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Wang YF, Hsu YF, Fang KT, Kuo LT. Gamification in medical education: identifying and prioritizing key elements through Delphi method. MEDICAL EDUCATION ONLINE 2024; 29:2302231. [PMID: 38194415 PMCID: PMC10778414 DOI: 10.1080/10872981.2024.2302231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Gamification has gained popularity in medical education, but key elements have not been formally identified. This study aimed to generate and prioritize a list of key elements of gamification in medical education. METHODS This study utilized a two-stage approach, including the Delphi method and qualitative interview. Nineteen medical educators with expertise in gamification participated in the Delphi method stage. Experts who had more than three years of experience with gamification in medical education constituted the expert panel. The experts were then asked to rate the gamification elements using the Likert five-point scale through at least two consensus-seeking rounds. Consensus for key elements was predefined as ≥ 51% of respondents rating an element as 'important' or"very important." In the qualitative interview stage, 10 experts provided feedback on the application of these key gamification elements. RESULTS Eighteen participants (11 males and 7 females) completed the entire Delphi process for this study. After two rounds of surveys, the consensus was reached on all elements. Thirteen elements scored more than 4 points (37%) and reached the criteria of key elements of gamification in medical education. The top five key elements were integration with instruction objectives, game rules, rapid feedback, fairness, and points/scoring. The thirteen key elements for successful gamification in medical education were further organized into two main categories: (1) gamification design principles and (2) game mechanisms. CONCLUSIONS Integration with educational objectives, gamification in curriculum design and teaching methods, and balancing between the mechanisms and principles were the three key components for successful gamification. This study explored the gamification key elements, providing practical tips for medical educators in their efforts to gamify medical education. Future studies involving learners could be performed to examine the efficacy of these key elements in gamification.
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Affiliation(s)
- Yung-Fu Wang
- Department of Information Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Ya-Fang Hsu
- Department of Long-term Care and Health Promotion, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Kwo-Ting Fang
- Department of Information Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Tessaro I, Hooper SM, Watt D, Menestres D, Farrell D. Development of an online tool to support financial and legal planning in dementia. PEC INNOVATION 2024; 5:100312. [PMID: 39035235 PMCID: PMC11259804 DOI: 10.1016/j.pecinn.2024.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Objective To develop, assess, and refine an online educational tool, Plan for Clarity, to support financial and legal planning in dementia. Methods A Delphi mixed-method study with three rounds of anonymous review by lay and professional stakeholders was designed to reach consensus about the content of the online tool and explore the socio-cultural and behavioral factors that could affect access and use. Results Consensus showed that the online tool covered key information, knowledge, and communication skills for financial and legal planning. Study themes: 1) the online tool had to be easy to navigate with relevant, easily understood information; 2) people with early signs of memory difficulties would be able to use the tool; 3) a referral from a trusted source is a primary way to facilitate access and use of the tool; and 4) discussions about financial and legal issues should be held early, ahead of barriers that can block discussion. Conclusion These data suggest this online tool is relevant and feasible for dementia care and support as well as aging more generally. Innovation Plan for Clarity is innovative as an evidence and theory-driven online education tool to address financial and legal planning for dementia care, particularly among underserved older adults.
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Affiliation(s)
- Irene Tessaro
- People Designs, Inc, 1304 Broad St., Durham, NC 27705, USA
| | - Sarah M. Hooper
- UC College of the Law San Francisco, 200 McAllister St., San Francisco, CA 94102, USA
| | - Denise Watt
- UC College of the Law San Francisco, 200 McAllister St., San Francisco, CA 94102, USA
| | | | - David Farrell
- People Designs, Inc, 1304 Broad St., Durham, NC 27705, USA
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Crasta JE, Martis J, Kromalic M, Jarrott S, Wengerd L, Darragh A. Characterizing Occupational Therapy Intervention for Children on the Autism Spectrum. Am J Occup Ther 2024; 78:7805205210. [PMID: 39029101 DOI: 10.5014/ajot.2024.050734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
IMPORTANCE Occupational therapy is one of the most used interventions for children on the autism spectrum. There is a critical need to develop an operationalized list of key treatment components of usual-care occupational therapy practice for children on the autism spectrum. OBJECTIVE To identify and develop consensus on definitions and examples of key treatment components of usual-care occupational therapy for children on the autism spectrum, ages 6 to 13 yr. DESIGN We conducted a Delphi study to obtain feedback from a panel of experts. SETTING Electronic survey. PARTICIPANTS 17 occupational therapy panelists with expertise in autism intervention. OUTCOMES AND MEASURES Panelists rated the definition and example of each treatment component and provided feedback through multiple rounds of survey. RESULTS On the basis of the panelists' feedback on Delphi Round 1, the criteria rating form was revised to include four questions for the definition and example of each treatment component. Through four Delphi rounds of consensus building, we developed an operationalized list of 20 treatment components with definitions and examples that incorporated elements of usual-care occupational therapy intervention for children on the autism spectrum. CONCLUSIONS AND RELEVANCE This operationalized list of treatment components serves as a foundational framework to improve education, practice, and research of occupational therapy intervention for children on the autism spectrum. Plain-Language Summary: This study identified and developed consensus on definitions and examples of key treatment components used in usual-care outpatient occupational therapy for children on the autism spectrum. Through four rounds of consensus building with 17 occupational therapy experts in autism, we identified 20 key treatment components central to occupational therapy practice. Our results have the potential to serve as a framework to improve education, practice, and clinical research in autism.
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Affiliation(s)
- Jewel E Crasta
- Jewel E. Crasta, PhD, OTR/L, is Assistant Professor, Occupational Therapy Division, Ohio State University, Columbus;
| | - Joseph Martis
- Joseph Martis, MA, is Research Associate, Occupational Therapy Division, Ohio State University, Columbus
| | - Meredith Kromalic
- Meredith Kromalic, OTD, BS, OTR, is Research Assistant, Occupational Therapy Division, Ohio State University, Columbus
| | - Shannon Jarrott
- Shannon Jarrott, PhD, is Professor, College of Social Work, Ohio State University, Columbus
| | - Lauren Wengerd
- Lauren Wengerd, PhD, OTR/L, is Assistant Professor, NeuroTech Institute, Ohio State University, Columbus
| | - Amy Darragh
- Amy Darragh, PhD, OTR/L, FAOTA, is Professor, Occupational Therapy Division, Ohio State University, Columbus
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Zochios V, Nasa P, Yusuff H, Schultz MJ, Antonini MV, Duggal A, Dugar S, Ramanathan K, Shekar K, Schmidt M. Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements. Intensive Care Med 2024:10.1007/s00134-024-07551-z. [PMID: 39102027 DOI: 10.1007/s00134-024-07551-z] [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: 04/13/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an integral part of the management algorithm of patients with severe respiratory failure refractory to evidence-based conventional treatments. Right ventricular injury (RVI) pertaining to abnormalities in the dimensions and/or function of the right ventricle (RV) in the context of VV-ECMO significantly influences mortality. However, in the absence of a universally accepted RVI definition and evidence-based guidance for the management of RVI in this very high-risk patient cohort, variations in clinical practice continue to exist. METHODS Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions. RESULTS The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes. CONCLUSION The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.
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Affiliation(s)
- Vasileios Zochios
- Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK.
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates
| | - Hakeem Yusuff
- Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Anesthesiology, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL Della Romagna, Cesena, Italy
- PhD program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy
| | - Abhijit Duggal
- Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kollengode Ramanathan
- National University Hospital, Singapore, 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- University of Queensland, Brisbane and Bond University, Gold Coast, QLD, Australia
| | - Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Pugh P, Hemingway P, Christian M, Higginbottom G. Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process. J Hum Nutr Diet 2024; 37:952-967. [PMID: 38739861 DOI: 10.1111/jhn.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. OBJECTIVE To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. METHODS Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. RESULTS Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). CONCLUSIONS Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.
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Affiliation(s)
- Pearl Pugh
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Pippa Hemingway
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Martin Christian
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
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van der Zijden CJ. International Expert Consensus on Semantics of Multimodal Esophageal Cancer Treatment: Delphi Study. Ann Surg Oncol 2024; 31:5075-5082. [PMID: 38717548 PMCID: PMC11236823 DOI: 10.1245/s10434-024-15367-w] [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: 02/12/2024] [Accepted: 04/10/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Recent developments in esophageal cancer treatment, including studies exploring active surveillance following chemoradiotherapy, have led to a need for clear terminology and definitions regarding different multimodal treatment options. OBJECTIVE The aim of this study was to reach worldwide consensus on the definitions and semantics of multimodal esophageal cancer treatment. METHODS In total, 72 experts working in the field of multimodal esophageal cancer treatment were invited to participate in this Delphi study. The study comprised three Delphi surveys sent out by email and one online meeting. Input for the Delphi survey consisted of terminology obtained from a systematic literature search. Participants were asked to respond to open questions and to indicate whether they agreed or disagreed with different statements. Consensus was reached when there was ≥75% agreement among respondents. RESULTS Forty-nine of 72 invited experts (68.1%) participated in the first online Delphi survey, 45 (62.5%) in the second survey, 21 (46.7%) of 45 in the online meeting, and 39 (86.7%) of 45 in the final survey. Consensus on neoadjuvant and definitive chemoradiotherapy with or without surgery was reached for 27 of 31 items (87%). No consensus was reached on follow-up after treatment with definitive chemoradiotherapy. CONCLUSION(S) Consensus was reached on most statements regarding terminology and definitions of multimodal esophageal cancer treatment. Implementing uniform criteria facilitates comparison of studies and promotes international research collaborations.
