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Ceresoli GL, Rossi G, Agustoni F, Bonomi L, Borghetti P, Bulotta A, Casartelli C, Cerea G, Colonese F, Del Signore E, Finocchiaro G, Gianoncelli L, Grisanti S, Maiolani M, Pagni F, Proto C, Rijavec E, Vittimberga I, Arcangeli S, Filippi AR. Management of patients with extensive small-cell lung cancer in the immunotherapy era: An Italian consensus through a Delphi approach. Crit Rev Oncol Hematol 2024; 199:104247. [PMID: 38307393 DOI: 10.1016/j.critrevonc.2023.104247] [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: 01/30/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Immunotherapy represented a turning point for treating extensive small-cell lung cancer (ES-SCLC). Although, many issues remain debated. METHODS A group of Italian medical and radiation oncologists with expertise in managing patients with ES-SCLC developed a list of statements divided in six areas of interest. The Delphi method was used to assess the consensus on the defined list of statements. RESULTS 32 statements were included in the final list to be voted by the Delphi panel, and 26 reached a consensus on the agreement. A prompt involvement of a multidisciplinary team is a priority to provide an integrated treatment strategy. First-line recommended treatment is immunotherapy in combination with platinum-based chemotherapy and etoposide for four cycles followed by maintenance immunotherapy. CONCLUSIONS While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool to guide the management of ES-SCLC patients in daily practice.
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Affiliation(s)
| | - Giulio Rossi
- Pathology Unit, Hospital Institute Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucia Bonomi
- Unit of Oncology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | | | - Giulio Cerea
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, IEO, Milan, Italy
| | - Giovanna Finocchiaro
- Medical Oncology and Hematologic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Rozzano, Italy
| | - Letizia Gianoncelli
- Medical Oncology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Maiolani
- U.O.C Oncologia Medica ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, University Milan Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Erika Rijavec
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Loscalzo SM, White LJ, Rosenblatt S, Woods-Hill CZ, Teran F, Wolfe H, Himebauch AS, Glau C, Nishisaki A, Conlon TW. Ultrasound in Cardiopulmonary Arrest and Resuscitation: Constructing Comprehensive Implementation Frameworks in High-Risk Settings. Pediatr Emerg Care 2024; 40:469-473. [PMID: 38713851 DOI: 10.1097/pec.0000000000003165] [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: 05/09/2024]
Abstract
OBJECTIVES Information obtained from point-of-care ultrasound during cardiopulmonary arrest and resuscitation (POCUS-CA) can be used to identify underlying pathophysiology and provide life-sustaining interventions. However, integration of POCUS-CA into resuscitation care is inconsistent. We used expert consensus building methodology to help identify discrete barriers to clinical integration. We subsequently applied implementation science frameworks to generate generalizable strategies to overcome these barriers. MEASURES AND MAIN RESULTS Two multidisciplinary expert working groups used KJ Reverse-Merlin consensus building method to identify and characterize barriers contributing to failed POCUS-CA utilization in a hypothetical future state. Identified barriers were organized into affinity groups. The Center for Implementation Research (CFIR) framework and Expert Recommendations for Implementing Change (CFIR-ERIC) tool were used to identify strategies to guide POCUS-US implementation. RESULTS Sixteen multidisciplinary resuscitation content experts participated in the working groups and identified individual barriers, consolidated into 19 unique affinity groups that mapped 12 separate CFIR constructs, representing all 5 CFIR domains. The CFIR-ERIC tool identified the following strategies as most impactful to address barriers described in the affinity groups: identify and prepare champions, conduct local needs assessment, conduct local consensus discussions, and conduct educational meetings. CONCLUSIONS KJ Reverse-Merlin consensus building identified multiple barriers to implementing POCUS-CA. Implementation science methodologies identified and prioritized strategies to overcome barriers and guide POCUS-CA implementation across diverse clinical settings.
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Affiliation(s)
| | - Lauren J White
- Department of Pediatrics, Critical Care Medicine, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT
| | - Samuel Rosenblatt
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | | | - Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY
| | | | - Adam S Himebauch
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Christie Glau
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Akira Nishisaki
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Thomas W Conlon
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
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Gagnon J, Chartrand J, Probst S, Lalonde M. Content of a wound care mobile application for newly graduated nurses: an e-Delphi study. BMC Nurs 2024; 23:331. [PMID: 38755617 PMCID: PMC11097557 DOI: 10.1186/s12912-024-02003-x] [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: 11/18/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses. METHODS Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined. RESULTS In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus. CONCLUSIONS The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses' perspectives on the competencies anticipated from newly graduated nurses.
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Affiliation(s)
- Julie Gagnon
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Département des sciences de la santé, Université du Québec à Rimouski, Rimouski, Québec, G5L 3A1, Canada.
| | - Julie Chartrand
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, 47 Avenue de Champel, Geneva, 1206, Switzerland
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton VIC 3168, Melbourne, Australia
- College of Medicine, Nursing and Health Sciences, University of Galway, University Road, Galway, H91TK33, Ireland
- Care Directorate, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Institut du Savoir Montfort, Montfort Hospital, 745A Montréal Road, Suite 202, Ottawa, ON, K1K 0T1, Canada
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Vu TA, Fenwick E, Doshi K, Gupta P, Quek SY, Chen C, Ting S, Ng ASL, Yap P, Yeo D, Milea D, Lamoureux E. Feasibility, comprehensibility and acceptability of the VISION-Cog, a novel tool to assess cognitive impairment in visually impaired older adults: a cross-sectional pilot study in Singapore. BMJ Open 2023; 13:e072151. [PMID: 37657840 PMCID: PMC10476112 DOI: 10.1136/bmjopen-2023-072151] [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: 01/23/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES We pilot-tested the VISually Independent test battery Of NeuroCOGnition (VISION-Cog) to determine its feasibility, comprehensibility and acceptability in evaluating cognitive impairment (CI) in visually impaired older Asian adults. DESIGN The VISION-Cog was iteratively fine-tuned through pilot studies and expert-panel discussion. In the first pilot study (Stage 1), we recruited 15 visually impaired and cognitively normal participants aged ≥60 years to examine the pilot VISION-Cog's feasibility (length of time to administer), comprehensibility (clarity of instructions) and acceptability (participant burden). We then presented the pilot results to the expert panel (Stage 2) who decided via agreement on a revised version of the VISION-Cog. Subsequently, we conducted a second pilot study (Stage 3) on another four participants to ascertain improvement in feasibility, comprehensibility and acceptability of the revised version. SETTING Singapore Eye Research Institute. PARTICIPANTS Nineteen Asian adults aged ≥60 years with visual impairment (defined as near visual acuity worse than N8) were recruited. OUTCOME MEASURE Revised VISION-Cog. RESULT The VISION-Cog was deemed feasible, taking approximately 60 min to complete on average. All participants agreed that the test instructions were clear, and the battery did not cause undue discomfort or frustration. The data collector rated all tests as very user-friendly (score of 5/5). Minor modifications to the pilot VISION-Cog were suggested by the panel to improve its safety, clarity of instructions and content validity, which were incorporated and iteratively tested in the second pilot study until no further issues emerged. CONCLUSIONS Using an iterative mixed-methods process, we have developed a feasible, comprehensible and acceptable 5-domain and 9-item visually independent VISION-Cog test battery suitable to assist CI diagnosis in older adults with visual impairment. We will assess its diagnostic potential against clinician-based assessment of CI in subsequent phases.
