exponential growth in numerous clinical applications. While cfDNA-based liquid biopsy has made significant strides in personalizing cancer treatment, the exploration and translation of epigenetics in liquid biopsy to clinical practice is still nascent. This comprehensive review seeks to provide a broad yet in-depth narrative of the present status of epigenetics in cfDNA liquid biopsy and its associated challenges. It highlights the potential of epigenetics in cfDNA liquid biopsy technologies with the hopes of enhancing its clinical translation. The momentum of cfDNA liquid biopsy technologies in recent years has propelled epigenetics to the forefront of molecular biology. We have only begun to reveal the true potential of epigenetics in both our understanding of disease and leveraging epigenetics in the diagnostic and therapeutic domains. Recent clinical applications of epigenetics-based cfDNA liquid biopsy revolve around DNA methylation in screening and early cancer detection, leading to the development of multi-cancer early detection tests and the capability to pinpoint tissues of origin. The clinical application of epigenetics in cfDNA liquid biopsy in minimal residual disease, monitoring, and surveillance are at their initial stages. A notable advancement in fragmentation patterns analysis has created a new avenue for epigenetic biomarkers. However, the widespread application of cfDNA liquid biopsy has many challenges, including biomarker sensitivity, specificity, logistics including infrastructure and personnel, data processing, handling, results interpretation, accessibility, and cost effectiveness. Exploring and translating epigenetics in cfDNA liquid biopsy technology can transform our understanding and perception of cancer prevention and management. cfDNA liquid biopsy has great potential in precision oncology to revolutionize conventional ways of early cancer detection, monitoring residual disease, treatment response, surveillance, and drug development. Adapting the implementation of liquid biopsy workflow to the local policy worldwide and developing point-of-care testing holds great potential to overcome global cancer disparity and improve cancer outcomes.
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Affiliation(s)
- Wan Ying Tan
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
- Department of Internal Medicine, Norwalk Hospital, Norwalk, CT 06850, USA
- Hematology & Oncology, Neag Comprehensive Cancer Center, UConn Health, Farmington, CT 06030, USA
| | | | - Olivia Ang-Olson
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
| | - Paromita Das
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
| | - Luisa Ladel
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
- Department of Internal Medicine, Norwalk Hospital, Norwalk, CT 06850, USA
| | - Bethsebie Sailo
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
| | - Linda He
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
| | - Anup Sharma
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8000, USA; (W.Y.T.); (P.D.); (L.L.); (B.S.); (L.H.)
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520-8000, USA
- Biological and Biomedical Sciences Program (BBS), Yale University, New Haven, CT 06520-8084, USA
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Santos PAFD, Rabiais ICM, Frade JM, Coutinho VRD, Baptista RCN. General nurse competencies in disaster: A delphi study. Nurse Educ Pract 2024; 79:104037. [PMID: 38968822 DOI: 10.1016/j.nepr.2024.104037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/08/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
AIM The aim of this study is to understand the significance of a disaster-related competence framework for Portuguese general nurses and identify from ICN - Core Competencies in Disaster Nursing version 2.0 core competencies description, those that are considered crucial for a competent preparedness and response in disaster scenarios. BACKGROUND Research suggests that the occurrence of disasters will be more recurrent, requiring that nurses, pillars of any health system, have knowledge, skills and preparedness to face these events. DESIGN An exploratory, cross-sectional qualitative study was carried out. Delphi method was used for data collection. METHODS The study group consisted of technical-scientific council's presidents or coordinators/directors of nursing courses, nurses integrated in the Portuguese Council of Nurses and National Nursing Specialty Colleges and nurses with experience in the field of disasters. RESULTS Findings revealed that there is consensus on sixteen competencies, considered relevant for developing general nurse knowledge and competence, both at a national or international level, in the field of disasters. CONCLUSIONS The development of these competencies which establishes practice standards, building nurses skills and knowledge and ultimately, influencing nursing level-entry curricula's, conferring professional autonomy and self-regulation, in the field of disaster are fundamental. Furthermore, this study may serve as a reference for future alignment of competency frameworks between European Union countries or others.
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Karam SG, Zhang Y, Pardo-Hernandez H, Siebert U, Koopman L, Noyes J, Tarride JE, Stevens AL, Welch V, Saz-Parkinson Z, Ens B, Devji T, Xie F, Hazlewood G, Mbuagbaw L, Alonso-Coello P, Brozek JL, Schünemann HJ. ROBVALU: a tool for assessing risk of bias in studies about people's values, utilities, or importance of health outcomes. BMJ 2024; 385:e079890. [PMID: 38866410 PMCID: PMC11167527 DOI: 10.1136/bmj-2024-079890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Samer G Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science and Departments of Epidemiology and Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Koopman
- Department of Specialist Medical Care, National Health Care Institute, Diemen, Netherlands
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Wales, UK
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
- Programs for Assessment of Technologies in Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Adrienne L Stevens
- Centre for Immunisation Programmes, Public Health Agency of Canada, ON, Canada
| | - Vivian Welch
- Bruyère Research Institute and, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Brendalynn Ens
- Implementation Support and Knowledge Mobilisation, Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Tahira Devji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí, Barcelona, Spain
| | - Jan L Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Centre (CERC), Humanitas Universityand Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Mistry A, Leslie A, Ojha S, Sharkey D. Identifying neonatal transport research priorities: a modified Delphi consensus. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327213. [PMID: 38857987 DOI: 10.1136/archdischild-2024-327213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES With increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport research questions as prioritised by parents and healthcare professionals (HCPs). DESIGN Key stakeholders participated in a modified three-stage Delphi consensus process. Research questions were identified and submitted through two survey stages before the final priority setting workshop. PARTICIPANTS Parents of babies who received neonatal care, neonatal HCPs and stakeholders. OUTCOME Identify the top 10 research priorities for neonatal transport. RESULTS Overall, 269 survey responses from HCPs/stakeholders (n=161) and parents (n=108) were analysed from two survey rounds. Consensus was reached on 22 of 43 research priorities for the final priority setting workshop. The agreed top research priorities covered the domains of: (1) Pain assessment and management, (2) Long-term neurological outcomes, (3) Impact of transfer on birth-related brain injury, (4) Investigating risk of transport, (5) Safety restraints for infants, (6) Optimal temperature management, (7) Respiratory management and outcomes, (8) Benchmarking of important of transport measures, (9) Understanding transport environmental exposures, (10) Mental health and burden of transfer on families. CONCLUSION We have identified the top research questions for neonatal transport through an extensive process actively engaging parents, HCPs and key stakeholders. Targeted funding and research resources, directed towards addressing these prioritised research areas, will inform evidence-based practices and international frameworks specific to neonatal transport, helping minimise research waste and ultimately improve outcomes for these high-risk infants and their families.
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Affiliation(s)
- Aarti Mistry
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Leslie
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
- UK-Neonatal Transport Research Collaborative (UK-NTRC), UK-Neonatal Transport Group, Nottingham, UK
| | - Shalini Ojha
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
- UK-Neonatal Transport Research Collaborative (UK-NTRC), UK-Neonatal Transport Group, Nottingham, UK
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Leston M, Ordóñez-Mena J, Joy M, de Lusignan S, Hobbs R, McInnes I, Lee L. Defining and Risk-Stratifying Immunosuppression (the DESTINIES Study): Protocol for an Electronic Delphi Study. JMIR Res Protoc 2024; 13:e56271. [PMID: 38842925 PMCID: PMC11190617 DOI: 10.2196/56271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts-which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients. OBJECTIVE We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for "adult immunosuppression." METHODS Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses. RESULTS This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024. CONCLUSIONS This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record-compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56271.
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Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - José Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Iain McInnes
- Wolfson Medical School Building, University of Glasgow, Glasgow, United Kingdom
| | - Lennard Lee
- Department of Oncology, University of Oxford, Oxford, United Kingdom
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Taher R, Bhanushali P, Allan S, Alvarez-Jimenez M, Bolton H, Dennison L, Wallace BE, Hadjistavropoulos HD, Hall CL, Hardy A, Henry AL, Lane S, Maguire T, Moreton A, Moukhtarian TR, Vallejos EP, Shergill S, Stahl D, Thew GR, Timulak L, van den Berg D, Viganò N, Stock BW, Young KS, Yiend J. Bridging the gap from medical to psychological safety assessment: consensus study in a digital mental health context. BJPsych Open 2024; 10:e126. [PMID: 38828683 DOI: 10.1192/bjo.2024.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Digital Mental Health Interventions (DMHIs) that meet the definition of a medical device are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. The MHRA uses procedures that were originally developed for pharmaceuticals to assess the safety of DMHIs. There is recognition that this may not be ideal, as is evident by an ongoing consultation for reform led by the MHRA and the National Institute for Health and Care Excellence. AIMS The aim of this study was to generate an experts' consensus on how the medical regulatory method used for assessing safety could best be adapted for DMHIs. METHOD An online Delphi study containing three rounds was conducted with an international panel of 20 experts with experience/knowledge in the field of UK digital mental health. RESULTS Sixty-four items were generated, of which 41 achieved consensus (64%). Consensus emerged around ten recommendations, falling into five main themes: Enhancing the quality of adverse events data in DMHIs; Re-defining serious adverse events for DMHIs; Reassessing short-term symptom deterioration in psychological interventions as a therapeutic risk; Maximising the benefit of the Yellow Card Scheme; and Developing a harmonised approach for assessing the safety of psychological interventions in general. CONCLUSION The implementation of the recommendations provided by this consensus could improve the assessment of safety of DMHIs, making them more effective in detecting and mitigating risk.
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Affiliation(s)
- Rayan Taher
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Palak Bhanushali
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Australia
- Orygen, Parkville, Australia
| | | | | | | | | | - Charlotte L Hall
- NIHR MindTech-MedTech Co-operative, NIHR Nottingham Biomedical Research Centre, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Amy Hardy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Sam Lane
- SilverCloud by Amwell, Boston, USA
| | - Tess Maguire
- School of Psychology, University of Southampton, UK
| | | | - Talar R Moukhtarian
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, UK
| | - Elvira Perez Vallejos
- NIHR MindTech-MedTech Co-operative, NIHR Nottingham Biomedical Research Centre, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Kent and Medway Medical School, Canterbury, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Graham R Thew
- Department of Experimental Psychology, University of Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, Netherlands
| | | | - Ben Wensley Stock
- University of Oxford Medical Sciences Division, University of Oxford, UK
| | - Katherine S Young
- SilverCloud by Amwell, Boston, USA
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Schönenberger N, Blanc AL, Hug BL, Haschke M, Goetschi AN, Wernli U, Meyer-Massetti C. Developing indicators for medication-related readmissions based on a Delphi consensus study. Res Social Adm Pharm 2024; 20:92-101. [PMID: 38433064 DOI: 10.1016/j.sapharm.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication-related readmissions challenge healthcare systems by burdening patients, increasing costs and straining resources. However, to date, there has been no consensus study on indicators for medication-related readmissions. OBJECTIVES This Delphi study aimed to develop a consensus-based set of indicators for detecting patients at risk of medication-related readmission. METHODS An expert panel of clinical pharmacists, physicians and nursing experts participated in a two-round Delphi study. In round 1, 31 indicators taken from the literature were rated for relevance on a scale from 1 to 9, with a median rating of 7 or higher suggesting relevance. The RAND/UCLA method was used to determine consensus. In round 2, indicators lacking consensus were re-rated together with a series of new indicators generated by the experts. Additional details were sought for some indicators. The main outcomes were the relevance of, consensus on, and completeness of the proposed indicators for identifying risks of 30-day medication-related readmission. RESULTS Thirty-eight experts participated in round 1. Consensus was found for all the indicators, with 25 included and 6 excluded. Thirty-four experts participated in round 2. Consensus was found for all 5 newly suggested indicators, and 4 were included. The expert panel prioritized the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (≥7 medications), (3) low rates of medication adherence (twice-weekly mistakes or missing administration), (4) complex medication regimens (≥3 doses, ≥2 dosage forms and ≥2 administration routes per day), and (5) multimorbidity (≥3 chronic conditions). The final set comprised 29 indicators. CONCLUSIONS The indicator set developed for flagging potential medication-related readmissions could guide priorities for clinical pharmacy services at hospital discharge, improving patient outcomes and resource use. A validation study of these indicators is planned.