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Affiliation(s)
- Charlène J van der Zijden
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Cuccia F, Franzese C, Badellino S, Borghetti P, Federico M, Marvaso G, Montesi G, Pontoriero A, Ferrera G, Alongi F, Scorsetti M. Stereotactic body radiotherapy for spinal oligometastases: a survey on patterns of practice on behalf of the Italian Association of Clinical Oncology and Radiotherapy (AIRO). Clin Exp Metastasis 2024:10.1007/s10585-024-10304-3. [PMID: 39088084 DOI: 10.1007/s10585-024-10304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The Study Group for the Biology and Treatment of the OligoMetastatic Disease on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) has conducted a national survey with the aim to depict the current patterns of practice of stereotactic body radiotherapy (SBRT) for spinal oligometastases. METHODS The Surveymonkey platform was used to send a 28-items questionnaire focused on demographic, clinical and technical aspects related to SBRT for spinal oligometastases. All the AIRO members were invited to fill the questionnaire. Data were then centralized to a single center for analysis and interpretation. RESULTS 53 radiation oncologists from 47 centers fulfilled the survey. A complete agreement was observed in proposing SBRT for spinal oligometastases, with the majority considering up to 3 concurrent spine oligometastases feasible for SBRT (73.5%), regardless of spine site (70%), vertebral segment (85%) and morphological features of the lesion (71.7%). Regarding dose prescription, fractionated regimens resulted as the preferred option, either in 3 (58.4%) or five sessions (34%), with a substantial agreement in applying a PTV-margin larger than 1 mm (almost 90% of participants), and ideally using both MRI and PET imaging to improve target volume and organs-at-risk delineation (67.9%). CONCLUSIONS This national italian survey illustrates the patterns of practice and the main issues for the indication of SBRT for spinal oligometastases. A substantial agreement in the numerical cut-off and vertebral segment involved for SBRT indication was reported, with a slight heterogeneity in terms of dose prescription and fractionation schemes.
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Affiliation(s)
- Francesco Cuccia
- Radiotherapy Unit, ARNAS Civico Hospital, Palermo, 90145, Italy.
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | | | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy
- University of Brescia, Brescia, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, ARNAS Civico Hospital, Milan, Italy
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McAlpine D, MacKay M, Grant LE, Papadopoulos A, McWhirter JE. Modernizing public health communication competencies in Canada: A survey of the Canadian public health workforce. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:664-679. [PMID: 38753267 DOI: 10.17269/s41997-024-00890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/03/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES Since the publication of the Core Competencies for Public Health in Canada in 2008, the public health and communication landscape has changed dramatically. Digital media and infodemics have shifted how practitioners must communicate and respond to health information. The age of the current competency framework, which is relied on for workforce development, alongside emerging public health challenges, have prompted calls for modernized competency statements. This study aims to (i) measure self-reported communication competence in the public health workforce, (ii) measure agreement with new communication competency statements, (iii) identify variation in agreement between sub-groups of professionals, and (iv) explore current and needed communication training. METHODS Using a mixed-methods online survey, a sample of 378 participants in various Canadian public health roles and regions were asked to rate their current communication competence and agreement with a modernized, evidence-based draft communication competency framework. The survey was distributed in both official languages through partner organizations and social media. Descriptive statistics were performed to assess agreement and variation was analyzed in relation to public health roles and experience. RESULTS While most participants self-reported communication competence, specific areas were rated lower. All 21 proposed competency statements received high agreement with some variation observed between expertise and experience levels. Demand for communication training is high. CONCLUSION Strong agreement with statements indicates support for a modernized communication competency framework among sampled professionals. Research to gather more evidence surrounding the communication demands of the public health workforce and observed variation in strong agreement for the proposed statements is underway.
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Affiliation(s)
- Devon McAlpine
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Melissa MacKay
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Lauren E Grant
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Jennifer E McWhirter
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
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Rhodin KE, Thornton SW, Leraas HJ, Beckhorn CB, Alseidi A, Greenberg JA, Shah KN, Migaly J, Tracy E. Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:874-883. [PMID: 38442205 DOI: 10.1097/acm.0000000000005685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships. METHOD Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement. RESULTS Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively). CONCLUSIONS This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.
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Raurell-Torredà M, Arrogante O, Aliberch-Raurell AM, Sánchez-Chillón FJ, Torralba-Melero M, Rojo-Rojo A, Gomez-Ibañez R, Lamoglia-Puig M, Farrés-Tarafa M, Zaragoza-García I. Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios. J Clin Nurs 2024; 33:3188-3198. [PMID: 38348543 DOI: 10.1111/jocn.17010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. BACKGROUND Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. DESIGN Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. METHODS The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. RESULTS Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. CONCLUSION NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. RELEVANCE FOR CLINICAL PRACTICE Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. PATIENT OR PUBLIC CONTRIBUTION Experts participated in the Delphi rounds and nurses in the pilot test.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Clinical Care, Universitat de Barcelona, Barcelona, Spain
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
| | - Oscar Arrogante
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | - Anna María Aliberch-Raurell
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francisco Javier Sánchez-Chillón
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Simulation Centre, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Martín Torralba-Melero
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Hospital General Universitario de Albacete, Albacete, Spain
| | - Andrés Rojo-Rojo
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Universidad Católica de Murcia, Campus de los Jerónimos, Murcia, Spain
| | - Rebeca Gomez-Ibañez
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Department of Nursing, Universitat Autónoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Montserrat Lamoglia-Puig
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Sant Joan de Déu Teaching Campus, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Farrés-Tarafa
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Sant Joan de Déu Teaching Campus, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Zaragoza-García
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
- InveCuid Group, Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
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Colacurci N, Filardi PP, Chiantera A, Colao A, Pasqualetti P, Lenzi A. Sharing the multidisciplinary clinical approach to peri- and postmenopausal women: A Delphi consensus among Italian gynecologists, endocrinologists, and cardiologists for an integrated and optimal approach to clinical practice. Int J Gynaecol Obstet 2024; 166:682-691. [PMID: 38404042 DOI: 10.1002/ijgo.15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri- and postmenopausal women. METHODS The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. RESULTS The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. CONCLUSIONS The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine-metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk.
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Affiliation(s)
- Nicola Colacurci
- Department of Obstetrics and Gynecology, Italian Society of Gynecology and Obstetrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Italian Society of Cardiology, Federico II University of Naples, Naples, Italy
| | - Antonio Chiantera
- Italian Hospital Obstetricians Gynecologists Association, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Italian Society of Endocrinology, Federico II University of Naples, Naples, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Disease, Sapienza Rome University, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza Rome University, Rome, Italy
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Fontrier AM, Kamphuis B, Kanavos P. How can health technology assessment be improved to optimise access to medicines? Results from a Delphi study in Europe : Better access to medicines through HTA. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:935-950. [PMID: 37917290 PMCID: PMC11283424 DOI: 10.1007/s10198-023-01637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/02/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Access to medicines is a shared goal across healthcare stakeholders. Since health technology assessment (HTA) informs funding decisions, it shapes access to medicines. Despite its wide implementation, significant access variations due to HTA are observed across Europe. This paper elicited the opinions of European stakeholders on how HTA can be improved to facilitate access. METHODS A scoping review identified HTA features that influence access to medicines within markets and areas for improvement, while three access dimensions were identified (availability, affordability, timeliness). Using the Delphi method, we elicited the opinions of European stakeholders to validate the literature findings. RESULTS Nineteen participants from 14 countries participated in the Delphi panel. Thirteen HTA features that could be improved to optimise access to medicines in Europe were identified. Of these, 11 recorded a positive impact on at least one of the three access dimensions. HTA features had mostly a positive impact on timeliness and a less clear impact on affordability. 'Early scientific advice' and 'clarity in evidentiary requirements' showed a positive impact on all access dimensions. 'Established ways to deal with uncertainty during HTA' could improve medicines' availability and timeliness, while more 'reliance on real-world evidence' could expedite time to market access. CONCLUSIONS Our results reiterate that increased transparency during HTA and the decision-making processes is essential; the use of and reliance on new evidence generation such as real-world evidence can optimise the availability of medicines; and better collaborations between regulatory institutions within and between countries are paramount for better access to medicines.