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Affiliation(s)
- Tai Anh Vu
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Kinjal Doshi
- Department of Psychology, National University of Singapore, Singapore
| | - Preeti Gupta
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Shin Yi Quek
- Department of Psychology, Ng Teng Fong General Hospital, Singapore
| | - Christopher Chen
- Departments of Pharmacology and Psychological Medicine, National University of Singapore, Singapore
| | - Simon Ting
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Donald Yeo
- KALL Psychological & Counselling Services Pte Ltd, Singapore
| | - Dan Milea
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
- Rothschild Foundation Hospital, Paris, France
| | - Ecosse Lamoureux
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia
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Alahmed S, Win K, Frost S, Al Mutair A, Fernandez R, Meedya S. Cultural and linguistic appropriateness of a web-based breastfeeding educational resource for Saudi women: Consensus development conference approach. Nurse Educ Pract 2023; 71:103717. [PMID: 37453369 DOI: 10.1016/j.nepr.2023.103717] [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: 03/06/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
AIM The purpose of this study was to investigate the cultural and linguistic appropriateness of the content, images and layout of the web-based breastfeeding educational resource for Saudi women using a consensus development approach. BACKGROUND Although the World Health Organization highly recommends exclusive breastfeeding, there is a decline in breastfeeding rates in Saudi Arabia, especially during hospital stay. The combining of health professional support with e-technology tools has been proposed as a method to increase exclusive breastfeeding. However, the cultural and linguistic appropriateness of an e-technology-based approach has not been explored in Saudi women. METHODS After developing a content draft of the web-based breastfeeding educational resource specific to Saudi culture, an online consensus development conference was organised with ten participants including two university researchers and eight health care providers to investigate the cultural and linguistic appropriateness of the educational content. The participants from Saudi Arabia were Saudi mothers who had breastfeeding experiences and were key maternity health professionals employed at the Maternity and Children Hospital of Dammam, Saudi Arabia. The SQUIRE checklist was used in the reporting of this study. RESULTS Feedback received prior to the meeting showed that 81% of the content was acceptable and minor changes were required. Changes were made to the content based on the suggestions and feedback received. The consensus group accepted all the changes and the content was finalised. CONCLUSIONS The online consensus development conference was found to be a very convenient way to decide on the cultural and linguistic appropriateness of the content of the web-based breastfeeding educational resource allowing the participation of experts from different countries; this was considered a critical step in ensuring the successful implementation of the intervention.
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Affiliation(s)
- Salma Alahmed
- School of Nursing, University of Wollongong, Australia; College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Khin Win
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Australia
| | - Steve Frost
- School of Nursing, University of Wollongong, Australia
| | - Abbas Al Mutair
- School of Nursing, University of Wollongong, Australia; College of Nursing, Princess Nourah Bent Abdulrahman University, Riyadh, Saudi Arabia; Research Center, Almoosa Specialist Hospital, Princess Nourah Bent Abdulrahman University, Riyadh, Saudi Arabia
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Australia
| | - Shahla Meedya
- School of Nursing, University of Wollongong, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia, University of Wollongong, Australia
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Ko JJ, Banerji S, Blais N, Brade A, Clelland C, Schellenberg D, Snow S, Wheatley-Price P, Yuan R, Melosky B. Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial. Curr Oncol 2023; 30:3817-3828. [PMID: 37185402 PMCID: PMC10137068 DOI: 10.3390/curroncol30040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
The PACIFIC trial showed a survival benefit with durvalumab through five years in stage III unresectable non-small cell lung cancer (NSCLC). However, optimal use of imaging to detect disease progression remains unclearly defined for this population. An expert working group convened to consider available evidence and clinical experience and develop recommendations for follow-up imaging after concurrent chemotherapy and radiation therapy (CRT). Voting on agreement was conducted anonymously via online survey. Follow-up imaging was recommended for all suitable patients after CRT completion regardless of whether durvalumab is received. Imaging should occur every 3 months in Year 1, at least every 6 months in Year 2, and at least every 12 months in Years 3–5. Contrast computed tomography was preferred; routine brain imaging was not recommended for asymptomatic patients. The medical oncologist should follow-up during Year 1 of durvalumab therapy, with radiation oncologist involvement if pneumonitis is suspected; medical and radiation oncologists can subsequently alternate follow-up. Some patients can transition to the family physician/community primary care team at the end of Year 2. In Years 1–5, patients should receive information regarding smoking cessation, comorbidity management, vaccinations, and general follow-up care. These recommendations provide guidance on follow-up imaging for patients with stage III unresectable NSCLC whether or not they receive durvalumab consolidation therapy.
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Sun A, Abdulkarim B, Blais N, Greenland J, Louie AV, Melosky B, Schellenberg D, Snow S, Liu G. Use of radiation therapy among patients with Extensive-stage Small-cell lung cancer receiving Immunotherapy: Canadian consensus recommendations. Lung Cancer 2023; 179:107166. [PMID: 36944282 DOI: 10.1016/j.lungcan.2023.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Thoracic radiation therapy (TRT) and prophylactic cranial irradiation (PCI) are commonly used in the management of extensive-stage small-cell lung cancer (ES-SCLC); however, Phase III trials of first-line immunotherapy often excluded these options. Guidance is needed regarding appropriate use of TRT, PCI, and magnetic resonance imaging (MRI) surveillance while new data are awaited. MATERIALS AND METHODS In two web-based meetings, a pan-Canadian expert working group of five radiation oncologists and four medical oncologists addressed eight clinical questions regarding use of radiation therapy (RT) and MRI surveillance among patients with ES-SCLC receiving immunotherapy. A targeted literature review was conducted using PubMed and conference proceedings to identify recent (January 2019-April 2022) publications in this setting. Fifteen recommendations were developed; online voting was conducted to gauge agreement with each recommendation. RESULTS After considering recently available evidence across lung cancer populations and clinical experience, the experts recommended that all patients with a response to chemo-immunotherapy, good performance status (PS), and limited metastases be considered for consolidation TRT (e.g., 30 Gy in 10 fractions). When considered appropriate after multidisciplinary team discussion, TRT can be initiated during maintenance immunotherapy. All patients who respond to concurrent chemo-immunotherapy should undergo restaging with brain MRI to guide decision-making regarding PCI versus MRI surveillance alone. MRI surveillance should be conducted for two years after response to initial therapy. PCI (e.g., 25 Gy in 10 fractions or 20 Gy in 5 fractions) can be considered for patients without central nervous system involvement who have a response to chemo-immunotherapy and good PS. Concurrent treatment with PCI and immunotherapy or with TRT, PCI, and immunotherapy is appropriate after completion of initial therapy. All recommendations were agreed upon unanimously. CONCLUSIONS These consensus recommendations provide practical guidance regarding appropriate use of RT and immunotherapy in ES-SCLC while awaiting new clinical trial data.