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Affiliation(s)
- Nicole Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, 1847, Rennaz, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1205, Geneva, Switzerland
| | - Balthasar L Hug
- Department of Internal Medicine, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland; University of Lucerne, Faculty of Health Sciences and Medicine, 6005, Lucerne, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Aljoscha N Goetschi
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Ursina Wernli
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Institute of Primary Healthcare (BIHAM), University of Bern, 3012, Bern, Switzerland
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Greenfield K, Schoth DE, Hain R, Bailey S, Mott C, Rajapakse D, Harrop E, Renton K, Anderson AK, Carter B, Johnson M, Liossi C. A rapid systematic review of breakthrough pain definitions and descriptions. Br J Pain 2024; 18:215-226. [PMID: 38751563 PMCID: PMC11092936 DOI: 10.1177/20494637231208093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. Objective This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. Design This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). Data sources CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. Results We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients (n = 30), clinicians (n = 6), and experts (n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Conclusions Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.
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Affiliation(s)
| | - Daniel E Schoth
- School of Psychology, University of Southampton, Highfield, UK
| | - Richard Hain
- Paediatric Palliative Medicine, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | - Simon Bailey
- Sir James Spence Institute,Royal Victoria Infirmary, Newcastle upon Tyne,UK
| | - Christine Mott
- Acorns Children’s Hospice, Birmingham,UK
- Birmingham Children’s Hospital, Birmingham,UK
| | - Dilini Rajapakse
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, UK
- Oxford University Hospitals NHS Trust,John Radcliffe Hospital, Oxford, UK
| | - Kate Renton
- University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, UK
- Naomi House & Jacksplace, Winchester, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine,Edge Hill University, Ormskirk, UK
| | | | - Christina Liossi
- School of Psychology, University of Southampton, Highfield, UK
- Psychological Services Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Rashid R, Sohrabi C, Kerwan A, Franchi T, Mathew G, Nicola M, Agha RA. The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery. Int J Surg 2024; 110:3151-3165. [PMID: 38445501 PMCID: PMC11175759 DOI: 10.1097/js9.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION First released in 2017, the STROCSS guidelines have become integral for promoting high-quality reporting of observational research in surgery. However, regular updates are essential to ensure they remain relevant and of value to surgeons. Building on the 2021 updates, the authors have developed the STROCSS 2024 guidelines. This timely revision aims to address residual reporting gaps, assimilate recent advances, and further strengthen observational study quality across all surgical disciplines. METHODS A core steering committee compiled proposed changes to update the STROCSS 2021 guidelines based on identified gaps in prior iterations. An expert panel of surgical research leaders then evaluated the proposed changes for inclusion. A Delphi consensus exercise was used. Proposals that scored between 7-9 on a nine-point Likert agreement scale, by ≥70% of Delphi participants, were integrated into the STROCSS 2024 checklist. RESULTS In total, 46 of 56 invited participants (82%) completed the Delphi survey and hence participated in the development of STROCSS 2024. All suggested amendments met the criteria for inclusion, indicating a high level of agreement among the Delphi group. All proposed items were therefore integrated into the final revised checklist. CONCLUSION The authors present the updated STROCSS 2024 guidelines, which have been developed through expert consensus to further enhance the transparency and reporting quality of observational research in surgery.
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Affiliation(s)
| | | | | | - Thomas Franchi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Maria Nicola
- Imperial College Healthcare NHS Trust, London, UK
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Gurland BH, Olson CH, McCarthy MS, Bordeianou LG. Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus. Dis Colon Rectum 2024; 67:841-849. [PMID: 38231033 DOI: 10.1097/dcr.0000000000003187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND There is wide variation in prolapse care. OBJECTIVE To determine core descriptor sets for rectal prolapse to enhance outcomes research. DESIGN Descriptors for patients undergoing rectal prolapse surgery were generated through a systematic review and expert opinion. Stakeholders were recruited internationally via listserv and social media. Experts were encouraged to consider the minimum descriptors that could be considered during clinical care, and descriptors were grouped into core descriptor sets. Consensus was defined as greater than 70% agreement. SETTING A 3-round Delphi process using a 9-point Likert scale based on expert results was distributed via survey. The final interactive meeting used a polling platform. PARTICIPANTS The Pelvic Floor Disorders Consortium interdisciplinary group convened to advance the clinical care of pelvic floor disorders. MAIN OUTCOME MEASURES To achieve expert consensus for core descriptor sets for rectal prolapse using a modified Delphi method. RESULTS A total of 206 providers participated, with survey response rates of 82% and 88%, respectively. Responders were from North America (56%), Europe (29%), and Latin America, Asia, Australia, New Zealand, and Africa (15%). Ninety-one percent of participants identified as colorectal surgeons and 80% reported >5 years of experience (35% reported >15 years). Fifty-seven attendees participated in the final meeting and voted on core descriptor sets. Ninety-three percent of participants agreed that descriptors such as age, BMI, frailty, nutrition, and the American Society of Anesthesiology score correlated to physiologic status. One hundred percent of participants agreed to include baseline bowel function. One hundred percent of participants reported willingness to complete a synoptic operative report. Follow-up intervals 1, 3, and 5 years after surgery (76%) with a collection of recurrence and functional outcomes at those time periods reached an agreement. LIMITATIONS Individual bias, self-identification of experts, and paucity of knowledge related to rectal prolapse. CONCLUSIONS This represents the first steps toward international consensus to unify language and data collection processes for rectal prolapse. See Video Abstract . CONJUNTOS DE DESCRIPTORES BSICOS PARA LA INVESTIGACIN DE RESULTADOS DE PROLAPSO RECTAL MEDIANTE UN CONSENSO DELPHI MODIFICADO ANTECEDENTES:Existe una amplia variación en la atención del prolapso.OBJETIVO:Determinar conjuntos de descriptores básicos para el prolapso rectal para mejorar los resultados de la investigación.DISEÑO:Los descriptores para pacientes sometidos a cirugía de prolapso rectal se generaron a través de una revisión sistemática y la opinión de expertos. Las partes interesadas fueron reclutadas internacionalmente a través de listas de servicio y redes sociales. Se animó a los expertos a considerar los descriptores mínimos que podrían considerarse durante la atención clínica, y los descriptores se agruparon en conjuntos de descriptores básicos. El consenso se definió como > 70% de acuerdo.AJUSTE:Se distribuyó mediante encuesta un proceso Delphi de tres rondas que utiliza una escala Likert de 9 puntos basada en resultados de expertos. La reunión interactiva final utilizó una plataforma de votación.PARTICIPANTES:El grupo interdisciplinario del Consorcio de Trastornos del Suelo Pélvico se reunió para avanzar en la atención clínica de los trastornos del suelo pélvico.MEDIDAS PRINCIPALES DE RESULTADOS:Lograr el consenso de expertos para los conjuntos de descriptores básicos para el prolapso rectal utilizando un método Delphi modificado.RESULTADOS:Participaron 206 proveedores con tasas de respuesta a la encuesta del 82% y 88% respectivamente. Los encuestados procedían de América del Norte (56%), Europa (29%) y América Latina, Asia, Australia, Nueva Zelanda y África (15%). El noventa y uno por ciento se identificó como cirujanos colorrectales y el 80% reportó más de 5 años de experiencia (35% > 15 años). Cincuenta y siete asistentes participaron en la reunión final y votaron sobre conjuntos de descriptores básicos. El noventa y tres por ciento estuvo de acuerdo en que descriptores como edad, índice de masa corporal, fragilidad, nutrición y puntuación de la Sociedad Estadounidense de Anestesiología se correlacionaban con el estado fisiológico. El cien por ciento estuvo de acuerdo en incluir la función intestinal inicial. El 100% refirió disposición para realizar un informe operativo sinóptico. Los intervalos de seguimiento 1,3,5 años después de la cirugía (76%) con un conjunto de recurrencias y los resultados funcionales en esos períodos de tiempo coincidieron.LIMITACIONES:Sesgo individual, autoidentificación de los expertos y escasez de conocimientos relacionados con el prolapso rectal.CONCLUSIONES:Esto representa los primeros pasos hacia un consenso internacional para unificar el lenguaje y los procesos de recolección de datos para el prolapso rectal. (Traducción-Yesenia Rojas-Khalil ).
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Schults JA, Charles KR, Millar J, Rickard CM, Chopra V, Lake A, Gibbons K, Long D, Rahiman S, Hutching K, Winderlich J, Spotswood NE, Johansen A, Secombe P, Pizimolas GA, Tu Q, Waak M, Allen M, McMullan B, Hall L. Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process. CRIT CARE RESUSC 2024; 26:71-79. [PMID: 39072236 PMCID: PMC11282349 DOI: 10.1016/j.ccrj.2024.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 07/30/2024]
Abstract
Introduction Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities. Objective We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care. Design We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care. Setting and participants Australian and New Zealand paediatric critical care survivors (aged >18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative. Interventions None. Main outcome measures Priorities for quality measures. Results Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated. Conclusions We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.