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Affiliation(s)
- Anna-Maria Fontrier
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Bregtje Kamphuis
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Bilsen MP, Conroy SP, Schneeberger C, Platteel TN, van Nieuwkoop C, Mody L, Caterino JM, Geerlings SE, Köves B, Wagenlehner F, Kunneman M, Visser LG, Lambregts MMC. A reference standard for urinary tract infection research: a multidisciplinary Delphi consensus study. THE LANCET. INFECTIOUS DISEASES 2024; 24:e513-e521. [PMID: 38458204 DOI: 10.1016/s1473-3099(23)00778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 03/10/2024]
Abstract
The absence of a consensus-based reference standard for urinary tract infection (UTI) research adversely affects the internal and external validity of diagnostic and therapeutic studies. This omission hinders the accumulation of evidence for a disease that imposes a substantial burden on patients and society, particularly in an era of increasing antimicrobial resistance. We did a three-round Delphi study involving an international, multidisciplinary panel of UTI experts (n=46) and achieved a high degree of consensus (94%) on the final reference standard. New-onset dysuria, urinary frequency, and urinary urgency were considered major symptoms, and non-specific symptoms in older patients were not deemed indicative of UTI. The reference standard distinguishes between UTI with and without systemic involvement, abandoning the term complicated UTI. Moreover, different levels of pyuria were incorporated in the reference standard, encouraging quantification of pyuria in studies done in all health-care settings. The traditional bacteriuria threshold (105 colony-forming units per mL) was lowered to 104 colony-forming units per mL. This new reference standard can be used for UTI research across many patient populations and has the potential to increase homogeneity between studies.
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Affiliation(s)
- Manu P Bilsen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
| | - Simon P Conroy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Caroline Schneeberger
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands; Department of Public Health and Primary Care, The Hague Health Campus, Leiden University Medical Center, The Hague, Netherlands
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Suzanne E Geerlings
- Amsterdam UMC, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, MN, USA
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Paakkari O, Kulmala M, Lyyra N, Saaranen T, Lindfors P, Tyrväinen H. The core competencies of a health education teacher. Health Promot Int 2024; 39:daae078. [PMID: 38984688 PMCID: PMC11234200 DOI: 10.1093/heapro/daae078] [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] [Indexed: 07/11/2024] Open
Abstract
Teachers play a crucial role in students' learning and in the development of health literacy. Hence, the aim of this study was to identify the core competencies needed for teachers of health education in supporting student learning. A three-round Delphi study was carried out over an 8-week period, through consultation with 25 Finnish experts in health education. An open-ended question was used to identify the core competencies for school health educators. The data were analysed using inductive content analysis. In subsequent rounds, experts were asked to assess the importance of the identified competencies on a 7-point Likert scale, and finally to rank the most important competencies. In total, 52 competencies were identified and categorized into eight core competence domains. Thereafter, 40 competencies were assessed and selected for the third round, in which the experts ranked the 15 most important competencies, encompassing four core domains, i.e. pedagogic and subject-specific didactic, social and emotional, content knowledge and continuous professional development. Other domains of competence identified in the present study were ethical competence, competence in school health promotion, contextual competence and professional well-being competence. The study defines health education teacher core competencies and domains, and the information can be used in teacher education programmes, for developing teaching and for teachers' self-evaluation.
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Affiliation(s)
- Olli Paakkari
- Faculty of Sport and Health Sciences, Research Centre for Health Promotion, University of Jyväskylä, Keskussairaalantie 4, 40014, Finland
| | - Markus Kulmala
- Faculty of Sport and Health Sciences, Research Centre for Health Promotion, University of Jyväskylä, Keskussairaalantie 4, 40014, Finland
| | - Nelli Lyyra
- Faculty of Sport and Health Sciences, Research Centre for Health Promotion, University of Jyväskylä, Keskussairaalantie 4, 40014, Finland
| | - Terhi Saaranen
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Yliopistonrinne 3, 70211 Kuopio, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Arvo Ylpön katu 34, 33014, Finland
| | - Heli Tyrväinen
- Health Sciences, Open University, University of Jyväskylä, Alvar Aallon katu 9, 40014, Finland
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Pfeifer R, Klingebiel FKL, Balogh ZJ, Beeres FJP, Coimbra R, Fang C, Giannoudis PV, Hietbrink F, Hildebrand F, Kurihara H, Lustenberger T, Marzi I, Oertel MF, Peralta R, Rajasekaran S, Schemitsch EH, Vallier HA, Zelle BA, Kalbas Y, Pape HC. Early major fracture care in polytrauma-priorities in the context of concomitant injuries: A Delphi consensus process and systematic review. J Trauma Acute Care Surg 2024:01586154-990000000-00776. [PMID: 39085995 DOI: 10.1097/ta.0000000000004428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures. METHODS This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach. RESULTS A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2). CONCLUSION A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room. LEVEL OF EVIDENCE Delphi-Consensus/Systematic Review; Level IV.
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Affiliation(s)
- Roman Pfeifer
- From the Department of Trauma Surgery (R.Pf., F.K.-L.K., Y.K., H.-C.P.), Harald-Tscherne Laboratory for Orthopaedic and Trauma Research (R.Pf., F.K.-L.K., Y.K., H.-C.P.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Traumatology (Z.J.B.), John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia; Department of Orthopaedic and Trauma Surgery (F.J.P.B.), Lucerne Cantonal Hospital, Lucerne, Switzerland; Riverside University Health System Medical Center and Loma Linda University School of Medicine (R.C.), Loma Linda, California; Department of Orthopaedics and Traumatology (C.F.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong; Academic Department of Trauma and Orthopaedics (P.V.G.), School of Medicine, University of Leeds; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom; Department of Trauma Surgery (F.Hie.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Orthopaedics (F.Hil.), Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany; Emergency Surgery Unit (H.K.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Trauma Surgery (T.L.), Aarau Cantonal Hospital, Aarau, Switzerland; Department of Trauma (I.M.), Hand, and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany; Department of Neurosurgery (M.F.O.), Clinical Neuroscience Center (M.F.O.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Surgery (R.Pe.), Trauma Surgery, Hamad Medical Corporation, Doha, Qatar; Department of Surgery (R.Pe.), Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic; Department of Orthopedics and Spine Surgery (S.R.), Ganga Hospital, Coimbatore, India; Department of Surgery, Division of Orthopaedic Surgery (E.H.S.), University of Western Ontario, London, Ontario, Canada; Department of Orthopaedic Surgery (H.A.V.), Case Western Reserve University, Cleveland, Ohio; and Department of Orthopaedics (B.A.Z.), UT Health San Antonio, San Antonio, Texas
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16
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Viegas R, Guerreiro MP, Duarte-Ramos F, Mendes R, da Costa FA. The role of community pharmacists and pharmacies in physical activity promotion: an interdisciplinary e-Delphi study. Int J Clin Pharm 2024; 46:947-956. [PMID: 38662124 PMCID: PMC11286711 DOI: 10.1007/s11096-024-01731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Physical activity has a key role in the prevention and control of noncommunicable diseases. Community pharmacists are an accessible source to provide brief advice to people on how to be more physically active. Nonetheless, there is a limited understanding of stakeholders' perspectives on their role in promoting physical activity, to inform policy and practice. The present study addresses this gap. AIM To determine consensus from different health professionals on the role of pharmacists and pharmacies in brief physical activity counselling in Portugal. METHOD This cross-sectional study used a two-round e-Delphi panel. The questionnaire was organised into four domains of physical activity promotion and comprised 37 items. Interdisciplinary experts rated their level of agreement using a 5-point Likert scale. Consensus was set at the outset as 75% or more of participants scoring 4 or 5 (consensus "in") or 1 or 2 (consensus "out"). RESULTS Forty-two health professionals involved in promoting physical activity in the ambulatory setting in Portugal were selected through purposive quota sampling. Eighteen out of 37 items were consensual in the first round and five more achieved consensus after the second round (62.2%). Physical activity promotion was seen as the role of all healthcare workforce and pharmacies were considered as suitable spaces for service provision, regardless of remuneration. CONCLUSION This study endorses a set of roles for physical activity promotion in community pharmacy from an interdisciplinary perspective. Consensually established perspectives can inform policy making and practice, streamlining the coordination of pharmacies with the national health service.