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Affiliation(s)
- Alexander Sun
- Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON M5G 1Z5, Canada.
| | - Bassam Abdulkarim
- McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montréal, QC H4A 3J1, Canada.
| | - Normand Blais
- Centre Hospitalier de l'Université de Montréal, University of Montréal, 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Canada.
| | - Jonathan Greenland
- Eastern Health, 300 Prince Philip Drive, St. John's, NL A1B 3V6, Canada.
| | - Alexander V Louie
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Barbara Melosky
- BC Cancer-Vancouver Centre, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | | | - Stephanie Snow
- QEII Health Sciences Centre, Dalhousie University, 5788 University Avenue, Halifax, NS B3H 1V8, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
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Kunonga TP, Hanratty B, Bower P, Craig D. A systematic review finds a lack of consensus in methodological approaches in health inequality/inequity focused reviews. J Clin Epidemiol 2023; 156:76-84. [PMID: 36813002 DOI: 10.1016/j.jclinepi.2023.02.013] [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: 10/13/2022] [Revised: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To critically review and analyze evidence synthesis articles using health inequality/inequity guidance to support their review. STUDY DESIGN AND SETTING A comprehensive, systematic search of six social science databases (1990 to May 2022) and grey literature sources was undertaken. A narrative approach to synthesis was adopted, describing and categorizing the characteristics of included articles. A comparison of the existing methodological guides was also conducted, discussing the similarities and differences between them. RESULTS From 205 identified reviews published between 2008 and 2022, 62 (30%) focusing on health inequality/inequity, met the criteria. The reviews were diverse in terms of methodology, populations, intervention level, and clinical areas. Only 19 (31%) reviews discussed the definition of inequality/inequity. Two methodological guides were identified: (i) the PROGRESS/Plus framework and (ii) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity checklist. CONCLUSION A critique on the methodological guides reaffirms a lack of clarity or guidance on how health inequality/inequity should be considered. The PROGRESS/Plus framework narrowly focuses on dimensions of health inequality/inequity but rarely considers the pathways and interactions of these dimensions and their effect on outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity checklist on the other hand provides guidance on report. A conceptual framework is needed to show the pathways and interactions of dimensions of health inequality/inequity.
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Affiliation(s)
- Tafadzwa Patience Kunonga
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK.
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, 5th Floor, Williamson Building, Manchester, M13 9PL, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
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Scoville J, Joyce E, Harper J, Hunsaker J, Gren L, Porucznik C, Kestle JRW. A survey and analysis of pediatric stroke protocols. J Stroke Cerebrovasc Dis 2022; 31:106661. [PMID: 35896054 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106661] [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: 04/28/2022] [Revised: 06/24/2022] [Accepted: 07/17/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives Despite their comparative rarity, about 10,000 ischemic strokes occur in children every year, and no standardized method of treatment exists. Protocols have been effective at increasing diagnosis accuracy and treatment efficacy in adults, but little has been done to evaluate such tools in children. A survey was developed to identify the proportion of pediatric hospitals that have stroke protocols and analyze the components used for diagnosis and treatment to identify consensus. Materials and methods Physicians at 50 pediatric hospitals that contributed to the Pediatric Hospital Inpatient Sample in specialties involved in the treatment of stroke (i.e, neurology, neurosurgery, radiology, pediatric intensive care, and emergency medicine) were invited in a purposive and referral manner to complete and 18-question survey. Consensus agreement was predefined as >75%. Results Of 264 surveys distributed, 93 (35%) were returned, accounting for 46 (92%) hospitals. Among the respondents, 76 (82%) reported the presence of a pediatric stroke protocol at their hospital. Consensus agreement was reached in 9 components, including the use of intravenous tissue plasminogen activator (90%) and mechanical thrombectomy (77%) as treatments for acute stroke. Consensus agreement was not reached in 10 components, including the use of prehospital (16%) and emergency department (59%) screening tools and a centralized contact method (57%). Conclusions Pediatric ischemic stroke is a potentially devastating disease that is potentially reversible if treated early. Most pediatric hospitals have developed stroke protocols to aid in diagnosis and treatment, but there is a lack of consensus on what the protocols should contain.
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Affiliation(s)
- Jonathan Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84123, USA; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84123, USA
| | - Jonathan Harper
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joshua Hunsaker
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lisa Gren
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Christina Porucznik
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - John R W Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84123, USA
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Jetté N, Kirkpatrick M, Lin K, Fernando SMS, French JA, Jehi L, Kumlien E, Triki CC, Wiebe S, Wimshurst J, Brigo F. What is a clinical practice guideline? A roadmap to their development. Special report from the Guidelines Task Force of the International League Against Epilepsy. Epilepsia 2022; 63:1920-1929. [PMID: 35722680 DOI: 10.1111/epi.17312] [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: 01/18/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Clinical practice guidelines (CPGs) are statements that provide evidence-based recommendations aimed at optimizing patient care. However, many other documents are often published as "guidelines" when they are not; these documents, although also important in clinical practice, are usually not systematically produced following rigorous processes linking the evidence to the recommendations. Specifically, the International League Against Epilepsy (ILAE) guideline development toolkit aims to ensure that high-quality CPGs are developed to fill knowledge gaps and optimize the management of epilepsy. In addition to adhering to key methodological processes, guideline developers need to consider that effective CPGs should lead to improvements in clinical processes of care and health care outcomes. This requires monitoring the effectiveness of epilepsy-related CPGs and interventions to remove the barriers to epilepsy CPG implementation. This article provides an overview of what distinguishes quality CPGs from other documents and discusses their benefits and limitations. We summarize the recently revised ILAE CPG development process and elaborate on the barriers and facilitators to guideline dissemination, implementation, and adaptation.