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Affiliation(s)
- Jessica A. Schults
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
- The University of Queensland Centre for Clinical Research, Queensland, Australia
| | - Karina R. Charles
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Johnny Millar
- Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Claire M. Rickard
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- The University of Queensland Centre for Clinical Research, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado School of Medicine, Aurora, United States
| | - Anna Lake
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School-based Youth Health Nursing Service, Child and Youth Community Health Service, Children's Health Queensland, Australia
| | - Kristen Gibbons
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Debbie Long
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katrina Hutching
- Paediatric Intensive Care Unit, Starship Child Health, Auckland, New Zealand
| | - Jacinta Winderlich
- Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Naomi E. Spotswood
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Johansen
- Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Georgina A. Pizimolas
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Quyen Tu
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
- Pharmacy, Queensland Children's Hospital, South Brisbane Queensland, Australia
- The University of Queensland Centre for Clinical Research, Queensland, Australia
| | - Michaela Waak
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Meredith Allen
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Brendan McMullan
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
| | - the Australian and New Zealand Intensive Care Society Paediatric Study Group
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- The Children’s Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
- Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Department of Medicine, University of Colorado School of Medicine, Aurora, United States
- School-based Youth Health Nursing Service, Child and Youth Community Health Service, Children's Health Queensland, Australia
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Starship Child Health, Auckland, New Zealand
- Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Pharmacy, Queensland Children's Hospital, South Brisbane Queensland, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
- School of Public Health, University of Queensland, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- The University of Queensland Centre for Clinical Research, Queensland, Australia
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Dice JL, Brismée JM, Froment FP, Henricksen J, Sherwin R, Pool J, Milne N, Clewley D, Basson A, Olson KA, Gross AR. Spinal manipulation and mobilisation among infants, children, and adolescents: an international Delphi survey of expert physiotherapists. J Man Manip Ther 2024; 32:284-294. [PMID: 38484120 PMCID: PMC11216234 DOI: 10.1080/10669817.2024.2327782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists. METHODS Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale. RESULTS Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included:Manipulation is not recommended: (1) for infants across all conditions, impairments, and spinal levels; and (2) for children and adolescents across most conditions and spinal levels.Manipulation may be recommended for adolescents to treat spinal region-specific joint hypomobility (thoracic, lumbar), and pain (thoracic).Mobilisation may be recommended for children and adolescents with hypomobility, joint pain, muscle/myofascial pain, or stiffness at all spinal levels. CONCLUSION Consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents.
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Affiliation(s)
- Jenifer L. Dice
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Frédéric P. Froment
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- President, International Academy of Musculoskeletal Physiotherapy, Paris, France
| | - Janis Henricksen
- School of Physical Therapy, University of St. Augustine, Dallas, TX, USA
| | - Rebecca Sherwin
- Physical Therapy Department, NELA Rehabilitation, West Monroe, Louisiana, USA
- Doctor of Physical Therapy Program, Hauser School of Physical Therapy, University of the Cumberlands, Williamsburg, KY, USA
| | - Jan Pool
- Institute of Movement Studies, University of Applied Sciences, Utrecht, The Netherlands
| | - Nikki Milne
- THINK Paediatrics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Derek Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Annalie Basson
- Faculty of Health Sciences, Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Kenneth A. Olson
- Private Practitioner, Northern Rehab Physical Therapy Specialists, DeKalb, IL, USA
| | - Anita R. Gross
- Rehabilitation Sciences, McMaster University, Hamilton, Canada
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Dahir KM, Rush ET, Diaz-Mendoza S, Kishnani PS. A Delphi panel to build consensus on assessing disease severity and disease progression in adult patients with hypophosphatasia in the United States. J Endocrinol Invest 2024; 47:1487-1497. [PMID: 38236379 PMCID: PMC11142979 DOI: 10.1007/s40618-023-02256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Hypophosphatasia (HPP) is an inborn error of metabolism with a variable presentation. We conducted a modified Delphi panel to obtain expert consensus on knowledge gaps regarding disease severity and progression in adult patients with HPP. METHODS Healthcare professionals (HCPs) with experience managing adult patients with HPP were recruited to participate in a 3-round Delphi panel (round 1: paper survey and 1:1 interview; rounds 2-3: email survey). Panelists rated the extent of their agreement with statements about disease severity and progression in adult patients with HPP. Consensus was defined as ≥ 80% agreement. RESULTS Ten HCPs completed round 1; nine completed rounds 2 and 3. Consensus was reached on 46/120 statements derived from steering committee input. Disease severity markers in adult patients with HPP can be bone-related (recurrent/poorly healing fractures, pseudo-fractures, metatarsal fractures, osteomalacia) or involve dentition or physiologic/functional manifestations (use of mobility devices/home modifications, abnormal gait, pain). Disease progression markers can include recurrent/poorly healing low-trauma fractures, development of ectopic calcifications, and/or impairment of functional activity. Panelists supported the development of a tool to help assess disease severity in the clinic and track changes in severity over time. Panelists also highlighted the role of a multidisciplinary team, centers with expertise, and the need to refer patients when disease severity is not clear. CONCLUSIONS These statements regarding disease severity, progression, and assessment methods address some knowledge gaps in adult patients with HPP and may be helpful for treating HCPs, although the small sample size affects the ability to generalize the healthcare provider experience.
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Affiliation(s)
- K M Dahir
- Division of Endocrinology and Metabolism, Vanderbilt University Medical Center, 1215 21st Ave S Suite 8210, Nashville, TN, 37232, USA.
| | - E T Rush
- Division of Clinical Genetics, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | | | - P S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Perowne R, Rowe S, Gutman LM. Understanding and Defining Young People's Involvement and Under-Representation in Mental Health Research: A Delphi Study. Health Expect 2024; 27:e14102. [PMID: 38872473 PMCID: PMC11176595 DOI: 10.1111/hex.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION The mental health of young people (aged 16-25 years) is a growing public health concern in the United Kingdom due to the increasing numbers of young people experiencing mental health difficulties, with many not in contact with mental health services. To design services that meet the needs of all young people, a diversity of young people must be involved in mental health research, beyond being participants. This Delphi study aimed to identify different types of 'involvement' and to define and describe 'under-representation' in young people's involvement in mental health research. METHODS Twenty-seven experts in young people's mental health research completed a series of online questionnaires. The experts were academic researchers, patient and public involvement (PPI) professionals and young 'experts by experience'. Round 1 generated panellists' views on 'involvement' and 'under-representation'. Round 2 summarised panellists' responses from Round 1 and sought consensus (minimum 70% agreement) in nine question areas. Round 3 validated the findings of the previous rounds. RESULTS Consensus was achieved in eight out of nine areas, resulting in a matrix (with definitions) of the different types of young people's involvement in mental health research, from being advisors to involvement ambassadors. The findings generated an agreed-upon definition of under-representation, an identification of when in the research process there is under-representation and the characteristics of the young people who are under-represented. Experts further agreed on demographic data that should be collected to improve reporting on involvement. CONCLUSIONS This study adds to our understanding of involvement and under-representation in the context of young people's mental health research through expert consensus. It provides a practical resource for researchers considering involving young people in the research process and suggests the data that should be collected to improve reporting on the diversity of the young people involved. PATIENT AND PUBLIC CONTRIBUTION A research oversight group of five young people advised on this study. They contributed throughout the project-from endorsing the research question to commenting on the findings and dissemination. Two of the group reviewed all participant materials and piloted the initial questionnaire.
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Affiliation(s)
- Rachel Perowne
- UCL Centre for Behaviour Change, Division of Psychology and Language Sciences, University College London, London, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, UK
| | - Leslie Morrison Gutman
- UCL Centre for Behaviour Change, Division of Psychology and Language Sciences, University College London, London, UK
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Brady K, Cleary R, O'Gorman E, McDonough S, Kerr C, Kiernan D, McConkey E, Ryan J, Malone A. Identifying the top 10 priorities of adolescents with a physical disability regarding participation in physical activity: A Delphi study. Dev Med Child Neurol 2024. [PMID: 38815177 DOI: 10.1111/dmcn.15986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
AIM To establish consensus among adolescents with a physical disability regarding their priorities for enhancing participation in physical activity and help inform the design of future interventions for participation in physical activity. METHOD We conducted a national multi-round Delphi study involving adolescents with a physical disability aged 13 to 17 years. Round 1 of the initial survey consisted of open-ended questions. Free-text responses were then analysed thematically, creating items categorized according to the family of participation-related constructs (fPRC). In round 2, participants rated the perceived importance of these items using a 5-point Likert scale. The top 10 priorities were constructed from the highest-ranked items. RESULTS One hundred and sixteen participants (mean age = 14 years 7 months, range = 13-17 years; 66 males; 58 with cerebral palsy; 43 wheelchair users) completed round 1; 108 items were included in round 2. Fifty-eight items were rated as either 'important' or 'really important' by 70% of participants. The top 10 priorities were rated as important or really important by 82% to 94% of participants with a mean Likert score of 4.40 (range = 4.25-4.63). Seven of the top 10 priorities were related to the environmental context of the fPRC. The other three were related to involvement and the related concept of preference. INTERPRETATION The priorities identified will help inform future physical activity interventions for adolescents with a physical disability.
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Affiliation(s)
- Karen Brady
- Central Remedial Clinic, Dublin, Ireland
- CP-Life Research Centre, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Ronan Cleary
- School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Suzanne McDonough
- School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Jennifer Ryan
- CP-Life Research Centre, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Ailish Malone
- CP-Life Research Centre, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Haladay D, Morris Z, Tilson J, Fitzgerald C, Applebaum D, Flom-Meland C, DeWaay D, Manal TJ, Gravano T, Anderson S, Miro R, Russ D, Klein A. Development of a Novel Evidence-Based Practice-Specific Competency for Doctor of Physical Therapy Students in Clinical Education: A Modified Delphi Approach. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00112. [PMID: 38814571 DOI: 10.1097/jte.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 03/04/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Evidence-based practice (EBP) results in high-quality care and decreases unwarranted variation in practice. REVIEW OF THE LITERATURE Few performance criteria related to EBP are included in physical therapy clinical education (CE) performance measures, despite EBP requirements in Doctor of Physical Therapy education. The purpose of this study was to develop EBP-specific competencies that may be used for Doctor of Physical Therapy students for use throughout CE. SUBJECTS Thirteen subject matter experts (SME) participated in this study. METHODS Subject matter experts were asked to rank each core EBP competency, from a previously described framework, using a 3-point Likert scale, which included "Not Essential," "Essential," and "Not Sure." A consensus of 70% or greater for the "Essential" rating advanced the competency to the final Delphi round, whereas a consensus of 70% or greater for the "Not Essential" rating was required for competency elimination. Subject matter experts voted to either "Accept" or "Modify" the competencies that had reached the inclusion consensus threshold. All competencies that reached consensus for inclusion after all 3 rounds were included in the final EBP Domain of Competence. RESULTS Consensus was achieved in round one for 38% (n = 26) of items. In round 2, a consensus was achieved for 20% (n = 8) of items. Of the items remaining after rounds 1 and 2, 6 overarching competencies were identified, and all remaining items served as descriptions and specifications in the final EBP Domain of Competence. DISCUSSION AND CONCLUSIONS The 6 competencies developed from this study constitute the EBP Domain of Competence and may be used throughout CE to assess students' EBP competency in clinical practice.