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Affiliation(s)
- Ruben Viegas
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Portugal
| | - Filipa Duarte-Ramos
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Filipa Alves da Costa
- Faculty of Pharmacy, University of Lisbon - Imed, Research Institute for Medicines, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
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Healy S, Patterson F, Biddle S, Dumuid D, Glorieux I, Olds T, Woods C, Bauman AE, Gába A, Herring MP, Kastelic K, Lachapelle U, Volpe SL, Benedičić Tomat S, Pedisic Z. It's about time to exercise: development of the Exercise Participation Explained in Relation to Time (EXPERT) model. Br J Sports Med 2024:bjsports-2024-108500. [PMID: 39060107 DOI: 10.1136/bjsports-2024-108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 07/28/2024]
Abstract
A perceived 'lack of time' is consistently the most commonly reported barrier to exercise. However, the term fails to capture the multifaceted nature of time-related factors. Recognising the need for a more comprehensive analysis of 'lack of time' as a barrier to exercise, the aim of this study was to develop the exercise participation explained in relation to time (EXPERT) model. The model was developed through a sequential process including (1) an umbrella literature review of time as a barrier, determinant, and correlate of physical activity; (2) a targeted review of existing temporal models; (3) drafting the model and refining it via discussions between eight authors; (4) a three-round Delphi process with eight panel members; and (5) consultations with seven experts and potential end-users. The final EXPERT model includes 31 factors within four categories: (1) temporal needs and preferences for exercise (ie, when and how long does an individual need/want to exercise), (2) temporal autonomy for exercise (ie, autonomy in scheduling free time for exercise), (3) temporal conditions for exercise (ie, available time for exercise) and (4) temporal dimensions of exercise (ie, use of time for exercise). Definitions, examples and possible survey questions are presented for each factor. The EXPERT model provides a comprehensive framework for understanding the multi-dimensional nature of 'time' as it relates to exercise participation. It moves beyond the simplistic notion of 'lack of time' and delves into the complexity of time allocation in the context of exercise. Empirical and cross-cultural validations of the model are warranted.
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Affiliation(s)
- Sean Healy
- Physical Activity for Health Research Centre, Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Freda Patterson
- Department of Health Behavior and Nutrition Sciences & Department of Epidemiology, University of Delaware, Newark, Delaware, USA
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Ignace Glorieux
- Brussels Institute for Social and Population Studies - Research Unit TOR, Vrije Universiteit Brussel, Brussel, Belgium
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Catherine Woods
- Physical Activity for Health Research Centre, Department of Physical Education and Sports Sciences, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Aleš Gába
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Matthew P Herring
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Kaja Kastelic
- Andrej Marušič Institute, Department of Health Studies, University of Primorska, Koper, Slovenia
- InnoRenew CoE, Izola, Slovenia
| | - Ugo Lachapelle
- Department of UrbanStudies and Tourism, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Stella L Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | | | - Zeljko Pedisic
- Institute of Health and Sport, Victoria University, Footscray, Victoria, Australia
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Elsten EECM, Pot IE, Geijteman ECT, Hedman C, van der Heide A, van der Kuy H, Fürst CJ, Eychmüller S, van Zuylen L, van der Rijt CCD. 'Recommendations for deprescribing of medication in the last phase of life: an international Delphi study'. J Pain Symptom Manage 2024:S0885-3924(24)00909-6. [PMID: 39094669 DOI: 10.1016/j.jpainsymman.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
CONTEXT Medications may become inappropriate for patients in the last phase of life and may even compromise their quality of life. OBJECTIVE To find consensus on recommendations regarding deprescribing of medications for adult patients with a life expectancy of six months or less. METHODS Experts working in palliative care or other relevant disciplines were asked to participate in this international Delphi study. Existing tools for deprescribing of medication in the last phase of life were integrated in a list of 42 recommendations regarding potential deprescription of various medication types. In two Delphi rounds, experts were asked to rate their agreement with each recommendation on a 5-point Likert-scale (strongly agree - strongly disagree). Recommendations were accepted, if at least 70% of the experts (strongly) agreed, the interquartile range (IQR) was one or less, and less than 10% strongly disagreed. RESULTS 47 experts from 10 countries participated (response rate 53%). In most cases (76%), consensus was reached on deprescribing recommendations for patients with a life expectancy of six months or less. The highest level of consensus was reached for recommendations on the deprescription of diuretics in case of decreasing fluid intake or increasing fluid loss, lipid modifying agents if prescribed for primary prevention, and vitamin K antagonists and direct oral anticoagulants in case of high bleeding risk. CONCLUSION A high level of consensus was reached on recommendations on potential deprescription of several medications for patients with a life expectancy of six months or less.
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Affiliation(s)
- E E C M Elsten
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - I E Pot
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands.
| | - E C T Geijteman
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands
| | - C Hedman
- R & D department, Stockholms Sjukhem Foundation, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - H van der Kuy
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C J Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - S Eychmüller
- University Center for Palliative Care, University Hospital Inselspital Bern, Bern, Switzerland
| | - L van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands
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Scott VC, Temple J, Jillani Z. Development of the Technical Assistance Engagement Scale: a modified Delphi study. Implement Sci Commun 2024; 5:84. [PMID: 39075574 PMCID: PMC11288084 DOI: 10.1186/s43058-024-00618-4] [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: 04/02/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Technical assistance (TA) is a tailored approach to capacity building that is commonly used to support implementation of evidence-based interventions. Despite its widespread applications, measurement tools for assessing critical components of TA are scant. In particular, the field lacks an expert-informed measure for examining relationship quality between TA providers and recipients. TA relationships are central to TA and significantly associated with program implementation outcomes. The current study seeks to address the gap in TA measurement tools by providing a scale for assessing TA relationships. METHODS We utilized a modified Delphi approach involving two rounds of Delphi surveys and a panel discussion with TA experts to garner feedback and consensus on the domains and items that compose the TA Engagement Scale. RESULTS TA experts represented various U.S. organizations and TA roles (e.g., provider, recipient, researcher) with 25 respondents in the first survey and 26 respondents in the second survey. The modified Delphi process resulted in a scale composed of six domains and 22 items relevant and important to TA relationships between providers and recipients. CONCLUSION The TA Engagement Scale is a formative evaluation tool intended to offer TA providers the ability to identify strengths and areas for growth in the provider-recipient relationship and to communicate about ongoing needs. As a standard measurement tool, it lends a step toward more systematic collection of TA data, the ability to generate a more coherent body of TA evidence, and enables comparisons of TA relationships across settings.
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Affiliation(s)
- Victoria C Scott
- Department of Psychological Science, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Jasmine Temple
- Department of Psychological Science, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Zara Jillani
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA
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Budin AJ, Sumithran P, MacCormick AD, Caterson ID, Brown WA. Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery - a modified Delphi study. Int J Obes (Lond) 2024:10.1038/s41366-024-01594-4. [PMID: 39060359 DOI: 10.1038/s41366-024-01594-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. METHODS A modified Delphi survey was distributed to patients pre- and post-surgery, and to a variety of healthcare practitioners involved in bariatric care. Across two rounds, participants were asked to rate a variety of physical and psychosocial outcomes of bariatric surgery from 0 (Not Important) to 10 (Extremely Important). Outcomes rated 8-10 by at least 70% of participants were considered highly important (prioritised). The highest-rated outcomes were compared between the three groups as well as between medical and allied health practitioner subgroups. RESULTS 20 pre-surgical patients, 95 post-surgical patients, and 28 healthcare practitioners completed both rounds of the questionnaire. There were 58 outcomes prioritised, with 21 outcomes (out of 90, 23.3%) prioritised by all three groups, 13 (14.4%) by two groups, and 24 (26.7%) prioritised by a single group or subgroup. Unanimously prioritised outcomes included 'Co-morbidities', 'General Physical Health', 'Overall Quality of Life' and 'Overall Mental Health'. Discordant outcomes included 'Fear of Weight Regain', 'Suicidal Thoughts', 'Addictive Behaviours', and 'Experience of Stigma or Discrimination'. CONCLUSION While there was considerable agreement between stakeholder groups on many outcomes, there remain several outcomes with discordant importance valuations that must be considered. In particular, healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups. Future work will consider these priorities to ensure resulting measures encompass all important outcomes and are beneficial and valid for end users.