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Affiliation(s)
- Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Katia Lin
- Neurology Division, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Sanjaya M S Fernando
- Division of Pediatric Neurology, Colombo North Teaching Hospital and the National Epilepsy Center of Colombo, Colombo, Sri Lanka
| | - Jacqueline A French
- Department of Neurology, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA
| | - Eva Kumlien
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Chahnez C Triki
- Department of Child Neurology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Samuel Wiebe
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jo Wimshurst
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Eakin MN, Bauer SE, Carr T, Dagli E, Ewart G, Garfield JL, Jaspers I, Kher S, Leone FT, Melzer AC, Moazed F, Moraes TJ, Reddy KP, Upson D, Kathuria H. Policy Recommendations to Eliminate Tobacco Use and Improve Health from the American Thoracic Society Tobacco Action Committee. Ann Am Thorac Soc 2022; 19:157-160. [PMID: 34347555 PMCID: PMC10285748 DOI: 10.1513/annalsats.202104-493ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah E. Bauer
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Carr
- American Lung Association, Chicago, Illinois
| | - Elif Dagli
- Marmara University, Health Institute Association, Istanbul, Turkey
| | - Gary Ewart
- American Thoracic Society, Washington, DC
| | - Jamie L. Garfield
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ilona Jaspers
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sucharita Kher
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Frank T. Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne C. Melzer
- Section of Pulmonary, Allergy, Critical Care and Sleep, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Farzad Moazed
- Division of Pulmonary and Critical Care Medicine, Alameda Health System, Oakland, California
| | - Theo J. Moraes
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Krishna P. Reddy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dona Upson
- Pulmonary, Critical Care and Sleep Medicine, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; and
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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12
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Romiti R, Carvalho AVED, Duarte GV. Brazilian Consensus on Psoriasis 2020 and Treatment Algorithm of the Brazilian Society of Dermatology. An Bras Dermatol 2021; 96:778-781. [PMID: 34565644 PMCID: PMC8790202 DOI: 10.1016/j.abd.2021.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ricardo Romiti
- Dermatology Department of Hospital das Clínicas da Universidade de São Paulo, SP, Brazil.
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Taylor B, South J, Robertson S, Ryan T, Wood E, King RL, Senek M, Tod A, Seymour J. Addressing current challenges in adult nursing: Describing a virtual consensus development project methodology. Nurs Open 2021; 9:900-907. [PMID: 34562307 PMCID: PMC8859052 DOI: 10.1002/nop2.1072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022] Open
Abstract
Aim This article describes the development and implementation of a virtual Consensus development project to address current challenges in adult nursing care in the UK. Design This is a Consensus Development Project (CDP). Methods The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host Consensus seminars, and consult with panel members and stakeholders. Results To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the Consensus development methodology and constructive commentary to support future Consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.
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Affiliation(s)
- Bethany Taylor
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Jane South
- School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Steve Robertson
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Emily Wood
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Rachel Louise King
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Michaela Senek
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Angela Tod
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
| | - Jane Seymour
- Division of Nursing & Midwifery, Department of Health Sciences, University of Sheffield, Sheffield, UK
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14
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Informed Application of the Standards on Support Surface Performance for Clinically Meaningful Use. Adv Skin Wound Care 2021; 33:600-606. [PMID: 33065682 DOI: 10.1097/01.asw.0000717212.46956.fc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Support Surface Standards Initiative (S3I) has evolved with the goal of standardizing language and performance evaluation of support surfaces. There is a consumer need for education about support surface standards to transfer new information with clinical relevance. OBJECTIVE To develop a framework for meaningful dialogue through consensus building that drives value-based purchasing, propose a clinically relevant path for understanding how to apply data from the standards into critical interprofessional analysis and support surface selection, and navigate the first tier of a process targeted as an educational initiative within the Standards Committee. METHODS The authors purposively sampled the S3I Tissue Integrity Group with a semi-structured qualitative survey to identify the essential components of support surfaces standard performance testing. A two-phase interview and review process was implemented within the larger S3I group to achieve consensus on content for knowledge transfer, with a threshold of 80% agreement within the Standards Committee. RESULTS Meaningful consensus was achieved on content associated with knowledge transfer of standards data. These standards will function as reliable benchmarks, enabling consumers to compare individual characteristics of one support surface to another. Product comparison will be based on the single characteristics of support surfaces and how those characteristics are relevant to the specific needs of the individual patient or patient populations, transferred in language that is meaningful to end users of the standards. CONCLUSIONS The consensus process facilitated construction of a clinically relevant, interprofessional framework for the product selection process within the Standards Committee. It will enable the next tier of educational dissemination beyond the Standards Committee to a broader base of consumers to engage in value-based purchasing with enhanced understanding of support surface performance characteristics.
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15
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Goldie K, Kerscher M, Fabi SG, Hirano C, Landau M, Lim TS, Woolery-Lloyd H, Mariwalla K, Park JY, Yutskovskaya Y. Skin Quality - A Holistic 360° View: Consensus Results. Clin Cosmet Investig Dermatol 2021; 14:643-654. [PMID: 34163203 PMCID: PMC8214518 DOI: 10.2147/ccid.s309374] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022]
Abstract
Introduction Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened. Methods A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement. Results There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy. Conclusion This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.
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Affiliation(s)
| | - Martina Kerscher
- Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | | | - Cyro Hirano
- Division of Dermatology General Polyclinic of Rio de Janeiro, Private Practice, CD Clinica Dermatologica, Rio de Janeiro, Brazil
| | - Marina Landau
- Dermatology Unit, Wolfson Medical Center, Holon, Israel
| | | | - Heather Woolery-Lloyd
- Department of Ethnic Skin Care, University of Miami Cosmetic Medicine and Research Institute, Miami Beach, FL, USA
| | | | - Je-Young Park
- Apkoo-Jung Department, Oracle Dermatology Center, Seoul, Republic of Korea
| | - Yana Yutskovskaya
- Dermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia
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16
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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17
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Edavalath M, Bharathan BP. Methodology for developing and evaluating diagnostic tools in Ayurveda - A review. J Ayurveda Integr Med 2021; 12:389-397. [PMID: 33678559 PMCID: PMC8185968 DOI: 10.1016/j.jaim.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/27/2022] Open
Abstract
Ayurveda has a holistic and person-centric approach towards health and disease, which in turn necessitates consideration of several factors in the process of a diagnostic workup. This concept of personalised diagnosis brings about a high level of variability among the clinicians with respect to their assessment methods and disease diagnosis. Developing and validating diagnostic tools for diseases enumerated in the Ayurvedic classical textbooks can help in standardising the clinical approach, even when attempting to arrive at a patient specific diagnosis. However, diagnostic research is a very less explored area in Ayurveda and there are no established standards for developing and evaluating diagnostic tools. This paper reviews the methodology for the development and validation of diagnostic tools, available in published literature and proposes to integrate this in the field of Ayurveda. The search was conducted on online databases including PubMed, Science Direct, Scopus, and Google scholar, with keywords - ayurvedic diagnosis, diagnostic tool development, validity, reliability, and diagnostic test assessment. The articles were screened based on their comprehensiveness, relevance, and feasibility, and the methodology elaborated in the selected articles was organized into a framework that can be adopted in Ayurveda. We have also tried to examine the methodological challenges of integrating the fundamentals of ayurvedic diagnosis within the current methods of diagnostic research and explored possible solutions. The proposed tool development process involves both qualitative and quantitative components, which may be carried out in three phases that include setting the diagnostic criteria, tool development and validation, and diagnostic test assessment.