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Affiliation(s)
- Douglas Haladay
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Zoe Morris
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Julie Tilson
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Caitlin Fitzgerald
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Donna Applebaum
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Cindy Flom-Meland
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Deborah DeWaay
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Tara Jo Manal
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Tamara Gravano
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Stephanie Anderson
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Rebecca Miro
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - David Russ
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Aimee Klein
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
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Querevalú-Pancorbo I, Rojas-Cama LF, Soncco-Llulluy F, Li J, Rosales-Rimache J. Abnormal uterine bleeding and associated factors: a cross-sectional study in high-performance Peruvian athletes. BMJ Open Sport Exerc Med 2024; 10:e001820. [PMID: 38818354 PMCID: PMC11138278 DOI: 10.1136/bmjsem-2023-001820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a problem that affects women and can cause outcomes such as anaemia, affecting women's quality of life. In high-performance athletes, this problem can be further exacerbated by intense physical activity, strict nutritional regimens and physical stress. Hypothesis There are factors that increase the risk of occurrence of AUB in high-performance Peruvian athletes. Study design Cross-sectional study. Level of evidence Level 4. Methods We applied an online questionnaire with questions to identify AUB according to the International Federation of Gynecology and Obstetrics criteria, demographic characteristics, sport practised and evaluation of the risk of an eating disorder using the Eating Attitudes Test questionnaire. We used a generalised linear model to identify factors associated with AUB. Results We evaluated 101 participants whose mean age was 22.3±4.3 years. The body mass index had a mean of 22.6±2.4 kg/m2. From the total of athletes, 68.3% (95% CI 58.6% to 76.7%) presented AUB. The bivariate analysis showed that the type of sport and the duration of the sporting activity were associated (p<0.05) with AUB, with AUB frequencies of 76.5% observed in athletes who practised anaerobic sports. The multivariate analysis did not report factors significantly associated with AUB. Conclusion We found a high frequency of AUB in high-performance Peruvian athletes, especially in those who practice anaerobic and resistance sports. Clinical relevance High-performance female athletes health must be evaluated periodically, and immediate actions are taken to control and treat AUB.
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Affiliation(s)
| | | | | | - Jair Li
- Escuela de Posgrado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jaime Rosales-Rimache
- Facultad de Ciencias de la Salud, Escuela de Tecnología Médica, Universidad Continental, Huancayo, Peru
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72
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Grottoli S, Maffei P, Tresoldi AS, Granato S, Benedan L, Mariani P, Giustina A. Insights from an Italian Delphi panel: exploring resistance to first-generation somatostatin receptor ligands and guiding second-line medical therapies in acromegaly management. J Endocrinol Invest 2024:10.1007/s40618-024-02386-3. [PMID: 38809458 DOI: 10.1007/s40618-024-02386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE First-line medical therapy for acromegaly management includes first-generation somatostatin receptor ligands (fgSRLs), but resistance limits their use. Despite international guidelines, the choice of second-line therapy is debated. METHODS We aim to discuss resistance to fgSRLs, identify second-line therapy determinants and assess glycemia's impact to provide valuable insights for acromegaly management in clinical practice. A group of Italian endocrinologists expert in the pituitary field participated in a two-round Delphi panel between July and September 2023. The Delphi questionnaire encompassed a total of 75 statements categorized into three sections: resistance to fgSRLs therapy and predictors of response; determinants for the selection of second-line therapy; the role of glycemia in the therapeutic management. The statements were rated on a 6-point Likert scale. RESULTS Fifty-nine (79%) statements reached a consensus. IGF-1 levels resulted central for evaluating resistance to fgSRLs, that should be defined considering also symptomatic clinical response, degree of tumor shrinkage and complications, using clinician- and patient-reported outcome tools available. Factors to be evaluated for the choice of second-line medical therapy are hyperglycemia-that should be managed as in non-acromegalic patients-tumor remnant, resistant headache and compliance. Costs do not represent a main determinant in the choice of second-line medical treatment. CONCLUSION The experts agreed on a holistic management approach to acromegaly. It is therefore necessary to choose currently available highly effective second-line medical treatment (pegvisomant and pasireotide) based on the characteristics of the patients.
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Affiliation(s)
- S Grottoli
- Department of Medical Science, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy.
| | - P Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University Hospital, Padua, Italy
| | | | - S Granato
- Medical Department, Pfizer Italia, Rome, Italy
| | - L Benedan
- Università Milano-Bicocca, Milan, Italy
| | - P Mariani
- Università Milano-Bicocca, Milan, Italy
| | - A Giustina
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
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73
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El Chaar M, Rogers AM, Mattar SG, Kukreja SS, Jenkins M, Askew C, Hassan M, Baker R, Smith E, Galvani C. First modified Delphi consensus statement on robotic-assisted da Vinci sleeve gastrectomy. Surg Obes Relat Dis 2024:S1550-7289(24)00628-2. [PMID: 38991936 DOI: 10.1016/j.soard.2024.04.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/29/2024] [Accepted: 04/26/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most commonly performed metabolic and bariatric surgery (MBS) procedure. Technical considerations related to the performance of SG are well established and reported in the literature but not in relation to robotic-assisted (RA) SG. We report the results of the first modified Delphi consensus-building exercise addressing technical considerations of RA da Vinci (dV) SG. OBJECTIVES Develop best practices for the performance of robotic-assisted da Vinci sleeve gastrectomy. SETTING Survey based consensus statement. METHODS A consensus building committee (CBC) was created comprising 10 experts in the field of RA surgery and MBS based on strict selection criteria. The CBC developed 49 consensus statements which were then shared with 240 experts in RA surgery. Our stopping criterion was stability in responses (≤15%). The consensus cut point was 70%. RESULTS The overall response rate was 49%. In the first round of voting, there was consensus agreement on 25 statements (51%), consensus disagreement on 14 (28%), and no consensus on the remaining statements (21%). In the second round of voting, we reached agreement on 3 additional statements. Experts recommended the use of the number of pauses generated by the stapler to guide choice of staple height (91.2%) and to upsize the staple height when using buttressing (92%). There was also consensus (81.4%) that the use of the closed staple height of 1.00 mm (white) is acceptable and that stapling of the antrum using a 1.5-mm staple (blue load) is also acceptable (73%). CONCLUSIONS Collective expert opinion structured through a modified Delphi consensus statement presents a practical guide for surgeons interested in performing dV-SG.
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Affiliation(s)
- Maher El Chaar
- Department of Surgery, St Luke's University Hospital and Health Network, Allentown, Pennsylvania.
| | | | | | | | | | | | | | | | - Eric Smith
- Kentucky Bariatric Institute, Georgetown, Kentucky
| | - Carlos Galvani
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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74
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Calzone KA, Stokes L, Peterson C, Badzek L. Update to the essential genomic nursing competencies and outcome indicators. J Nurs Scholarsh 2024. [PMID: 38797885 DOI: 10.1111/jnu.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Genomic healthcare applications have relevance to all healthcare professionals including nursing, and most evidence-based clinical applications impact the quality and safety of healthcare. To guide nursing genomic competency initiatives, the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics were established through a process of consensus in 2005. A 2009 update incorporated outcome indicators consisting of specific areas of knowledge and clinical performance indicators, to help support academic integration. Almost 20 years have elapsed since these competencies were first established, yet incorporating the competencies into general and specialty scope and standards of nursing practice is inconsistent, competency integration into curricula is highly uneven, continuing education in genomics for nurses is limited, and the genomic capacity of the nursing workforce remains low. These deficits have persisted despite substantial advances in genomic technology which substantially reduced costs and increased evidence-based clinical applications, including direct to consumer genomic tests, the integration of genomics into evidence-based guidelines, and evidence that genomics impacts the quality and safety of healthcare. DESIGN The aim of this project was to update and achieve consensus on genomic competencies applicable to all registered nurses. This was a mixed methods study. METHODS The update to the competencies was performed based first on a literature review to update the competencies based on the current state of the evidence. Using the updated content, a modified Delphi study was conducted with registered nurse panelists from clinical, academic, and research settings. Once consensus was achieved, the competencies were made available through the American Nurses Association for public comment. Public comments were then reviewed and integrated as needed. RESULTS The literature review resulted in a transition from genetics to genomics, given the reduction in costs, which resulted in an expansion of the scope of testing in both the germline and somatic contexts. Two Delphi rounds were required to reach consensus prior to the public comment period. Public comments were solicited through the American Nurses Association, and each comment was reviewed by the authors and addressed as indicated. CONCLUSION The Essentials of Genomic Nursing: Competencies and Outcome Indicators constitute the minimum competency in genomics required of all registered nurses regardless of the level of academic training, role, or specialty. CLINICAL RELEVANCE Evidence-based genomic applications span the entire healthcare continuum and, therefore, are relevant for all registered nurses regardless of academic training, role, practice setting, or clinical expertise. These competencies serve as the guide for the minimum requirements for registered nurse practice as well as guide curricula and continuing education for all registered nurses, including but not limited to administrators, educators, nursing leaders, practicing nurses, and researchers.
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Affiliation(s)
- Kathleen A Calzone
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Liz Stokes
- Center for Ethics and Human Rights, American Nurses Association, Silver Spring, Maryland, USA
| | - Cheryl Peterson
- Nursing Programs, American Nurses Association, Silver Spring, Maryland, USA
| | - Laurie Badzek
- Penn State University, State College, Pennsylvania, USA
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Karami M, Hafizi N, Nickfarjam AM, Refahi S. Development of minimum data set and dashboard for monitoring adverse events in radiology departments. Heliyon 2024; 10:e30054. [PMID: 38707457 PMCID: PMC11068645 DOI: 10.1016/j.heliyon.2024.e30054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background To reduce the risk of errors, patient safety monitoring in the medical imaging department is crucial. Interventions are required and these can be provided as a framework for documenting, reporting, evaluating, and recognizing events that pose a threat to patient safety. The aim of this study was to develop minimum data set and dashboard for monitoring adverse events in radiology departments. Material and methods This developmental research was conducted in multiple phases, including content determination using the Delphi technique; database designing using SQL Server; user interface (UI) building using PHP; and dashboard evaluation in three aspects: the accuracy of calculating; UI requirements; and usability. Results This study identified 26 patient safety (PS) performance metrics and 110 PS-related significant data components organized into 14 major groupings as the system contents. The UI was built with three tabs: pre-procedure, intra-procedure, and post-procedure. The evaluation results proved the technical feasibility of the dashboard. Finally, the dashboard's usability was highly rated (76.3 out of 100). Conclusion The dashboard can be used to supplement datasets to obtain a more accurate picture of the PS condition and to draw attention to characteristics that professionals might otherwise overlook or undervalue.