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Affiliation(s)
- Alyssa J Budin
- Department of Surgery, School of Translational Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia.
| | - Priya Sumithran
- Department of Surgery, School of Translational Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - Andrew D MacCormick
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Otahuhu, Auckland, New Zealand
| | - Ian D Caterson
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Wendy A Brown
- Department of Surgery, School of Translational Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
- Alfred Health, The Alfred Centre, Melbourne, VIC, Australia
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Sun H, Wang Y, Cai H, Wang P, Jiang J, Shi C, Wei Y, Hao Y. The development of a performance evaluation index system for Chinese Centers for Disease Control and Prevention: a Delphi consensus study. Glob Health Res Policy 2024; 9:28. [PMID: 39044214 PMCID: PMC11265441 DOI: 10.1186/s41256-024-00367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The performance evaluation of the Centers for Disease Control and Prevention (CDC) is crucial for enhancing the quality of public health services. With the ongoing reform of the CDC system in China, the existing performance evaluation system faces challenges. This study used the Delphi method to develop a new performance evaluation system for China's provincial, city, and county-level CDC. METHODS Following the "Structure-Process-Outcome" model, assessment indicators were systematically collected. Indicators were modified and screened through two Delphi rounds based on CDC responsibilities, health development, and national policies. Twenty-four experts provided ratings and recommendations, and the research team evaluated questionnaire reliability, expert positivity, expert authority, and opinion consistency. RESULTS The preliminary index system identified through the literature review and pre-survey included 11 primary, 30 secondary, and 64 tertiary indicators. After the first round of consultation, two secondary indicators and 11 tertiary indicators were removed and 22 tertiary indicators were added. After the second round of consultation, three secondary indicators and 11 tertiary indicators were removed and three tertiary indicators were added, at which point the p-value of the test for Kendall's coefficient of concordance W was < 0.001 and the coefficient of variation was within acceptable limits (< 0.25), so the consultation was concluded. The final index system included 11 primary, 25 secondary, and 67 tertiary indicators. CONCLUSIONS This study responded to the CDC system reform by developing a comprehensive performance evaluation index system for provincial, city, and county-level CDC in China. The index system is both scientifically grounded and practical, serving as an effective tool for promoting the high-quality work of CDC organizations.
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Affiliation(s)
- Huimin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Huanle Cai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pengyu Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jie Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Congxing Shi
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yongyue Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Yuantao Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Botana López M, Camafort Babkowski M, Campuzano Ruiz R, Cebrián Cuenca A, Gargallo Fernández M, David de Paz H, Redondo-Antón J, Artime E, Díaz-Cerezo S, Rubio de Santos M. Barriers and Strategies to Optimize the Use of Glucagon-Like Peptide 1 Receptor Agonists in People with Type 2 Diabetes and High Cardiovascular Risk or Established Cardiovascular Disease: A Delphi Consensus in Spain. Adv Ther 2024:10.1007/s12325-024-02938-2. [PMID: 39039388 DOI: 10.1007/s12325-024-02938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for glycemic control, with many also demonstrating cardiovascular (CV) benefit, in people with type 2 diabetes (T2D). This study aimed to find a consensus on the barriers and strategies for the optimal use of GLP-1 RAs in people with T2D and high CV risk or established cardiovascular disease (CVD) in Spain. METHODS A two-round Delphi survey (53 questions) was conducted among members of four national scientific societies in Spain, including physicians experienced in the management of people with T2D. The degree of consensus was evaluated with a 7-point Likert scale, establishing consensus when ≥ 70% of the panelists agreed (6-7) or disagreed (1-2). RESULTS A total of 97 physicians participated in the first round (endocrinology: 34%, family and community medicine: 21%, internal medicine: 23%, and cardiology: 23%), and 96 in the second round. The main barriers identified were: therapeutic inertia and late use of GLP-1 RAs; lack of a comprehensive approach to CV risk; lack of knowledge on the usefulness of GLP-1 RAs in CVD prevention and treatment; and economic/administrative barriers. Strategies with a highest consensus included: the need to establish simple protocols that integrate awareness of CV risk monitoring; training professionals and patients; and the use of new technologies. CONCLUSION Physicians identified clinical, healthcare, and economic/administrative barriers that limit the use of GLP-1 RAs in people with T2D and high CV risk or established CVD in Spain, highlighting the importance of integrating these therapies according to clinical practice guidelines.
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Affiliation(s)
- Manuel Botana López
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Miguel Camafort Babkowski
- Servicio de Medicina Interna, ICMiD, Hospital Clínic, Barcelona, Spain
- Departamento de Medicina, Universidad de Barcelona; CiberOBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Campuzano Ruiz
- Servicio de Cardiología, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Ana Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco, Cartagena, Spain
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Manuel Gargallo Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Madrid, y Fundación Jiménez Díaz, Madrid, Spain
| | - Héctor David de Paz
- Outcomes'10, Parque Científico, Tecnológico y Empresarial, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Weigl M, Lifschitz M, Dodt C. Key factors for sustainable working conditions in emergency departments: an EUSEM-initiated, Europe-wide consensus survey. Eur J Emerg Med 2024:00063110-990000000-00139. [PMID: 39012362 DOI: 10.1097/mej.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
BACKGROUND AND IMPORTANCE Modern emergency medicine (EM) is a complex, demanding, and occasionally stressful field of work. Working conditions, provider well-being, and associated health and performance outcomes are key factors influencing the establishment of a sustainable emergency department (ED) working environment. OBJECTIVES This multinational European Delphi survey aimed to identify unequivocal major factors for good and poor ED working conditions and their possible effects on health care provider well-being. DESIGN/SETTING AND PARTICIPANTS A total of 18 experts from six European countries (Belgium, Finland, Germany, Italy, Romania, and the UK) covering three different hospital sizes (small, medium, and large) in their respective countries participated in the two-round Delphi survey. All panelists held leadership roles in EM. OUTCOME MEASURES AND ANALYSIS The first step involved conducting an extensive literature search on ED working conditions. The second step involved the first Delphi round, which consisted of structured interviews with the panelists. The survey was designed to obtain information concerning important working conditions, comments regarding work-life factors identified from the literature, and ratings of their importance. Interviews were transcribed and analyzed following a standardized protocol. In the second Delphi round, experts rated the relevance of items consolidated from the first Delphi round (classified into ED work system factors, provider health outcomes, and ED work-life intervention approaches). RESULTS A nearly unequivocal consensus was obtained in four ED work condition categories, including positive (e.g. job challenges, personal motivation, and case complexities) and negative (e.g. overcrowding, workflow interruptions/multitasking, medical errors) ED work conditions. The highly relevant adverse personal health events identified included physical fatigue, exhaustion, and burnout. Concerning intervention practices, the panelists offered a wide spectrum of opportunities with less consensus. CONCLUSION Work system conditions exert positive and negative effects on the work life of ED providers across Europe. Although most European countries have varying health care systems, the expert-based survey results presented herein strongly suggest that improvement strategies should focus on system-related external stressors common in various countries. Our findings lay the scientific groundwork for future intervention studies at the local and systemic levels to improve ED provider work life.
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Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Lifschitz
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christoph Dodt
- Acute and Emergency Care Clinic; München Klinik Bogenhausen, Munich, Germany
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de Wit W, Frielink N, Roeg D, Embregts PJCM. Sexual support and education for adults with mild intellectual disabilities: a Delphi study on multiple perspectives. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39021295 DOI: 10.1111/jir.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Providing appropriate sexual support and education for adults with mild intellectual disabilities (IDs) is a source of considerable debate, resulting in diverse, non-funded and potentially adverse practices. This study aims to identify a consensus among experts regarding what conditions are conducive to successful sexual support and education for adults with mild IDs. METHODS A Delphi study was conducted with 13 experts, including experts-by-experience, relatives, support staff, psychologists and sexologists. Qualitative data on the conditions for sexual support and education were gathered in the first round and thematically analysed. In the following three quantitative rounds, consensus was achieved using Likert-type response scales and participants' feedback. RESULTS Round 1 resulted in 82 conditions on six themes: 'the necessary attitude', 'requirements', 'approach to delivering sexual support and education', 'appropriate providers', 'settings and timing' and 'effective collaboration with the network'. In the following three quantitative rounds, the experts reached consensus on 68 conditions distributed across the six themes. CONCLUSIONS The six themes highlight conducive conditions for successful sexual support and education for adults with mild IDs, emphasising the significance of a safe and supportive environment, comprehensive educational programmes, and the promotion of autonomy and protection. The consensus-based findings have distinct implications for practice and future research.
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Affiliation(s)
- W de Wit
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Zuidwester, Middelharnis, The Netherlands
| | - N Frielink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - D Roeg
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Kwintes Supported Housing, Zeist, The Netherlands
| | - P J C M Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Puchi C, Paravic-Klijn T, Salazar A. Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi. Qual Manag Health Care 2024:00019514-990000000-00076. [PMID: 39038040 DOI: 10.1097/qmh.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND OBJECTIVES The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique. METHODS The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts. RESULTS Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care. CONCLUSIONS The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.