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Affiliation(s)
- Mukesh Edavalath
- Department of Roganidana, VPSV Ayurveda College, Kottakkal, Kerala, India.
| | - Benil P Bharathan
- Department of Agadatantra, VPSV Ayurveda College, Kottakkal, Kerala, India
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18
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Tallouzi MO, Mathers JM, Moore DJ, Bucknall N, Calvert MJ, Murray PI, Denniston AK. Development of a Core Outcome Set for Clinical Trials in Non-infectious Uveitis of the Posterior Segment. Ophthalmology 2021; 128:1209-1221. [PMID: 33515595 DOI: 10.1016/j.ophtha.2021.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials. DESIGN Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting. PARTICIPANTS Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners. METHODS A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS. MAIN OUTCOME MEASURE Items recommended for inclusion in the COS for NIU-PS. RESULTS A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control. CONCLUSIONS This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Melanie J Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands at the University Hospitals Birmingham NHS Foundation Trust, and the University of Birmingham, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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19
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Jha V. An online survey of the changing trends of the cardiac surgeries in the era of COVID-19. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Robinson DAG, Snow S, Brade A, Ho C, Wheatley-Price P, Blais N, Cheema P, Swaminath A. Applicability of the PACIFIC trial results in patients not eligible for the PACIFIC trial: Canadian rapid consensus statement and recommendations. Cancer Treat Res Commun 2020; 25:100265. [PMID: 33310367 DOI: 10.1016/j.ctarc.2020.100265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The PACIFIC study established durvalumab as a standard of care for consolidation therapy in patients treated with radical intent chemoradiation for stage III inoperable non-small cell lung cancer. In clinical practice, many patients are not eligible for trials, yet radical intent chemoradiation may still be used. METHODS A virtual anonymous tumour board Delphi-model was used in order to generate consensus on the use of durvalumab in six clinical situations where chemoradiation is used in clinical practice and recommended in guidelines, yet not PACIFIC eligible. Two anonymous iterations were sent and recommendations were circulated for approval and comment. Results are presented using a modified PICOT format (patients, intervention, control, outcomes, and ongoing trials). RESULTS In three of the scenarios, consensus was reached and recommendations were for the use of consolidation durvalumab, but being respectful of potentially increased toxicity/reduced benefit in comparison to PACIFIC results (treatment of stage IIB inoperable, recurrent mediastinal disease, and residual gross disease post attempted surgical removal). There was a recommendation against using durvalumab in resected stage III disease with R1 or R0 margins, even if chemoradiation were considered. There was not consensus on the use of consolidation durvalumab in the setting of oligometastatic disease or in the setting of large cell neuroendocrine carcinoma or combined small cell carcinoma. CONCLUSION Treatment of 'real-world' lung cancer often involves chemoradiation in settings outside of stage III and eligible for the PACIFIC study. This paper offers recommendations in these scenarios based on a consensus approach.
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Affiliation(s)
- Dr Andrew G Robinson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada; Departments of Oncology, Queen's University, Kingston, Canada.
| | | | - Anthony Brade
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Cheryl Ho
- University of British Columbia, Vancouver, Canada
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21
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Dominguez Torres LC, Torregrosa Almonacid L, Sánchez Maldonado W, Lasprilla N, Vargas Barato F, Niño Rodríguez ÁLVAROENRIQUE, Rosero Rosero GA, Hoyos Duque SI, Vega Peña NV, Cadavid LG, Jiménez G, Sarmiento Ramírez JG, Osorio M, Zapata Acevedo CM, Caicedo R, Medina R, Zuluaga-Zuluaga M, Herrera M, Posada JC, Coba Barrios H, León Rodríguez JP, Luna-Jaspe C, Merlano Martínez JJ, Molina Restrepo JJ, Bustillo C, Pacheco Trujillo MA. Educación quirúrgica durante la Pandemia COVID-19: Primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Este consenso presenta las recomendaciones de la División de Educación de la Asociación Colombiana de Cirugía para los programas de especialización en cirugía general del país, con el fin de enfrentar la Pandemia Covid-19 en los próximos años. Las recomendaciones se realizaron mediante un método informal de consenso de expertos conformado por todos los directores de los programas de especialización en cirugía general en Colombia. Las principales recomendaciones se relacionan con los procesos de selección en los programas, investigación, bioseguridad, vigilancia de volumen operatorio, evaluación, simulación y virtualidad, rotaciones especiales, esquemas de trabajo y evaluación de la calidad programática.