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Affiliation(s)
- Mahtab Karami
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Health Information Technology and Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Hafizi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali-Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Technology and Management, School of Allied-Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Refahi
- Department of Medical Physics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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LaBella D, Khanna O, McBurney-Lin S, Mclean R, Nedelec P, Rashid AS, Tahon NH, Altes T, Baid U, Bhalerao R, Dhemesh Y, Floyd S, Godfrey D, Hilal F, Janas A, Kazerooni A, Kent C, Kirkpatrick J, Kofler F, Leu K, Maleki N, Menze B, Pajot M, Reitman ZJ, Rudie JD, Saluja R, Velichko Y, Wang C, Warman PI, Sollmann N, Diffley D, Nandolia KK, Warren DI, Hussain A, Fehringer JP, Bronstein Y, Deptula L, Stein EG, Taherzadeh M, Portela de Oliveira E, Haughey A, Kontzialis M, Saba L, Turner B, Brüßeler MMT, Ansari S, Gkampenis A, Weiss DM, Mansour A, Shawali IH, Yordanov N, Stein JM, Hourani R, Moshebah MY, Abouelatta AM, Rizvi T, Willms K, Martin DC, Okar A, D'Anna G, Taha A, Sharifi Y, Faghani S, Kite D, Pinho M, Haider MA, Alonso-Basanta M, Villanueva-Meyer J, Rauschecker AM, Nada A, Aboian M, Flanders A, Bakas S, Calabrese E. A multi-institutional meningioma MRI dataset for automated multi-sequence image segmentation. Sci Data 2024; 11:496. [PMID: 38750041 PMCID: PMC11096318 DOI: 10.1038/s41597-024-03350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Meningiomas are the most common primary intracranial tumors and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on brain MRI for diagnosis, treatment planning, and longitudinal treatment monitoring. However, automated, objective, and quantitative tools for non-invasive assessment of meningiomas on multi-sequence MR images are not available. Here we present the BraTS Pre-operative Meningioma Dataset, as the largest multi-institutional expert annotated multilabel meningioma multi-sequence MR image dataset to date. This dataset includes 1,141 multi-sequence MR images from six sites, each with four structural MRI sequences (T2-, T2/FLAIR-, pre-contrast T1-, and post-contrast T1-weighted) accompanied by expert manually refined segmentations of three distinct meningioma sub-compartments: enhancing tumor, non-enhancing tumor, and surrounding non-enhancing T2/FLAIR hyperintensity. Basic demographic data are provided including age at time of initial imaging, sex, and CNS WHO grade. The goal of releasing this dataset is to facilitate the development of automated computational methods for meningioma segmentation and expedite their incorporation into clinical practice, ultimately targeting improvement in the care of meningioma patients.
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Affiliation(s)
- Dominic LaBella
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Omaditya Khanna
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shan McBurney-Lin
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Pierre Nedelec
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Arif S Rashid
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ujjwal Baid
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Radhika Bhalerao
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Scott Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Devon Godfrey
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Anahita Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Collin Kent
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Florian Kofler
- Helmholtz AI, Helmholtz Munich, Neuherberg, Germany
- Department of Computer Science, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Tech nical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kevin Leu
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Maxence Pajot
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Zachary J Reitman
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey D Rudie
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Rachit Saluja
- Department of Radiology, Cornell University, Ithaca, NY, USA
| | - Yury Velichko
- Department of Radiology, Northwestern University, Evanston, IL, USA
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Pranav I Warman
- Duke University Medical Center, School of Medicine, Durham, NC, USA
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Khanak K Nandolia
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Daniel I Warren
- Department of Neuroradiology, Washington University, St. Louis, MO, USA
| | - Ali Hussain
- University of Rochester Medical Center, Rochester, NY, USA
| | - John Pascal Fehringer
- Faculty of Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | | | - Lisa Deptula
- Ross University School of Medicine, Bridgetown, Barbados
| | - Evan G Stein
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - Aoife Haughey
- Department of Neuroradiology, JDMI, University of Toronto, Toronto, TO, Canada
| | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria of Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | | | | | | | - David Maximilian Weiss
- Department of Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | | | - Islam H Shawali
- Department of Radiology, Kasr Alainy, Cairo University, Cairo, Egypt
| | - Nikolay Yordanov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Joel M Stein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roula Hourani
- Department of Radiology, American University of Beirut Medical center, Beirut, Lebanon
| | | | | | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | | | - Dann C Martin
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abdullah Okar
- Faculty of Medicine, Hamburg University, Hamburg, Germany
| | - Gennaro D'Anna
- Neuroimaging Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Ahmed Taha
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yasaman Sharifi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahriar Faghani
- Radiology Informatics Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dominic Kite
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Marco Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Javier Villanueva-Meyer
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Andreas M Rauschecker
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Ayman Nada
- University of Missouri, Columbia, MO, USA
| | - Mariam Aboian
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Adam Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Spyridon Bakas
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Neurological Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Evan Calabrese
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
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Sebong PH, Pardosi J, Goldman RE, Suryo AP, Susianto IA, Meliala A. Identifying Physician Public Health Competencies to Address Healthcare Needs in Underserved, Border, and Outer Island Areas of Indonesia: A Rapid Assessment. TEACHING AND LEARNING IN MEDICINE 2024:1-12. [PMID: 38743583 DOI: 10.1080/10401334.2024.2353573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
Phenomenon: Most medical schools in Indonesia have developed innovations to integrate public health content into the curricula. However, ensuring that all schools meet appropriate standards regarding the quality of subjects, content relevancy, and course delivery takes time and effort. Approach: This study employed a rapid assessment procedure to identify the current knowledge and competencies required to practice medicine effectively in underserved, border, and outer island areas of Indonesia. Ninety-three participants from six remote districts were involved in 12 focus group discussions. Qualitative data were analyzed using content analysis using the social determinants of health as a guiding framework. Findings: Under decentralized health system governance, the local socio-geographical context is critical to understanding the current public health landscape. Medical education with respect to public health must emphasize physicians' ability to advocate and encourage the coordination of healthcare services in responding to disasters, as well as community-based surveillance and other relevant data for synergistic disease control. As part of a healthcare facility management team, prospective doctors should be able to apply systems thinking and provide critical input to improve service delivery at local health facilities. Also, recognizing underlying factors is essential to realizing effective interprofessional collaboration practices and aligning them with leadership skills. Insights: This study outlines recommendations for medical schools and relevant colleges in formulating compulsory block or integrated public health curricula. It also provides a public health learning topic that may aid medical schools in training their students to be competent for practice in underserved, border, and outer island areas. Medical schools should offer initiatives for students to acquire the necessary public health competencies merited by the population's health needs.
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Affiliation(s)
- Perigrinus Hermin Sebong
- Department of Public Health, Faculty of Medicine, Soegijapranata Catholic University, Semarang, Indonesia
| | - Jerico Pardosi
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Roberta Ellen Goldman
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, Massachusetts
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Indra Adi Susianto
- Faculty of Medicine, Soegijapranata Catholic University, Semarang, Indonesia
| | - Andreasta Meliala
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Salehpour S, Aleyasin A, Moini A, Mousavifar N, Mohammadhossein N, Abdollahi Fard S, Marzie S, Mohammadzadeh M, Fischer R. Luteinizing hormone supplementation in controlled ovarian stimulation: the Iran Delphi consensus. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1397446. [PMID: 38784124 PMCID: PMC11111922 DOI: 10.3389/frph.2024.1397446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Numerous consensus documents worldwide address luteinizing hormone (LH) supplementation in controlled ovarian stimulation, yet to the best of our knowledge, only one consensus paper has been published in the Arab region. This study presents a Delphi consensus by seven Iranian infertility experts, offering real-world clinical perspectives. The aim was to develop evidence-based opinions on LH's role alongside FSH in various aspects of assisted reproductive technology (ART), including LH levels, monitoring, r-hLH use, and suggested activity. Methods Employing the Delphi consensus approach, the Iran consensus unfolded in three steps. In Step 1, eight out of 10 statements gained approval, while two unclear statements were removed. In Step 2, the 20-member extended panel voted on the remaining eight statements. Results Only one (statement 3) lacked consensus (55% agreement), prompting a modification. The revised statement (noted as statement 3') obtained an 83% agreement. Discussion The clinical perspectives included in this consensus complement clinical guidelines and policies that help further improve treatment outcomes, especially for patients with FSH and LH deficiencies.
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Affiliation(s)
- Saghar Salehpour
- Obstetrics and Gynecology Department, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Ashraf Aleyasin
- Obstetrics and Gynecology Department, Tehran Medical Science University, Tehran, Iran
| | - Ashraf Moini
- Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nezhat Mousavifar
- Armaghan Infertility Center, Mashhad Medical Science University, Mashhad, Iran
| | - Nasresfahani Mohammadhossein
- Animal Biotechnology Department, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
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Hakkenbrak NAG, Harmsen AMK, Zuidema WP, Reijnders UJL, Schober P, Bloemers FW. Classification of trauma-related preventable death; protocol of a Delphi procedure. PLoS One 2024; 19:e0298692. [PMID: 38709732 PMCID: PMC11073670 DOI: 10.1371/journal.pone.0298692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/29/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Trauma-related (preventable) death is used to evaluate the management and quality of trauma care worldwide. Therefore, it is necessary to identify fatalities in the trauma care population and assess them on preventability. However, the definition on trauma-related preventable death lacks validity due to differences in terminology and classifications. This study aims to reach consensus on the definition of trauma-related preventable death by performing a Delphi procedure, thereby, improving the assessment of trauma-related preventable death and thereby enhancing the quality of trauma care. METHODS Based on the results of a recently performed systematic review Hakkenbrak (2021). The definitions used to describe trauma-related preventable death could be divided into four categories: 1) Clinical definition based on panel review or expert opinion, 2) Trauma prediction algorithm, 3) Clinical definition with an additional trauma prediction algorithm and 4) Others (e.g., errors in care or detailed clinical definition). A three round, electronic Delphi study will be performed in the Netherlands to reach consensus. Experts from the department of Trauma surgery, Neurosurgery, Forensic medicine, Anaesthesiology and Emergency medicine, of the designated Level 1 trauma centres in the Netherlands, will be invited to participate. In the first round the panel will comment on the composed categories and trauma prediction algorithms. In the second and third round a feedback report will be presented and the questions with disagreement will be retested. DISCUSSION The identification and assessment of trauma-related preventable death is necessary to evaluate and improve trauma care. Therefore, a valid, fair, and applicable definition of trauma-related preventable death is required. The Delphi technique is utilized to reach group consensus to obtain a scientifically valid definition of trauma-related preventable death.
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Affiliation(s)
- Nadia A. G. Hakkenbrak
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Trauma Unit, Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Annelieke M. K. Harmsen
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Wietse P. Zuidema
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Udo J. L. Reijnders
- Department of Forensic Medicine, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Frank W. Bloemers
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Gareri P, Cotroneo AM, Gelmini G, Mossello E, Massaia M. An algorithm for the early diagnosis and correct approach to dementia management: results of a multiprofessional team. Aging Clin Exp Res 2024; 36:102. [PMID: 38702570 PMCID: PMC11068660 DOI: 10.1007/s40520-024-02749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUNG The early identification of cognitive disorder is a primary scope, because it could reduce the rate of severe cognitive impairment and thus contribute to reduce healthcare costs in the next future. AIMS The present paper aimed to build a virtuous diagnostic path of cognitive impairment, highlighting all the professionalism that can serve this purpose. METHODS The Delphi method was used by the experts, who reviewed the information available during each meeting related to the following topics: early diagnosis of cognitive impairment, definition of Mild Cognitive Impairment, unmet needs in post-stroke patients, critical decision-making nodes in complex patients, risk factors, neuropsychological, imaging diagnosis, blood tests, the criteria for differential diagnosis and the possible treatments. RESULTS The discussion panels analyzed and discussed the available evidences on these topics and the related items. At each meeting, the activities aimed at the creation of a diagnostic-welfare flow chart derived from the proposal of the board and the suggestions of the respondents. Subsequently, the conclusions of each panel were written, and the study group reviewed them until a global consensus was reached. Once this process was completed, the preparation of the final document was carried out. CONCLUSIONS Eventually, we built an algorithm for the early diagnosis and treatment, the risk factors, with the possible differences among the different kinds of dementia.