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Affiliation(s)
- Carolina Puchi
- Author Affiliation: Faculty of Nursing, Universidad de Concepción, Concepción, Chile
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Castrejón I, Cano L, Cuadrado MJ, Borrás J, Galindo M, Salman-Monte TC, Amorós C, San Román C, Cabezas I, Comellas M, Muñoz A. Patient-reported outcome measures for systemic lupus erythematosus: an expert Delphi consensus to guide implementation in routine care. BMC Rheumatol 2024; 8:31. [PMID: 39010239 PMCID: PMC11251319 DOI: 10.1186/s41927-024-00401-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: 02/28/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) may result in great impact on patients' quality of life, social relationships, and work productivity. The use of patient-reported outcome measures (PROMs) in routine care could help capture disease burden to guide SLE management and optimize disease control. We aimed to explore the current situation, appropriateness, and feasibility of PROMs to monitor patients with SLE in routine care, from healthcare professionals' and patients' perspectives. METHODS A scientific committee developed a Delphi questionnaire, based on a focus group with patients and a literature review, including 22 statements concerning: 1) Use of PROMs in routine care (n = 2); 2) PROMs in SLE management (n = 13); 3) Multidisciplinary management of patients with SLE (n = 4), and 4) Aspects on patient empowerment (n = 3). Statements included in Sects. 2-4 were assessed from three perspectives: current use, appropriateness, and feasibility (with currently available resources). For each statement, panellists specified their level of agreement using a 7-point Likert scale. A consensus was reached when ≥ 70% of the panellists agreed (6,7) or disagreed (1,2) on each statement. RESULTS Fifty-nine healthcare professionals and 16 patients with SLE participated in the Delphi-rounds. A consensus was reached on the value of PROMs to improve SLE management (83%) and the key role of healthcare professionals (77%) and the need for a digital tool connected to the electronic medical record (85%) to promote and facilitate PROMs collection. PROMs most frequently used in clinical practice are pain (56%), patient's global assessment (44%) and fatigue (39%), all on visual analogue scales. Panellists agreed on the need to implement multidisciplinary consultation (79%), unify complementary tests (88%), incorporate pharmacists into the healthcare team (70%), and develop home medication dispensing and informed telepharmacy programmes (72%) to improve quality of care in patients with SLE. According to panellists, patient associations (82%) and nurses (80%) are critical to educate and train patients on PROMs to enhance patient empowerment. CONCLUSIONS Although pain, fatigue, and global assessment were identified as the most feasible, PROMs are not widely used in routine care in Spain. The present Delphi consensus can provide a road map for their implementation being key for SLE management.
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Affiliation(s)
- Isabel Castrejón
- Departamento de Medicina, Servicio de Reumatología, Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónUniversidad Complutense de Madrid, C. del Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Laura Cano
- Enfermería Reumatología, H. Regional de Málaga, Málaga, Spain
| | - María José Cuadrado
- Servicio de Reumatología, H. Clínica Universitaria de Navarra, Madrid, Spain
| | | | - Maria Galindo
- Servicio de Reumatología, H. 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | - Alejandro Muñoz
- Servicio de Reumatología, H. Universitario Virgen del Rocío, Sevilla, Spain
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Koontalay A, Botti M, Hutchinson A. Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study. J Adv Nurs 2024. [PMID: 39014994 DOI: 10.1111/jan.16330] [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: 02/19/2024] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
AIMS To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). DESIGN The study design was based on a three-round e-Delphi survey. METHODS A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. RESULTS There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. CONCLUSION Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. IMPACT This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.
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Affiliation(s)
- Apinya Koontalay
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Institute of Health Transformation, Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
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Buijs GS, Kievit AJ, Walinga AB, Schafroth MU, Hirschmann MT, Blankevoort L. Visible fluid motion on manipulation as the new threshold for intraoperatively determined knee arthroplasty component loosening: A Delphi study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39010716 DOI: 10.1002/ksa.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE There is a lack of a clear, uniform definition for intraoperatively assessed component loosening of a knee arthroplasty component, complicating the interpretation and interchangeability of results of diagnostic studies using an intraoperative observation as the reference test. The purpose of this study was to establish a consensus among specialised knee revision surgeons regarding the definition of intraoperatively determined loosening of total or unicondylar knee arthroplasty components. METHODS Utilising the Delphi consensus method, an international panel of highly specialised knee revision surgeons was invited to participate in a three-round process. The initiation of the first round involved the exploration of possible criteria for intraoperatively determined loosening with open questions. The second round focused on rating these criteria importance on a five-point Likert scale. For the third round, criteria that reached consensus were summarised in consecutive definitions for intraoperatively determined loosening and proposed to the panel. Consensus was established when over 70% of participants agreed with a definition for intraoperatively determined loosening. RESULTS The 34 responding panel members described in total 60 different criteria in the first round of which 34 criteria received consensus in the second round. Summarising these criteria resulted in four different definitions as minimal requirements for intraoperatively determined loosening. Eighty-eight percent of the panel members agreed on defining a component as loose if there is visible fluid motion at the interface observed during specific movements or when gently applying direct force. CONCLUSION This study successfully established a consensus using a Delphi method among knee revision surgeons on the definition of intraoperatively determined component loosening. By agreeing on the visibility of fluid motion as new definition, this study provides a standardised reference for future diagnostic research. This definition will enhance the interpretability and interchangeability of future diagnostic studies evaluating knee arthroplasty component loosening. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- George S Buijs
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Alex B Walinga
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Michael T Hirschmann
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
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Poizeau F, Leducq S, Fardet L, Beylot-Barry M, Chaby G, Chastagner M, Corgibet F, Gouillon L, Jouan N, Jullien D, Acher A, Amatore F, Amici JM, Aubert H, Aubin F, Beneton N, Bouilly D, Bursztejn AC, Buzenet C, Chamaillard-Pujol M, Charles J, Cottencin-Charriere AC, Duval Modeste B, Fauconneau A, Fougerousse AC, Girard C, Goujon C, Khemis A, Le Ru Y, Lepelley-Dupont C, Mahé E, Marcellin X, Nicolas C, Pallure V, Parier J, Quiles N, Stoebner PE, Tauber M, Vermersch A, Viguier M, Villani AP, Chosidow O, Guillot B. Treatment of moderate-to-severe psoriasis in adults: An expert consensus statement using a Delphi method to produce a decision-making algorithm. Ann Dermatol Venereol 2024; 151:103287. [PMID: 39013256 DOI: 10.1016/j.annder.2024.103287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/22/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND New highly effective drugs for moderate-to-severe cutaneous psoriasis are regularly marketed, and the hierarchy of treatments thus requires frequent review. OBJECTIVES A Delphi method was used to enable a structured expert consensus on the use of systemic treatments and phototherapy among adults with moderate-to-severe psoriasis. METHODS The Delphi method consists in achieving a convergence of opinions among a panel of experts using several rounds of questionnaires with controlled feedback between rounds. A two-part Delphi questionnaire was administered online to French psoriasis experts. In the first part, 180 items related to the prescription of systemic treatments and phototherapy for adult patients with moderate-to-severe psoriasis were grouped into 21 sections covering different lines of treatment and different forms of cutaneous psoriasis. The experts voted on each proposal using an ordinal 7-point Likert scale. The second part comprised 11 open-ended questions about special indications for each therapeutic class. These were converted into 101 questions for subsequent rounds. Consensus was deemed to have been reached if more than 80% of the experts agreed with a given proposal. RESULTS Three rounds of questionnaires were sequentially sent to 35 participants between November 2021 and March 2022. Thirty-three (94%) completed all three rounds. For plaque psoriasis, only methotrexate was recommended by the experts as first-line systemic treatment (89% of votes). Cyclosporin was advocated in pustular and erythrodermic psoriasis, and acitretin was suggested for hyperkeratotic and palmoplantar psoriasis. In the event of failure of or intolerance to non-biological systemic treatments, guselkumab, risankizumab, ixekizumab or secukinumab were recommended by more than 80% of the experts. Tumor Necrosis Factor (TNF) inhibitors remain useful for patients with cardiovascular risk factors. Special indications were provided for each therapeutic class (methotrexate/narrowband ultraviolet B phototherapy, psoralen/ultraviolet A phototherapy, cyclosporin, acitretin, apremilast, TNF inhibitors, interleukin (IL)-12/23 inhibitors, IL-17(R)A inhibitors, and IL-23 inhibitors). CONCLUSIONS This expert consensus statement indicate that newly available IL-17 and IL-23 inhibitors may be favored over TNF and IL-12/23 inhibitors as first-line biologics. The Centre of Evidence of the French Society of Dermatology has drawn up a decision-making algorithm to guide clinicians in the therapeutic management of moderate-to-severe psoriasis.