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22
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D. J Ren Nutr 2020; 31:132-143. [PMID: 32586712 DOI: 10.1053/j.jrn.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022] Open
Abstract
We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick, Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan, Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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Uttley L, Indave BI, Hyde C, White V, Lokuhetty D, Cree I. Invited commentary-WHO Classification of Tumours: How should tumors be classified? Expert consensus, systematic reviews or both? Int J Cancer 2020; 146:3516-3521. [PMID: 32170735 PMCID: PMC7818407 DOI: 10.1002/ijc.32975] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Lesley Uttley
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited Kingdom
| | - Blanca Iciar Indave
- World Health Organization, Classification of Tumours GroupInternational Agency for Research on CancerLyonFrance
| | - Chris Hyde
- Exeter Test Group, College of Medicine and HealthUniversity of ExeterExeterUnited Kingdom
| | - Valerie White
- World Health Organization, Classification of Tumours GroupInternational Agency for Research on CancerLyonFrance
| | - Dilani Lokuhetty
- World Health Organization, Classification of Tumours GroupInternational Agency for Research on CancerLyonFrance
| | - Ian Cree
- World Health Organization, Classification of Tumours GroupInternational Agency for Research on CancerLyonFrance
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Benedetto U, Goodwin A, Kendall S, Uppal R, Akowuah E. A nationwide survey of UK cardiac surgeons' view on clinical decision making during the coronavirus disease 2019 (COVID-19) pandemic. J Thorac Cardiovasc Surg 2020; 160:968-973. [PMID: 32505456 PMCID: PMC7235560 DOI: 10.1016/j.jtcvs.2020.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND No firm recommendations are currently available to guide decision making for patients requiring cardiac surgery during the coronavirus disease 2019 (COVID-19) pandemic. Systematic appraisal of senior surgeons' consensus can be used to generate interim recommendations until data from clinical observations become available. Hence, we aimed to collect and quantitatively appraise nationwide UK consultants' opinions on clinical decision making for patients requiring cardiac surgery during the COVID-19 pandemic. METHODS We E-mailed a Web-based questionnaire to all consultant cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland mailing list on the April 17, 2020, and we predetermined to close the survey on the April 21, 2020. This survey was primarily designed to gather information on UK surgeons' opinions using 12 items. Strong consensus was predefined as an opinion shared by at least 60% of responding consultants. RESULTS A total of 86 consultant surgeons undertook the survey. All UK cardiac units were represented by at least 1 consultant. Strong consensus was achieved for the following key questions: (1) before any hospital admission for cardiac surgery, nasopharyngeal swab, polymerase chain reaction, and computed tomography of the chest should be performed; (2) the use of full personal protective equipment should to be adopted in every case by the theater team regardless of the patient's COVID-19 status; (3) the risk of COVID-19 exposure for patients undergoing heart surgery should be considered moderate to high and likely to increase mortality if it occurs; and (4) cardiac procedures should be decided based on a rapidly convened multidisciplinary team discussion for every patient. The majority believed that both aortic and mitral surgery should be considered in selected cases. The role of coronary artery bypass graft surgery during the pandemic was controversial. CONCLUSIONS In this unprecedented pandemic period, this survey provides information for generating interim recommendations until data from clinical observations become available.
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Affiliation(s)
- Umberto Benedetto
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
| | - Andrew Goodwin
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
| | - Simon Kendall
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, London, United Kingdom
| | - Enoch Akowuah
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
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Webster L, Gudin J, Raffa RB, Kuchera J, Rauck R, Fudin J, Adler J, Mallick-Searle T. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:714-723. [PMID: 31917418 PMCID: PMC7139205 DOI: 10.1093/pm/pnz356] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE An expert panel convened to reach a consensus on common misconceptions surrounding buprenorphine, a Schedule III partial µ-opioid receptor agonist indicated for chronic pain. The panel also provided clinical recommendations on the appropriate use of buprenorphine and conversion strategies for switching to buprenorphine from a full µ-opioid receptor agonist for chronic pain management. METHODS The consensus panel met on March 25, 2019, to discuss relevant literature and provide recommendations on interpreting buprenorphine as a partial µ-opioid receptor agonist, prescribing buprenorphine before some Schedule II, III, or IV options, perioperative/trauma management of patients taking buprenorphine, and converting patients from a full µ-opioid receptor agonist to buprenorphine. RESULTS The panel recommended that buprenorphine's classification as a partial µ-opioid receptor agonist not be clinically translated to mean partial analgesic efficacy. The panel also recommended that buprenorphine be considered before some Schedule II, III, or IV opioids in patients with a favorable risk/benefit profile on the basis of metabolic factors, abuse potential, and tolerability and that buprenorphine be continued during the perioperative/trauma period. In addition, switching patients from a full µ-opioid receptor agonist to buprenorphine should be considered with no weaning period at starting doses that are based on the previous opioid dose. CONCLUSIONS These recommendations provide a framework for clinicians to address most clinical scenarios regarding buprenorphine use. The overall consensus of the panel was that buprenorphine is a unique Schedule III opioid with favorable pharmacologic properties and a safety profile that may be desirable for chronic pain management.
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Affiliation(s)
| | - Jeffrey Gudin
- Department of Anesthesiology and Pain Management, Englewood Hospital and Medical Center, Englewood, New Jersey; Rutgers New Jersey Medical School, Newark, New Jersey
| | - Robert B Raffa
- College of Pharmacy, The University of Arizona Health Sciences, Tucson, Arizona
- Temple University School of Pharmacy, Philadelphia, Pennsylvania; Neumentum Inc, Palo Alto, California
| | - Jay Kuchera
- Resolute Pain Solutions, Okeechobee, Florida
| | - Richard Rauck
- Carolinas Pain Institute, Winston-Salem, North Carolina
| | - Jeffrey Fudin
- Remitigate LLC, Delmar, New York; Western New England University College of Pharmacy, Springfield, Massachusetts
- Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Jeremy Adler
- Pacific Pain Medicine Consultants, Encinitas, California
| | - Theresa Mallick-Searle
- Division of Pain Medicine, Stanford Medicine Outpatient Center, Redwood City, California, USA
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Donkor A, Luckett T, Aranda S, Vanderpuye V, Phillips J. Developing a readiness self-assessment tool for low- and middle-income countries establishing new radiotherapy services: A participant validation study. Phys Med 2020; 71:88-99. [PMID: 32109751 DOI: 10.1016/j.ejmp.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Assessing low-and middle-income countries' (LMICs') readiness to establish new radiotherapy services is an important but empirically understudied concept. The purpose of this study is to develop and confirm a core set of readiness requirements and criteria that can be used to gauge LMICs preparedness to establish radiotherapy services. METHODS Based on a systematic review and semi-structured expert interviews, a pool of requirements and criteria were generated. To confirm or disconfirm these items, we adopted a synthesised member checking process, also known as participant validation. A purposive sampling strategy was used to recruit radiotherapy experts. Items were sent via email. Each item was reviewed by participants. Qualitative comments were analysed thematically. FINDINGS Seven of the 17 experts who participated in an earlier semi-structured interview contributed to this participant validation study. The final version of the readiness self-assessment tool for LMICs establishing new radiotherapy services contains 37 requirements mapped into four readiness domains, grouped under the following categories: commitment; cooperation; capacity; and catalyst. Among 23 criteria for commitment domain, participants reviewed 22 as relevant for inclusion. The cooperation requirements considered important, included: "strategic planning team", "stakeholder involvement" and a "technical assistance plan". Capacity requirements, which were endorsed included: "responsible project manager"; "availability of radiotherapy expertise"; and "training for initial core staff". Participants' feedbacks supported the inclusion of all the requirements and criteria related to catalyst. CONCLUSION The readiness self-assessment tool is a promising planning and evaluation tool for use by stakeholders interested in expanding access to radiotherapy services in LMICs.
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Affiliation(s)
- Andrew Donkor
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, NSW, Australia; National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Ghana.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, NSW, Australia.
| | - Sanchia Aranda
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, NSW, Australia; Cancer Council Australia, NSW, Australia.