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Affiliation(s)
- Pietro Gareri
- Department of Frailty, Head Physician CDCD Catanzaro Lido - ASP Catanzaro, Viale Crotone 214, 88100, Catanzaro, Italy.
| | | | | | - Enrico Mossello
- Department of Experimental and Clinical Medicine, University of Florence and SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy
| | - Massimiliano Massaia
- Head Physician CDCD, Complex Unit of University Geriatrics - AO Health and Science City, Turin, Italy
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Basu S, Yudkin JS, Jawad M, Ghattas H, Hamad BA, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos EP, Millett C. Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003168. [PMID: 38696423 PMCID: PMC11065248 DOI: 10.1371/journal.pgph.0003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024]
Abstract
We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.
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Affiliation(s)
- Sanjay Basu
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, United States of America
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - John S. Yudkin
- Division of Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | | | - Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gloria Safadi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Marie-Elizabeth Ragi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Raeda El Sayed Ahmad
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:258-269. [PMID: 38677968 DOI: 10.1016/j.joim.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 04/29/2024]
Abstract
Urinary incontinence (UI) is a common problem worldwide. It has a major impact on physical and social activities and interpersonal relationships. UI is common in women, but is under-reported and under-treated. It affects the quality of life of female patients severely. Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method. This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions, which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison. This CPG also provides one protocol for conventional filiform needle therapy, two therapy protocols for deep needling stimulation on lumbosacral acupoints, and four moxibustion therapy protocols, based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. J Integr Med. 2024; 22(3): 258-269.
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Affiliation(s)
- Chao Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shan-Ze Wang
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shuo Du
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Guan-Qun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Guo
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiao-Long Xie
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bi-Hui Peng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shi-Hao Du
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Ji-Ping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
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Ryvlin P, Barba C, Bartolomei F, Baumgartner C, Brazdil M, Fabo D, Fahoum F, Frauscher B, Ikeda A, Lhatoo S, Mani J, McGonigal A, Metsahonkala EL, Mindruta I, Nguyen DK, Rheims S, Rocamora R, Rydenhag B, Schuele S, Schulze-Bonhage A, Surges R, Vulliemoz S, Beniczky S. Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study. Epilepsia 2024; 65:1346-1359. [PMID: 38420750 DOI: 10.1111/epi.17928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This study was undertaken to develop a standardized grading system based on expert consensus for evaluating the level of confidence in the localization of the epileptogenic zone (EZ) as reported in published studies, to harmonize and facilitate systematic reviews in the field of epilepsy surgery. METHODS We conducted a Delphi study involving 22 experts from 18 countries, who were asked to rate their level of confidence in the localization of the EZ for various theoretical clinical scenarios, using different scales. Information provided in these scenarios included one or several of the following data: magnetic resonance imaging (MRI) findings, invasive electroencephalography summary, and postoperative seizure outcome. RESULTS The first explorative phase showed an overall interrater agreement of .347, pointing to large heterogeneity among experts' assessments, with only 17% of the 42 proposed scenarios associated with a substantial level of agreement. A majority showed preferences for the simpler scale and single-item scenarios. The successive Delphi voting phases resulted in a majority consensus across experts, with more than two thirds of respondents agreeing on the rating of each of the tested single-item scenarios. High or very high levels of confidence were ascribed to patients with either an Engel class I or class IA postoperative seizure outcome, a well-delineated EZ according to all available invasive EEG (iEEG) data, or a well-delineated focal epileptogenic lesion on MRI. MRI signs of hippocampal sclerosis or atrophy were associated with a moderate level of confidence, whereas a low level was ascribed to other MRI findings, a poorly delineated EZ according to iEEG data, or an Engel class II-IV postoperative seizure outcome. SIGNIFICANCE The proposed grading system, based on an expert consensus, provides a simple framework to rate the level of confidence in the EZ reported in published studies in a structured and harmonized way, offering an opportunity to facilitate and increase the quality of systematic reviews and guidelines in the field of epilepsy surgery.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
- Member of the ERN EpiCARE
| | - Fabrice Bartolomei
- Member of the ERN EpiCARE
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Christoph Baumgartner
- Member of the ERN EpiCARE
- Department for Epileptology and Clinical Neurophysiology, Medical Faculty, Sigmund Freud University, Vienna, Austria
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Milan Brazdil
- Member of the ERN EpiCARE
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniel Fabo
- Epilepsy Unit, Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Birgit Frauscher
- Department of Neurology and Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Samden Lhatoo
- Department of Neurology, University of Texas Health Science Center, Houston, Texas, USA
| | - Jayanti Mani
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, India
| | - Aileen McGonigal
- Department of Neurosciences, Mater Misericordiae Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Eeva-Liisa Metsahonkala
- Member of the ERN EpiCARE
- Epilepsia Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Ioana Mindruta
- Member of the ERN EpiCARE
- Clinical Neuroscience Department, Carol Davila University of Medicine and Pharmacy, Epilepsy Monitoring, Bucharest, Romania
- Emergency University Hospital Bucharest, Bucharest, Romania
| | - Dang Khoa Nguyen
- Division of Neurology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sylvain Rheims
- Member of the ERN EpiCARE
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Rodrigo Rocamora
- Member of the ERN EpiCARE
- Epilepsy Monitoring Unit, Department of Neurology and Medical Research Institute, Hospital del Mar, Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bertil Rydenhag
- Member of the ERN EpiCARE
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Stephan Schuele
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Andreas Schulze-Bonhage
- Member of the ERN EpiCARE
- Epilepsy Center, Neurocenter, University Medical Center-University of Freiburg, Freiburg, Germany
| | - Rainer Surges
- Member of the ERN EpiCARE
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Sandor Beniczky
- Member of the ERN EpiCARE
- Department of Clinical Neurophysiology, Danish Epilepsy Center and Aarhus University Hospital, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fu QW, Liu Y, Chen SC, Zhang LZ, Liu WT, Liu ZQ, Liu Y, Xie Y, Fu L, Liu M, Zhang DZ, Yang SS, Zhang FB, Huang HY, Zhong J, Pang KY, Chen YN, Yang YP, Dai ML, Liu SY, Zhang SP, Xiang F, Tang M, Li PJ, Fang CS, Zhang QX, Yeung WF, Li XR. Extending the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in Traditional Chinese Medicine (TCM): The GRADE-TCM. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 127:155487. [PMID: 38490078 DOI: 10.1016/j.phymed.2024.155487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
AIM To extend and form the "Grading of Recommendations Assessment, Development and Evaluation in Traditional Chinese Medicine" (GRADE-TCM). METHODS Methodologies were systematically reviewed and analyzed concerning evidence-based TCM guidelines worldwide. A survey questionnaire was developed based on the literature review and open-end expert interviews. Then, we performed expert consensus, discussion meeting, opinion collection, external examination, and the GRADE-TCM was formed eventually. RESULTS 265 Chinese and English TCM guidelines were included and analyzed. Five experts completed the open-end interviews. Ten methodological entries were summarized, screened and selected. One round of consensus was conducted, including a total of 22 experts and 220 valid questionnaire entries, concerning 1) selection of the GRADE, 2) GRADE-TCM upgrading criteria, 3) GRADE-TCM evaluation standard, 4) principles of consensus and recommendation, and 5) presentation of the GRADE-TCM and recommendation. Finally, consensus was reached on the above 10 entries, and the results were of high importance (with voting percentages ranging from 50 % to 81.82 % for "very important" rating) and strong reliability (with the Cr ranging from 0.93 to 0.99). Expert discussion meeting (with 40 experts), opinion collection (in two online platforms) and external examination (with 14 third-party experts) were conducted, and the GRADE-TCM was established eventually. CONCLUSION GRADE-TCM provides a new extended evidence-based evaluation standard for TCM guidelines. In GRADE-TCM, international evidence-based norms, characteristics of TCM intervention, and inheritance of TCM culture were combined organically and followed. This is helpful for localization of the GRADE in TCM and internationalization of TCM guidelines.
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Affiliation(s)
- Qin-Wei Fu
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Yang Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Shu-Cheng Chen
- School of Nursing, The Hongkong Polytechnic University, Hongkong 999077, China
| | - Lan-Zhi Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Wei-Ting Liu
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Zhi-Qing Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Ying Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Yan Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Li Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Min Liu
- Chengdu Women's and Children's Central Hospital, Chengdu 610031, China
| | - Da-Zheng Zhang
- The People's Hospital of Dujiangyan, Chengdu 611800, China
| | - Sha-Sha Yang
- First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550002, China
| | - Fu-Bin Zhang
- Leshan Traditional Chinese Medicine Hospital, Leshan 614000, China
| | - He-Yin Huang
- Sichuan Integrative Medicine Hospital, Chengdu 610042, China
| | - Juan Zhong
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Kai-Yun Pang
- Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng 475000, China
| | - Yong-Na Chen
- Sanmenxia Traditional Chinese Medicine Hospital, Sanmenxia 472000, China
| | - Ye-Peng Yang
- Shanxi University of Chinese Medicine, Taiyuan 030619, China
| | - Meng-Lin Dai
- Yunnan University of Chinese Medicine, Kunming 650500, China
| | - Shu-Yun Liu
- Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Shi-Peng Zhang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Feng Xiang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Mi Tang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Pei-Jia Li
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Cai-Shan Fang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Qin-Xiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China; Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China; Second Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Sichuan Family Planning Research Institute, World Health Organization Collaborating Centre (WHOCC), CHN-56, Chengdu 610041, China.
| | - Wing-Fai Yeung
- School of Nursing, The Hongkong Polytechnic University, Hongkong 999077, China.
| | - Xin-Rong Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China.
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Ramaswamy V, Danciu T, Kennedy EN, Romito L, Stewart D, Gul G, Marucha P, Quinonez RB. American Dental Education Association Compendium Entrustable Professional Activities Workgroup report. J Dent Educ 2024; 88:639-653. [PMID: 38693898 DOI: 10.1002/jdd.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary. METHODS Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs. RESULTS Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n = ∼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language. CONCLUSION These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.
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Affiliation(s)
- Vidya Ramaswamy
- Director for Curriculum Evaluation and Promotion of Teaching and Learning at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Theodora Danciu
- Clinical Professor and Director of Engaged Learning and Assessment at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Erinne N Kennedy
- Assistant Professor and Assistant Dean for Curriculum and Integrated Learning at Kansas City University College of Dental Medicine, Joplin, Missouri, USA
| | - Laura Romito
- Professor and Associate Dean of Education and Academic Affairs at the Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Denice Stewart
- Adjunct Professor at the University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gulsun Gul
- Chief of Innovation, Clinical Education & Public Health at the American Dental Education Association, Washington, District of Columbia, USA
| | - Phillip Marucha
- Co-Chair, ADEA EPA group; Professor, Oregon Health & Science University School of Dentistry, Portland, Oregon, USA
| | - Rocio B Quinonez
- Co-Chair, ADEA EPA group; Professor and Associate Dean for Curriculum, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Du SH, Chen S, Wang SZ, Wang GQ, Du S, Guo W, Xie XL, Peng BH, Yang C, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:245-257. [PMID: 38616445 DOI: 10.1016/j.joim.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
Acupuncture is one of the most effective complementary therapies for allergic rhinitis (AR) and has been recommended by several clinical practice guidelines (CPGs) for AR. However, these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols, therefore limiting the applicability of acupuncture therapies for AR. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi method. The CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion interventions. These include one strong recommendation for the intervention based on high-quality evidence, three conditional recommendations for either the intervention or standard care, and 11 conditional recommendations for the intervention based on very low quality of evidence. The CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Du SH, Chen S, Wang SZ, Wang GQ, Du S, Guo W, Xie XL, Peng BH, Yang C, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis. J Integr Med. 2024; 22(3): 245-257.