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Affiliation(s)
- F Poizeau
- Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France; Dermatology, Rennes University Hospital, Rennes, France; Centre of Evidence of The French Society of Dermatology, Paris, France.
| | - S Leducq
- Centre of Evidence of The French Society of Dermatology, Paris, France; University of Tours, Nantes University, INSERM, SPHERE 1246, Tours, France; Dermatology, Tours University Hospital, Tours, France
| | - L Fardet
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Private Practitioner, Nogent-sur-Marne, France
| | - M Beylot-Barry
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - Guillaume Chaby
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Amiens-Picardie University Hospital, Amiens, France
| | - M Chastagner
- Hospices Civils de Lyon, Claude Bernard Lyon I University, Dermatology, Edouard Herriot Hospital, Lyon, France
| | - F Corgibet
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Private Practitioner, Dijon, France
| | - L Gouillon
- Hospices Civils de Lyon, Claude Bernard Lyon I University, Dermatology, Edouard Herriot Hospital, Lyon, France
| | - N Jouan
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Private Practitioner, Brest, France
| | - D Jullien
- Centre of Evidence of The French Society of Dermatology, Paris, France; Hospices Civils de Lyon, Claude Bernard Lyon I University, Dermatology, Edouard Herriot Hospital, Lyon, France
| | - A Acher
- Dermatology, Private Practitioner, Caen, France
| | - F Amatore
- Dermatology, Nord University Hospital, Aix-Marseille University, Marseille, France
| | - J-M Amici
- Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - H Aubert
- Dermatology, Nantes University Hospital, Nantes, France
| | - F Aubin
- Dermatology, Besançon University Hospital, Besançon, France
| | - N Beneton
- Dermatology, Le Mans Hospital, Le Mans, France
| | | | | | - C Buzenet
- Dermatology, Private Practitioner, Bayonne, France
| | | | - J Charles
- Dermatology, Grenoble Alpes University Hospital, La Tronche, France
| | | | | | - A Fauconneau
- Dermatology, Bordeaux University Hospital, Bordeaux, France; Dermatology, Private Practitioner, Gradignan, France
| | - A-C Fougerousse
- Dermatology, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France; ResoPso, Paris, France
| | - C Girard
- Dermatology, Montpellier University Hospital, Montpellier, France
| | - C Goujon
- Dermatology, Lyon Sud Hospital, Lyon, France
| | - A Khemis
- Dermatology, Private Practitioner, Nice, France
| | - Y Le Ru
- Dermatology, Private Practitioner, Brest, France
| | | | - E Mahé
- Dermatology, Argenteuil Hospital, Argenteuil, France
| | - X Marcellin
- Dermatology, Private Practitioner, Villeurbanne, France
| | - C Nicolas
- Dermatology, Private Practitioner, Commercy, France
| | - V Pallure
- Dermatology, Perpignan Hospital, Perpignan, France
| | - J Parier
- Dermatology, Private Practitioner, Saint-Maur-des-Fossés, France
| | - N Quiles
- Dermatology, Saint Joseph Hospital, Marseille, France
| | - P-E Stoebner
- Dermatology, Nîmes University Hospital, Nîmes, France
| | - M Tauber
- Clinical Immunology and Allergology, Lyon University Hospital, Lyon, France
| | - A Vermersch
- Dermatology, Calais Hospital, Calais, France
| | - M Viguier
- Dermatology, Reims University Hospital, Reims, France
| | - A P Villani
- Hospices Civils de Lyon, Claude Bernard Lyon I University, Dermatology, Edouard Herriot Hospital, Lyon, France
| | - O Chosidow
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Hôpital Henri-Mondor APHP, Créteil, France
| | - B Guillot
- Centre of Evidence of The French Society of Dermatology, Paris, France; Dermatology, Univ Montpellier, Montpellier, France
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Powell PA, Rowen D, Keetharuth A, Mukuria C, Shah K. Who should value children's health and how? An international Delphi study. Soc Sci Med 2024; 355:117127. [PMID: 39019000 DOI: 10.1016/j.socscimed.2024.117127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
Valuing child health necessitates normative methodological decisions on whose preferences should be elicited and who should be imagined as experiencing impaired health. Formal guidance is limited and expert consensus unclear. This study sought to establish the degree of consensus among expert stakeholders on normative issues of who to ask and who should be imagined when valuing child health (7-17 years) to inform UK health technology assessment. Sixty-two experts (n = 47 in Round 2) from 18 countries participated in a modified, two-round online Delphi survey (Round 1: May-June 2023; Round 2: September-October 2023). Participants were expert stakeholders in child health valuation, including academics (n = 38); industry/consultancy representatives (including the charity/not-for-profit sector; n = 13); and UK policy/government representatives (n = 11). The Delphi survey was modified between rounds and consisted of 9-point Likert, categorical, multiple-choice, and free-text questions on normative issues in valuing child health. Responses were analysed descriptively and thematically. An a priori criterion of ≥75% agreement was established for formal consensus, while areas approaching consensus (≥70% agreement) and without consensus were identified as a future research primer. Consensus was observed that older adolescents (aged 16-17 years) and adults (18+ years) should be asked to value child health states. There was consensus that the former should think about themselves when valuing the health states and the latter should imagine a child of some form (e.g., imagining themselves as a child or another hypothetical child). However, no consensus was evident on what form this should take. Several other methodological issues also reached consensus. These findings are largely consistent with recent views elicited qualitatively from members of the public and other stakeholders on normative issues in valuing child health. The results mean that, contrary to what has been done in previous child health valuation studies, efforts should be made to involve both older adolescents (16+ years) and adults in child health valuation.
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Affiliation(s)
- Philip A Powell
- Sheffield Centre for Health and Related Research, University of Sheffield, UK.
| | - Donna Rowen
- Sheffield Centre for Health and Related Research, University of Sheffield, UK
| | - Anju Keetharuth
- Sheffield Centre for Health and Related Research, University of Sheffield, UK
| | - Clara Mukuria
- Sheffield Centre for Health and Related Research, University of Sheffield, UK
| | - Koonal Shah
- National Institute for Health and Care Excellence, London, UK
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Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2024; 49:471-501. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
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Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Ainslie-Garcia MH, Anderson LA, Bloch BV, Board TN, Chen AF, Craigie S, Danker W, Gunja N, Harty J, Hernandez VH, Lebedeva K, Hameed D, Mont MA, Nunley RM, Parvizi J, Perka C, Piuzzi NS, Rolfson O, Rychlik J, Romanini E, Sanz-Ruiz P, Sierra RJ, Suleiman L, Tsiridis E, Vendittoli PA, Wangen H, Zagra L. Identifying Critical Evidence Gaps in Wound Closure and Incision Management After Total Knee Arthroplasty: Delphi Panel Insights. J Arthroplasty 2024:S0883-5403(24)00656-9. [PMID: 38972434 DOI: 10.1016/j.arth.2024.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/30/2024] [Accepted: 06/22/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION In orthopaedic surgery, particularly total knee arthroplasty (TKA), the management of surgical wounds is critical for optimal wound healing and successful patient outcomes. Despite advances in surgical techniques, challenges persist in effectively managing surgical wounds to prevent complications and infections. This study aimed to identify and address the critical evidence gaps in wound management in TKA, including preoperative optimization, intraoperative options, and for the avoidance of postoperative complications. These are important issues surrounding wound management, which is essential for improving patient recovery and the overall success of the surgery. METHODS Utilizing the Delphi method, this study brought together 20 experienced orthopaedic surgeons from Europe and North America. Conducted from April to September 2023, the process involved three stages: an initial electronic survey, a virtual meeting, and a concluding electronic survey. The panel reviewed and reached a consensus on 26 specific statements about wound management in TKA based on a comprehensive literature review. During these three stages and after further panel review, an alternative goal of the Delphi panel was to also identify critical evidence gaps in the current understanding of wound management practices for TKA. RESULTS While the panel reached consensus on various wound management practices, they highlighted several major evidence gaps. Also, there was general consensus on issues such as wound closure methods including the use of mesh-adhesive dressings, skin glue, staples, sutures (including barbed sutures),and negative-pressure wound therapy (NPWT). However, it was deemed necessary that further evidence needs to be generated to address the cost-effectiveness of each and develop best practices for promoting patient outcomes. The identification of these gaps points to areas requiring more in-depth research and improvements to enhance wound care in TKA. DISCUSSION The identification of these major evidence gaps underscores the need for targeted research in wound management surrounding TKA. Addressing these evidence gaps is crucial for the future development of more effective, efficient, and patient-friendly wound care strategies. Future research should prioritize these areas, focusing on comparative effectiveness studies and further developing clear guidelines for the use of emerging technologies. Bridging these gaps has the potential to improve patient outcomes, reduce complications, and elevate the overall success rate of TKA surgeries.