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Ghana.
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, NSW, Australia.
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Saad F, Canil C, Finelli A, Hotte SJ, Malone S, Shayegan B, So AI, Aaron L, Basappa NS, Conter HJ, Danielson B, Gotto G, Hamilton RJ, Izard JP, Kapoor A, Kolinsky M, Lalani AKA, Lattouf JB, Morash C, Morgan SC, Niazi T, Noonan KL, Ong M, Rendon RA, Sehdev S, Hew H, Park-Wyllie L, Chi KN. Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum. Can Urol Assoc J 2019; 14:E137-E149. [PMID: 31702544 DOI: 10.5489/cuaj.6082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The management of advanced prostate cancer (PCa) continues to evolve with the emergence of new diagnostic and therapeutic strategies. As a result, there are multiple areas in this landscape with a lack of high-level evidence to guide practice. Consensus initiatives are an approach to establishing practice guidance in areas where evidence is unclear. We conducted a Canadian-based consensus forum to address key controversial areas in the management of advanced PCa. METHODS As part of a modified Delphi process, a core scientific group of PCa physicians (n=8) identified controversial areas for discussion and developed an initial set of questions, which were then reviewed and finalized with a larger group of 29 multidisciplinary PCa specialists. The main areas of focus were non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), metastatic castration-resistant prostate cancer (mCRPC), oligometastatic prostate cancer, genetic testing in prostate cancer, and imaging in advanced prostate cancer. The predetermined threshold for consensus was set at 74% (agreement from 20 of 27 participating physicians). RESULTS Consensus participants included uro-oncologists (n=13), medical oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, consensus was reached in 30 questions (n=5 unanimously). Consensus was more common for questions related to biochemical recurrence, sequencing of therapies, and mCRPC. CONCLUSIONS A Canadian consensus forum in PCa identified areas of agreement in nearly 50% of questions discussed. Areas of variability may represent opportunities for further research, education, and sharing of best practices. These findings reinforce the value of multidisciplinary consensus initiatives to optimize patient care.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Christina Canil
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Shawn Malone
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Bobby Shayegan
- St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Alan I So
- Prostate Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lorne Aaron
- Service d-Urologie and Centre de la Prostate, Longueuil, QC, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Henry J Conter
- William Osler Health System, University of Western Ontario, Brampton, ON, Canada
| | - Brita Danielson
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Geoffrey Gotto
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Robert J Hamilton
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jason P Izard
- Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Anil Kapoor
- St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Michael Kolinsky
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Jean-Baptiste Lattouf
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | | | - Scott C Morgan
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Krista L Noonan
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Michael Ong
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ricardo A Rendon
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Sandeep Sehdev
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Huong Hew
- Medical Affairs, Janssen Inc, Toronto, ON, Canada
| | | | - Kim N Chi
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
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Hinkelbein J, Böhm L, Braunecker S, Genzwürker HV, Kalina S, Cirillo F, Komorowski M, Hohn A, Siedenburg J, Bernhard M, Janicke I, Adler C, Jansen S, Glaser E, Krawczyk P, Miesen M, Andres J, De Robertis E, Neuhaus C. In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM). Intern Emerg Med 2018; 13:1305-1322. [PMID: 29730774 DOI: 10.1007/s11739-018-1856-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/21/2018] [Indexed: 01/08/2023]
Abstract
By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.
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Affiliation(s)
- Jochen Hinkelbein
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany.
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany.
| | - Lennert Böhm
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Stefan Braunecker
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Critical Care, King's College Hospital, London, UK
| | | | - Steffen Kalina
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | - Fabrizio Cirillo
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Matthieu Komorowski
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | | | - Michael Bernhard
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Ilse Janicke
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department for Cardiology and Angiology, Heart Center Duisburg, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - Christoph Adler
- Department of Internal Medicine III, Heart Center of the University of Cologne, Cologne, Germany
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Eckard Glaser
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- , Gerbrunn, Germany
| | - Pawel Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Janusz Andres
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Christopher Neuhaus
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
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Lee E, Dalton J, Ngendahimana D, Bebo P, Davis A, Remley D, Smathers C, Freedman DA. Consensus modeling to develop the farmers' market readiness assessment and decision instrument. Transl Behav Med 2018; 7:506-516. [PMID: 28730383 DOI: 10.1007/s13142-017-0504-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nutrition-related policy, system, and environmental (PSE) interventions such as farmers' markets have been recommended as effective strategies for promoting healthy diet for chronic disease prevention. Tools are needed to assess community readiness and capacity factors influencing successful farmers' market implementation among diverse practitioners in different community contexts. We describe a multiphase consensus modeling approach used to develop a diagnostic tool for assessing readiness and capacity to implement farmers' market interventions among public health and community nutrition practitioners working with low-income populations in diverse contexts. Modeling methods included the following: phase 1, qualitative study with community stakeholders to explore facilitators and barriers influencing successful implementation of farmers' market interventions in low-income communities; phase 2, development of indicators based on operationalization of qualitative findings; phase 3, assessment of relevance and importance of indicators and themes through consensus conference with expert panel; phase 4, refinement of indicators based on consensus conference; and phase 5, pilot test of the assessment tool. Findings illuminate a range of implementation factors influencing farmers' market PSE interventions and offer guidance for tailoring intervention delivery based on levels of community, practitioner, and organizational readiness and capacity.
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Affiliation(s)
- Eunlye Lee
- Department of Population and Quantitative Health Sciences School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jarrod Dalton
- Department of Quantitative Health Sciences at Cleveland Clinic, Cleveland, OH, USA
| | - David Ngendahimana
- Department of Population and Quantitative Health Sciences School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Pat Bebo
- College of Food, Agricultural, and Environmental Sciences, the Ohio State University, Columbus, OH, USA
| | | | - Daniel Remley
- College of Food, Agricultural, and Environmental Sciences, the Ohio State University, Columbus, OH, USA
| | - Carol Smathers
- College of Food, Agricultural, and Environmental Sciences, the Ohio State University, Columbus, OH, USA
| | - Darcy A Freedman
- Department of Population and Quantitative Health Sciences School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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30
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Barosi G, Gale RP. Is there expert consensus on expert consensus? Bone Marrow Transplant 2018; 53:1055-1060. [DOI: 10.1038/s41409-018-0128-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 01/09/2023]
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Heringa M, van der Heide A, Floor-Schreudering A, De Smet PAGM, Bouvy ML. Better specification of triggers to reduce the number of drug interaction alerts in primary care. Int J Med Inform 2017; 109:96-102. [PMID: 29195711 DOI: 10.1016/j.ijmedinf.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Drug interaction alerts (drug-drug and drug-disease interaction alerts) for chronic medications substantially contribute to alert fatigue in primary care. The aim of this study was to determine which events require (re)assessment of a drug interaction and whether using these events as triggers in clinical decision support systems (CDSSs) would affect the alert rate. METHODS Two random 5% data samples from the CDSSs of 123 community pharmacies were used: dataset 1 and 2. The top 10 of most frequent drug interaction alerts not involving laboratory values were selected. To reach consensus on events that should trigger alerts (e.g. first time dispensing, dose modification) for these drug interactions, a two-step consensus process was used. An expert panel of community pharmacists participated in an online survey and a subsequent consensus meeting. A CDSS with alerts based on the consensus was simulated in both datasets. RESULTS Dataset 1 and 2 together contained 1,672,169 prescriptions which led to 591,073 alerts. Consensus on events requiring alerts was reached for the ten selected drug interactions. The simulation showed a reduction of the alert rate of 93.0% for the ten selected drug interactions (comparable for dataset 1 and 2), corresponding with a 28.3% decrease of the overall drug interaction alert rate. CONCLUSION By consensus-based better specification of the events that trigger drug interaction alerts in primary care, the alert rate for these drug interactions was reduced by over 90%. This promising approach deserves further investigation to assess its consequences and applicability in daily practice.