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Affiliation(s)
- Shi-Hao Du
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shan-Ze Wang
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Guan-Qun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shuo Du
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Guo
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiao-Long Xie
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bi-Hui Peng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Chao Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Ji-Ping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
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Viljoen A, Leech R, Heyns T. Consensus on the content of an instrument to measure person-centred teamwork: An e-Delphi study. J Clin Nurs 2024; 33:1786-1797. [PMID: 38284483 DOI: 10.1111/jocn.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS AND OBJECTIVES To establish consensus on items to be included in an instrument to measure person-centred teamwork in a hospital setting. The objective was to identify the items through a methodological literature review. Refine the items and obtain consensus on the items. BACKGROUND A definition and related attributes of person-centred teamwork have been agreed upon. An instrument is needed to measure and monitor person-centred teamwork in hospital settings. DESIGN Consensus, electronic Delphi design. METHODS Items were identified through a methodological literature review. These items were included in three electronic Delphi rounds. Using purposive and snowball sampling, 16 international experts on person-centred care, teamwork and/or instrument development were invited to participate in three electronic Delphi rounds via Google Forms. Descriptive statistics were used to demonstrate their agreement on the relevance and clarity of each item. Items were included if consensus was 0.75. Content analysis was used to analyse written feedback from experts. RESULTS The response rate was 56% (n = 9/16). Nine experts participated over an 8-week period to reach consensus on the items to be included in an instrument to measure person-centred teamwork in hospital settings. The experts' responses and suggestions for rephrasing, removing and adding items were incorporated into each round. CONCLUSION A Delphi consensus exercise was completed, and experts reached agreement on 38 items to be included in an instrument that can be used to evaluate person-centred teamwork in hospital settings. RELEVANCE TO CLINICAL PRACTICE We engaged with nine international experts in the academic and clinical field of person-centeredness, teamwork and/or instrument development. An online platform was used to allow the experts to give input into the study. The experts engaged from their own environment with full autonomy and anonymity. Person-centred teamwork, aimed at improving practice is now measurable. Person-centred teams improve outcomes of patients. Person-centred teamwork was specifically developed to assist low compliance areas in hospitals.
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Affiliation(s)
- Alida Viljoen
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronell Leech
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Hurley ET, Calvo E, Collin P, Claro R, Magosch P, Schoierer O, Karelse A, Rasmussen J. European Society for Surgery of the Shoulder and Elbow (SECEC) rotator cuff tear registry Delphi consensus. JSES Int 2024; 8:478-482. [PMID: 38707551 PMCID: PMC11064705 DOI: 10.1016/j.jseint.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background The purpose of this study was to establish consensus statements via a Delphi process on the factors that should be included in a registry for those patients undergoing rotator cuff tear treatment. Methods A consensus process on the treatment of rotator cuff utilizing a modified Delphi technique was conducted. Fifty-seven surgeons completed these consensus statements and 9 surgeons declined. The participants were members of the European Society for Surgery of the Shoulder and Elbow committees representing 23 European countries. Thirteen questions were generated regarding the diagnosis and follow-up of rotator cuff tears were distributed, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80%-89% agreement, whereas strong consensus was defined as 90%-99% agreement, and unanimous consensus was defined by 100% agreement with a proposed statement. Results Of the 13 total questions and consensus statements on rotator cuff tears, 1 achieved unanimous consensus, 6 achieved strong consensus, 5 achieved consensus, and 1 did not achieve consensus. The statement that reached unanimous consensus was that the factors in the patient history that should be evaluated and recorded in the setting of suspected/known rotator cuff tear are age, gender, comorbidities, smoking, traumatic etiology, prior treatment including physical therapy/injections, pain, sleep disturbance, sports, occupation, workmen's compensation, hand dominance, and functional limitations. The statement that did not achieve consensus was related to the role of ultrasound in the initial diagnosis of patients with rotator cuff tears. Conclusion Nearly all questions reached consensus among 57 European Society for Surgery of the Shoulder and Elbow members representing 23 different European countries. We encourage surgeons to use this minimum set of variables to establish rotator cuff registries and multicenter studies. By adapting and using compatible variables, data can more easily be compared and eventually merged across countries.
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Affiliation(s)
- Eoghan T. Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Emilio Calvo
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rui Claro
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | | | | | | | | | - SECEC Committee Members
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- American Hospital of Paris, Neuilly-sur-Seine, France
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- University Medical Center, Heidelberg, Germany
- Ghent University Hospital, Ghent, Belgium
- Herlev and Gentofte University Hospital, Hellerup, Denmark
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Ziemer LS, De Haan CE, Cardwell AL, Gambino JM, McLear RC, Silverman S, Spattini G, Thompson M. ACVR and ECVDI consensus statement for teleradiology. Vet Radiol Ultrasound 2024; 65:288-293. [PMID: 38507602 DOI: 10.1111/vru.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024] Open
Abstract
Increased demand for the interpretation of diagnostic images by board-certified radiologists and profound advancements in technology have led to extremely rapid growth in the field of veterinary teleradiology over the past decade. The aim of this consensus statement is to provide a guideline for best practices for quality and safety in veterinary teleradiology. The statement addresses appropriate image acquisition and transmission, the creation of teleradiology submissions, quality control in teleradiology, and appropriate documentation of imaging reports, as deficiencies in any of these areas may directly affect the standard of patient care. The consensus statement may be used as a guide for radiologists, primary care veterinarians, technicians, and students for the use of teleradiology in practice.
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Affiliation(s)
- Lisa S Ziemer
- Antech Imaging Services, Philadelphia, Pennsylvania, USA
| | | | - Amy L Cardwell
- Ocean State Veterinary Specialists, East Greenwich, Rhode Island, USA
| | | | | | | | | | - Margret Thompson
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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Macaluso FS, Caprioli F, Benedan L, Bezzio C, Caporali R, Cauli A, Chimenti MS, Ciccia F, D'Angelo S, Fantini MC, Festa S, Iannone F, Lubrano E, Mariani P, Papi C, Provenzano G, Pugliese D, Rispo A, Saibeni S, Salvarani C, Variola A, Zenga M, Armuzzi A, Orlando A, Gerli R. The management of patients with inflammatory bowel disease-associated spondyloarthritis: Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and Italian Society of Rheumatology (SIR) recommendations based on a pseudo-Delphi consensus. Autoimmun Rev 2024; 23:103533. [PMID: 38521214 DOI: 10.1016/j.autrev.2024.103533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Spondyloarthritis (SpA) is the most frequent extraintestinal manifestation in patients with inflammatory bowel diseases (IBD). When IBD and spondyloarthritis coexist, musculoskeletal and intestinal disease features should be considered when planning a therapeutic strategy. Treatment options for IBD and SpA have expanded enormously over the last few years, but randomized controlled trials with specific endpoints focused on SpA are not available in the IBD setting. To address this important clinical topic, the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and the Italian Society of Rheumatology (SIR) jointly planned to draw updated therapeutic recommendations for IBD-associated SpA using a pseudo-Delphi method. This document presents the official recommendations of IG-IBD and SIR on the management of IBD-associated SpA in the form of 34 statements and 4 therapeutic algorithms. It is intended to be a reference guide for gastroenterologists and rheumatologists dealing with IBD-associated SpA.
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Affiliation(s)
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Laura Benedan
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Roberto Caporali
- Rheumatology Unit, Department of Clinical and Community Sciences, University of Milan, ASST Gaetano Pini-CTO, Milan, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, AOU and University of Cagliari, Cagliari, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Naples, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | | | | | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy
| | - Paolo Mariani
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | | | | | - Daniela Pugliese
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; IBD Unit, CEMAD, Digestive Diseases Center, Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Simone Saibeni
- IBD Center, Gastroenterology Unit, Rho Hospital ASST Rhodense, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, Italy
| | | | - Mariangela Zenga
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine & Surgery, University of Perugia, Italy
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Galloway AM, Keene DJ, Anderson A, Holton C, Redmond AC, Siddle HJ, Richards S, Perry DC. Clinical consensus recommendations for the non-surgical treatment of children with Perthes' disease in the UK. Bone Joint J 2024; 106-B:501-507. [PMID: 38688522 DOI: 10.1302/0301-620x.106b5.bjj-2023-1283.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes' disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. Methods A two-round, modified Delphi study was conducted online. An advisory group of children's orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to 'Exercises', 'Physical activity', 'Education/information sharing', 'Input from other services', and 'Monitoring assessments'. The survey was shared with clinicians who regularly treat children with Perthes' disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as 'points to consider'. Results A total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for 'points to consider'. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes' disease and their families. Conclusion Children's orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes' disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore.
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Affiliation(s)
- Adam M Galloway
- University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David J Keene
- University of Exeter, Exeter, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Consultant Podiatrist, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Richards
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Daniel C Perry
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
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Snyder CW, Kristiansen KO, Jensen AR, Sribnick EA, Anders JF, Chen CX, Lerner EB, Conti ME. Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society. J Trauma Acute Care Surg 2024; 96:799-804. [PMID: 37880842 DOI: 10.1097/ta.0000000000004181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. METHODS Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. RESULTS The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. CONCLUSION This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level II.
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Affiliation(s)
- Christopher W Snyder
- From the Division of Pediatric Surgery (C.W.S.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Department of Anesthesia (K.O.K., M.E.C.), Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire; Division of Pediatric Surgery (A.R.J.), Benioff Children's Hospital, University of California-San Francisco, San Francisco, California; Department of Pediatric Neurosurgery (E.A.S.), Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Emergency Medicine (J.F.A.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatric Anesthesiology (C.X.C.), Seattle Children's Hospital, Seattle, Washington; and Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York
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Montesanti S, Sehgal A, Zaeem L, McManus C, Squires S, Silverstone P. Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool. BMC PRIMARY CARE 2024; 25:146. [PMID: 38684969 PMCID: PMC11059610 DOI: 10.1186/s12875-024-02396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta's PHC settings by exploring readiness factors. METHODS An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators. RESULTS Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta. CONCLUSION The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.
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Affiliation(s)
- Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Anika Sehgal
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lubna Zaeem
- Islamic Family and Social Services Association, Edmonton, AB, Canada
| | - Carrie McManus
- Sagesse Domestic Violence Prevention Society, Calgary, AB, Canada
| | - Suzanne Squires
- Westgrove Clinic, Westview Primary Care Network, Spruce Grove, AB, Canada
| | - Peter Silverstone
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Curtin M, Cruice M, Morgan G, Herman R. Assessing parent-child interaction with deaf and hard of hearing infants aged 0-3 years: An international multi-professional e-Delphi. PLoS One 2024; 19:e0301722. [PMID: 38683866 PMCID: PMC11057743 DOI: 10.1371/journal.pone.0301722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Most deaf babies are born to hearing families who do not yet have the skills to communicate effectively with their child. Adaptations to communication are important because the quality of parent-child interaction (PCI) predicts how a deaf child develops language. Teachers of Deaf children and Speech and Language Therapists support families with communication in the home. Currently, there are no assessments that appraise how a parent interacts with their deaf baby. Previous research has identified which parent behaviours and approaches are used in PCI assessments in research and practice. The current paper forms consensus on the core content and best practices of a new PCI tool for deaf children aged 0-3 years. METHODS An international sample of expert academics and practitioners (n = 83) were recruited to take part in a two-round modified electronic Delphi study. Participants were presented with 69 statements focusing on (i) which parent behaviours were important in assessment (ii) the methods to be used in PCI assessment. Participants rated the extent to which they agreed or disagreed with each statement on a five-point Likert scale and gave comments to support their response. Consensus was defined as >80% of participants rating the statement as a (4) 'highly important' or a (5) 'essential'. If consensus was not reached, participant comments were used to generate new statements which were rated in the second round. This project involved a patient and public involvement (PPI) group of hearing and deaf parents and professionals to design and guide the study. RESULTS Consensus was achieved on 52 statements and ranged from 80-99%. A further six statements were additionally included. Within the 58 statements included, 36 were parent behaviours which centred on the parent's observation of, and response to, their child's behaviour and/or language. The remaining 22 statements focused on methods used in the assessment such as parents having their PCI filmed, parents having the opportunity to review the video and assess themselves alongside a professional, and parents being involved in subsequent goal setting. CONCLUSIONS This e-Delphi presented the parent behaviours and methods of assessment to be included in a new PCI tool for deaf children. Future co-production work and acceptability and feasibility testing are discussed.
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Affiliation(s)
- Martina Curtin
- Speech and Language Therapy (Paediatrics, Community), Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Language and Communication Science, City, University of London, London, United Kingdom
| | - Madeline Cruice
- Language and Communication Science, City, University of London, London, United Kingdom
| | - Gary Morgan
- Universitat Oberta de Catalunya, Psychology and Education Sciences, Barcelona, Spain
| | - Rosalind Herman
- Language and Communication Science, City, University of London, London, United Kingdom
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95
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Packendorff N, Magnusson C, Wibring K, Axelsson C, Hagiwara MA. Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care. Scand J Trauma Resusc Emerg Med 2024; 32:38. [PMID: 38685120 PMCID: PMC11059688 DOI: 10.1186/s13049-024-01209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. METHODS The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. RESULTS From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. CONCLUSION This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.
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Affiliation(s)
- Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Carl Magnusson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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96
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Nasa P, Bos LD, Estenssoro E, van Haren FM, Serpa Neto A, Rocco PR, Slutsky AS, Schultz MJ. Consensus statements on the utility of defining ARDS and the utility of past and current definitions of ARDS-protocol for a Delphi study. BMJ Open 2024; 14:e082986. [PMID: 38670604 PMCID: PMC11057280 DOI: 10.1136/bmjopen-2023-082986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS), marked by acute hypoxemia and bilateral pulmonary infiltrates, has been defined in multiple ways since its first description. This Delphi study aims to collect global opinions on the conceptual framework of ARDS, assess the usefulness of components within current and past definitions and investigate the role of subphenotyping. The varied expertise of the panel will provide valuable insights for refining future ARDS definitions and improving clinical management. METHODS A diverse panel of 35-40 experts will be selected based on predefined criteria. Multiple choice questions (MCQs) or 7-point Likert-scale statements will be used in the iterative Delphi rounds to achieve consensus on key aspects related to the utility of definitions and subphenotyping. The Delphi rounds will be continued until a stable agreement or disagreement is achieved for all statements. ANALYSIS Consensus will be considered as reached when a choice in MCQs or Likert-scale statement achieved ≥80% of votes for agreement or disagreement. The stability will be checked by non-parametric χ2 tests or Kruskal Wallis test starting from the second round of Delphi process. A p-value ≥0.05 will be used to define stability. ETHICS AND DISSEMINATION The study will be conducted in full concordance with the principles of the Declaration of Helsinki and will be reported according to CREDES guidance. This study has been granted an ethical approval waiver by the NMC Healthcare Regional Research Ethics Committee, Dubai (NMCHC/CR/DXB/REC/APP/002), owing to the nature of the research. Informed consent will be obtained from all panellists before the start of the Delphi process. The study will be published in a peer-review journal with the authorship agreed as per ICMJE requirements. TRIAL REGISTRATION NUMBER NCT06159465.
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Affiliation(s)
- Prashant Nasa
- Department of Intensive Care, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, UAE
| | - Lieuwe D Bos
- Department of Intensive Care, Amsterdam UMC, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Elisa Estenssoro
- Facultad de Ciencias Médicas, Universidad Nacional de la Plata, La Plata, Argentina
- Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Argentina
| | - Frank Mp van Haren
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam UMC, Amsterdam, The Netherlands
- Monash University, Clayton, VIC, Australia
- Austin Hospital, Heidelberg, VIC, Australia
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Patricia Rm Rocco
- Laboratory of Pulmonary Investigations, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, UK
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, Vienna, Austria
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97
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Moyal-Smith R, Elam M, Boulanger J, Balaban R, Cox JE, Cunningham R, Folcarelli P, Germak MC, O'Reilly K, Parkerton M, Samuels NW, Unsworth F, Sato L, Benjamin E. Reducing the Risk of Delayed Colorectal Cancer Diagnoses Through an Ambulatory Safety Net Collaborative. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00121-1. [PMID: 38763793 DOI: 10.1016/j.jcjq.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND An estimated 12 million adults in the United States experience delayed diagnoses and other diagnostic errors annually. Ambulatory safety nets (ASNs) are an intervention to reduce delayed diagnoses by identifying patients with abnormal results overdue for follow-up using registries, workflow redesign, and patient navigation. The authors sought to co-design a collaborative and implement colorectal cancer (CRC) ASNs across various health care settings. METHODS A working group was convened to co-design implementation guidance, measures, and the collaborative model. Collaborative sites were recruited through a medical professional liability insurance program and chose to begin with developing an ASN for positive at-home CRC screening or overdue surveillance colonoscopy. The 18-month Breakthrough Series Collaborative ran from January 2022 to July 2023, with sites continuing to collect data while sustaining their ASNs. Data were collected from sites monthly on patients in the ASN, including the proportion that was successfully contacted, scheduled, and completed a follow-up colonoscopy. RESULTS Six sites participated; four had an operational ASN at the end of the Breakthrough Series, with the remaining sites launching three months later. From October 2022 through February 2024, the Collaborative ASNs collectively identified 5,165 patients from the registry as needing outreach. Among patients needing outreach, 3,555 (68.8%) were successfully contacted, 2,060 (39.9%) were scheduled for a colonoscopy, and 1,504 (29.1%) completed their colonoscopy. CONCLUSION The Collaborative successfully identified patients with previously abnormal CRC screening and facilitated completion of follow-up testing. The CRC ASN Implementation Guide offers a comprehensive road map for health care leaders interested in implementing CRC ASNs.
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98
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Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange IV CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau A, Senussi MH, Sorrell VL, West FM, Sarwal A. Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus. POCUS JOURNAL 2024; 9:95-108. [PMID: 38681157 PMCID: PMC11044939 DOI: 10.24908/pocus.v9i1.17240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.
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Affiliation(s)
- Brandon Oto
- Bridgeport Hospital, Yale New Haven HealthBridgeport, CTUSA
| | | | - Leon Chen
- Memorial Sloan Kettering Cancer CenterNew York, NYUSA
| | | | - Ria Dancel
- University of North Carolina at Chapel HillChapel Hill, NCUSA
| | - Steven Fox
- University of Alabama at BirminghamBirmingham, ALUSA
| | | | | | | | | | | | | | | | | | - Michael J Lanspa
- Intermountain Medical Center and the University of UtahMurray , UTUSA
| | - Viveta Lobo
- Stanford University School of MedicineStanford, CAUSA
| | | | | | | | - Vincent L. Sorrell
- Gill Heart and Vascular Institute, University of KentuckyLexington, KYUSA
| | | | - Aarti Sarwal
- Wake Forest University School of MedicineWinston-Salem, NCUSA
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Maaß L, Zeeb H, Rothgang H. International perspectives on measuring national digital public health system maturity through a multidisciplinary Delphi study. NPJ Digit Med 2024; 7:92. [PMID: 38609458 PMCID: PMC11014962 DOI: 10.1038/s41746-024-01078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, to which 54 experts from diverse continents and academic fields actively contributed to at least one of three rounds. 54 experts participated in developing and rating multidisciplinary quality indicators to measure the maturity of national digital public health systems. Participants established consensus on these indicators with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone in advancing DiPH on a global scale.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Department Prevention and Evaluation, Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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100
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Campbell S, Knox K, Lazarus S, Maye J. Consensus Guidelines for Assessment and Comprehensive Outcomes Evaluation in Rural Pain Clinics. Pain Manag Nurs 2024:S1524-9042(24)00105-X. [PMID: 38609803 DOI: 10.1016/j.pmn.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 04/14/2024]
Abstract
Recent advancements in nurse anesthesiology fellowship training programs have helped to establish advanced pain management services for rural communities. Consensus guidelines to direct the rural provider toward the most valid and reliable measures for pain assessment and functional outcomes evaluation are not presently available. The primary aim of this initiative was to establish consensus guidelines for a comprehensive outcome evaluation program with specific time intervals for assessments that can be utilized by all rural pain clinics. The American Association of Nurse Anesthesiology Nonsurgical Pain Management Advisory Panel members provided formative and expert feedback for this initiative. The Delphi model was utilized to achieve consensus through multiple rounds of surveys. Items achieving >70% agree/strongly agree were kept; items with >70% disagree/strongly disagree were rejected; items meeting neither advanced to the following round for evaluation until consensus was met. During round I, consensus was reached for: (1) the use of the Numerical Rating Scale for pain severity; and (2) timing of pain severity & functional pain outcomes on each office visit and before/after each intervention. Round II, consensus was achieved for: (1) the use of Wong-Baker FACES Pain Rating Scale as a suitable instrument when literacy or communication pose a barrier but not as a primary assessment; and (2) the use of the Brief Pain Index-Short Form for functional outcome measures. During round III, consensus was reached for: (1) the use of the Oswestry Disability Index as a functional outcome measure; and (2) pain reassessment being performed within 14 days of intervention. This initiative provides rural pain clinics with a comprehensive outcome evaluation program with specific time intervals for assessments.
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Affiliation(s)
- Sarah Campbell
- University of South Florida, College of Nursing, Tampa, Florida
| | - Karissa Knox
- University of South Florida, College of Nursing, Tampa, Florida
| | - Sarah Lazarus
- University of South Florida, College of Nursing, Tampa, Florida
| | - John Maye
- University of South Florida, College of Nursing, Tampa, Florida.
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