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Affiliation(s)
- Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands; Health Base Foundation, Papiermolen 36, 3994 DK Houten, The Netherlands.
| | - Annet van der Heide
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.
| | - Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.
| | - Peter A G M De Smet
- Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Marcel L Bouvy
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.
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Hernández-Borges AA, Pérez-Estévez E, Jiménez-Sosa A, Concha-Torre A, Ordóñez-Sáez O, Sánchez-Galindo AC, Murga-Herrera V, Balaguer-Gargallo M, Nieto-Moro M, Pujol-Jover M, Aleo-Luján E. Set of Quality Indicators of Pediatric Intensive Care in Spain: Delphi Method Selection. Pediatr Qual Saf 2017; 2:e009. [PMID: 30229149 PMCID: PMC6132791 DOI: 10.1097/pq9.0000000000000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This study objective was to identify, select, and define a basic set of quality indicators for pediatric intensive care in Spain. METHODS (1) Review of the literature to identify quality indicators and their defining elements and (2) selection of indicators by consensus of a group of experts using basic Delphi methodology (2 rounds) and forms distributed by email among experts from the Spanish society of pediatric intensive care. RESULTS We selected quality indicators according to their relevance and feasibility and the experts' agreement on their incorporation in the final set. We included only those indicators whose assessment was within the highest tertile and greater than or equal to 70% evaluator agreement in the final selection. Starting from an initially proposed set of 136 indicators, 31 experts first selected 43 indicators for inclusion in the second round. Twenty indicators were selected for the final set. This "top 20" set comprised 9 process indicators, 9 of results (especially treatment-associated adverse effects), and 2 indicators of structure. Several of them are classical indicators in intensive care medicine (rates of hospital-acquired infections, pressure ulcers, etc.), whereas others are specifically pediatric (eg, unrestricted parent visitation or training the parents of technology-dependent children). CONCLUSIONS We reached a consensus on a set of 20 essential quality indicators for pediatric intensive care in Spain. A significant subset reflects the peculiarities of pediatric care. We consider this subset as a starting point for future projects of network collaboration between pediatric intensive care units in Spain.
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Affiliation(s)
- Angel A. Hernández-Borges
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Pérez-Estévez
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro Jiménez-Sosa
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Andrés Concha-Torre
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Olga Ordóñez-Sáez
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Amelia C. Sánchez-Galindo
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Vega Murga-Herrera
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Mónica Balaguer-Gargallo
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Montserrat Nieto-Moro
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Montserrat Pujol-Jover
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Esther Aleo-Luján
- From the Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pediatric Intensive Care Unit, Hospital Universitario Cruces, Bilbao, Spain; Pediatric Intensive Care Unit, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitario de Salamanca, Salamanca, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatric Intensive Care Unit, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain; and Pediatric Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
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Foth T, Efstathiou N, Vanderspank-Wright B, Ufholz LA, Dütthorn N, Zimansky M, Humphrey-Murto S. The use of Delphi and Nominal Group Technique in nursing education: A review. Int J Nurs Stud 2016; 60:112-20. [PMID: 27297373 DOI: 10.1016/j.ijnurstu.2016.04.015] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/29/2016] [Accepted: 04/25/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Consensus methods are used by healthcare professionals and educators within nursing education because of their presumed capacity to extract the profession's' "collective knowledge" which is often considered tacit knowledge that is difficult to verbalize and to formalize. Since their emergence, consensus methods have been criticized and their rigour has been questioned. Our study focuses on the use of consensus methods in nursing education and seeks to explore how extensively consensus methods are used, the types of consensus methods employed, the purpose of the research and how standardized the application of the methods is. DESIGN AND DATA SOURCES A systematic approach was employed to identify articles reporting the use of consensus methods in nursing education. The search strategy included keyword search in five electronic databases [Medline (Ovid), Embase (Ovid), AMED (Ovid), ERIC (Ovid) and CINAHL (EBSCO)] for the period 2004-2014. We included articles published in English, French, German and Greek discussing the use of consensus methods in nursing education or in the context of identifying competencies. REVIEW METHOD A standardized extraction form was developed using an iterative process with results from the search. General descriptors such as type of journal, nursing speciality, type of educational issue addressed, method used, geographic scope were recorded. Features reflecting methodology such as number, selection and composition of panel participants, number of rounds, response rates, definition of consensus, and feedback were recorded. RESULTS 1230 articles were screened resulting in 101 included studies. The Delphi was used in 88.2% of studies. Most were reported in nursing journals (63.4%). The most common purpose to use these methods was defining competencies, curriculum development and renewal, and assessment. Remarkably, both standardization and reporting of consensus methods was noted to be generally poor. Areas where the methodology appeared weak included: preparation of the initial questionnaire; the selection and description of participants; number of rounds and number of participants remaining after each round; formal feedback of group ratings; definitions of consensus and a priori definition of numbers of rounds; and modifications to the methodology. CONCLUSIONS The findings of this study are concerning if interpreted within the context of the structural critiques because our findings lend support to these critiques. If consensus methods should continue being used to inform best practices in nursing education, they must be rigorous in design.
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Affiliation(s)
- Thomas Foth
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5.
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Science, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | | | | | - Nadin Dütthorn
- Münster School of Health, Department of Health Care Education, University of Applied Science in Münster, Niedersachsen, Germany
| | - Manuel Zimansky
- Department of Nursing Sciences, Faculty of Health Sciences, Osnabrück University, Niedersachsen, Germany
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