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Affiliation(s)
| | | | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Service, City Hospital, Nottingham, UK
| | - Tim N Board
- Professor of Orthopaedics, Centre for Hip Surgery, Wrightington Hospital, Wigan
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samantha Craigie
- Department of Value and Evidence, EVERSANA, Burlington, Ontario, Canada
| | - Walter Danker
- Health Economics and Market Access, J&J MedTech, Raritan, New Jersey
| | - Najmuddin Gunja
- Health Economics and Market Access, J&J MedTech, Raritan, New Jersey
| | - James Harty
- Trauma and Orthopaedics Department, Cork University Hospital, Cork, Ireland
| | - Victor H Hernandez
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Kate Lebedeva
- Department of Value and Evidence, EVERSANA, Burlington, Ontario, Canada
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, 63130-4899, USA
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie, Orthopädische Universitätsklinik der Charité, Berlin, Deutschland
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ola Rolfson
- Professor, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joshua Rychlik
- Department of Value and Evidence, EVERSANA, Burlington, Ontario, Canada
| | - Emilio Romanini
- Centre for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
| | - Pablo Sanz-Ruiz
- Department of Surgery, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040, Madrid, Spain
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Linda Suleiman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison St, Chicago, IL, 60612, USA
| | - Eleftherios Tsiridis
- Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Pascal-André Vendittoli
- Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal University, Montreal, QC, Canada
| | - Helge Wangen
- Department of Orthopaedic Surgery, Elverum, Innlandet Hospital Trust
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Hurley E, Byrne S, Walsh E, Foley T, Woods N, Dalton K. Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes. Int J Clin Pharm 2024:10.1007/s11096-024-01749-3. [PMID: 38967733 DOI: 10.1007/s11096-024-01749-3] [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: 11/27/2023] [Accepted: 05/02/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria aim to reduce inappropriate/unnecessary medications in frail older adults, which should minimise adverse drug events and additional healthcare expenditure. Little is known about the economic outcomes of applying these criteria as an intervention. AIM To evaluate cost avoidance of pharmacist-led application of STOPPFrail to frail older nursing home residents with limited life expectancy. METHOD Pharmacist-identified STOPPFrail-defined potentially inappropriate medications that were deprescribed by patients' general practitioners were assigned a rating by a multidisciplinary panel, i.e. the probability of an adverse drug event occurring if the medication was not deprescribed. The intervention's net cost benefit and cost-benefit ratio were then determined by factoring in adverse drug event cost avoidance (calculated from probability of adverse drug event ratings), direct cost savings (deprescribed medication costs/reimbursement fees), and healthcare professionals' salaries. RESULTS Of the 176 potentially inappropriate medications deprescribed across 69 patients, 65 (36.9%) were rated as having a medium or high probability of an adverse drug event occurring if not deprescribed. With €27,162 for direct cost savings, €61,336 for adverse drug event cost avoidance, and €2,589 for healthcare professionals' salary costs, there was a net cost benefit of €85,909 overall. The cost-benefit ratio was 33.2 and remained positive in all scenarios in sensitivity analyses. CONCLUSION Pharmacist-led application of STOPPFrail to frail older nursing home residents is associated with significant cost avoidance. Wider implementation of pharmacist interventions in frail older nursing home residents should be considered to reduce potentially inappropriate medications and patient harm, alongside substantial cost savings for healthcare systems.
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Affiliation(s)
- Eoin Hurley
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland.
| | - Stephen Byrne
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland
| | - Elaine Walsh
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Noel Woods
- Centre for Policy Studies, University College Cork, Cork, Ireland
| | - Kieran Dalton
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland
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Toomey CM, Bhardwaj A, Browne J, Dowling I, Grealis S, Hayes P, Higgins N, Maguire D, O'Hora J, Rector J, Wood-Thornsbury A, Kennedy N. Guideline-based exercise management for hip and knee osteoarthritis: a cross-sectional comparison of healthcare professional and patient beliefs in Ireland. BMJ Open 2024; 14:e080646. [PMID: 38969380 PMCID: PMC11227783 DOI: 10.1136/bmjopen-2023-080646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/23/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES To identify within-stakeholder agreement and between-stakeholder differences in beliefs regarding exercise for osteoarthritis among general practitioners (GPs), physiotherapists (PTs) and people with hip and knee osteoarthritis (PwOA). A secondary objective was to explore the association between referral patterns and beliefs of PwOA. DESIGN Cross-sectional. SETTING Online surveys administered to GPs, PTs and PwOA in Ireland via social media and healthcare networks. PARTICIPANTS 421 valid responses (n=161 GPs, n=163 PTs, n=97 PwOA). PRIMARY AND SECONDARY OUTCOME MEASURES Nine belief statements related to exercise effectiveness, safety and delivery were rated on a 5-point Likert scale and analysed for within-stakeholder consensus. χ2 tests assessed differences in agreement between groups. Multivariable linear regression models tested associations between beliefs in PwOA and referral to/attendance at physiotherapy. RESULTS Positive within-stakeholder consensus (>75% agreement) was reached for most statements (7/9 GPs, 6/9 PTs, 5/9 PwOA). However, beliefs of PwOA were significantly less positive compared with healthcare professionals for six statements. All stakeholders disagreed that exercise is effective regardless of the level of pain. Attendance at physiotherapy (49% of PwOA), rather than referral to physiotherapy from a GP only, was associated with positive exercise beliefs for PwOA (β=0.287 (95% CI 0.299 to 1.821)). CONCLUSIONS Beliefs about exercise therapy for osteoarthritis are predominantly positive across all stakeholders, although less positive in PwOA. PwOA are more likely to have positive beliefs if they have seen a PT for their osteoarthritis. Knowledge translation should highlight the effectiveness of exercise for all levels of pain and osteoarthritis disease.
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Affiliation(s)
- Clodagh M Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Participatory Health Research Unit, University of Limerick, Limerick, Ireland
| | - Avantika Bhardwaj
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jacqui Browne
- Patient Author, IMPACT Steering Committee, Limerick, Ireland
| | - Ian Dowling
- Ian Dowling Physiotherapy Clinic, Limerick, Ireland
- Clinician Author, IMPACT Steering Committee, Limerick, Ireland
| | - Stacey Grealis
- Patient Author, IMPACT Steering Committee, Limerick, Ireland
- Centre of Arthritis Research, University College Dublin, Dublin, Ireland
| | - Peter Hayes
- Health Research Institute, University of Limerick, Limerick, Ireland
- Clinician Author, IMPACT Steering Committee, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall Higgins
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Darragh Maguire
- Clinician Author, IMPACT Steering Committee, Limerick, Ireland
- Department of Physiotherapy, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - John O'Hora
- Clinician Author, IMPACT Steering Committee, Limerick, Ireland
- Community Healthcare West, Health Service Executive, Co. Roscommon, Ireland
| | - Joseph Rector
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Norelee Kennedy
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Allende MI, Muñoz-Venturelli P, Gonzalez F, Bascur F, Anderson CS, Ouyang M, Cabieses B, Obach A, Cano-Nigenda V, Arauz A. Recommendations for Implementing the INTERACT3 Care Bundle for Intracerebral Hemorrhage in Latin America: Results of a Delphi Method. Cerebrovasc Dis 2024:1-8. [PMID: 38964290 DOI: 10.1159/000540038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC). METHODS A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank statements relevant to 7 domains (training, resources/infrastructure, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal). The pre-defined consensus threshold was 75%. RESULTS A total of 43 statements reached consensus by the third round, with 12 new statements emerging through rounds. The highest-ranked statements in each domain emphasized critical aspects, but successful implementation requires appropriate resourcing. Key priorities were continuous training of all healthcare workers in ICH management, establishing protocols aligned with available resources, and collaborative interdisciplinary care supported by institutional networks. Statements related to anticoagulation reversal had the highest priority. CONCLUSIONS Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.
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Affiliation(s)
- Ma Ignacia Allende
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile,
| | - Paula Muñoz-Venturelli
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Francisca Gonzalez
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Facultad de Ciencias de la Salud Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Francisca Bascur
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Craig S Anderson
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Baltica Cabieses
- Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Alexandra Obach
- Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Vanessa Cano-Nigenda
- Instituto Nacional de Neurología y Neurocirugía Manual Velasco Suarez, Mexico City, Mexico
| | - Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manual Velasco Suarez, Mexico City, Mexico
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Kim JH, Kim YR, Han MH, Han S, Jeon EH, Hwang EY, Yang JW, Lee SY, Lee G. A study on the formative usability testing for modular powered wheelchair. Disabil Rehabil Assist Technol 2024:1-9. [PMID: 38965819 DOI: 10.1080/17483107.2024.2372310] [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: 12/06/2023] [Accepted: 05/02/2024] [Indexed: 07/06/2024]
Abstract
The increasing prevalence of mobility impairments underscores the urgent need for accessible and affordable mobility aids. To overcome the mobility limitations of people with disabilities, there is an increasing need for the development of lightweight and portable powered wheelchairs that can be easily loaded. This study aimed to perform an early health technology assessment and a formative usability evaluation on a modular (detachable) powered wheelchair. It aimed to gauge device satisfaction among users, pinpoint areas for improvement, and detect any unforeseen errors to inform future development. Engaging 16 participants, including powered wheelchair users, healthcare professionals, and caregivers, the research evaluated the wheelchair's functionality in various scenarios, emphasizing safety, effectiveness, and convenience. Statistical analyses of task performance and satisfaction surveys highlighted that, while powered wheelchair users successfully completed tasks focusing on driving and power control, healthcare professionals and caregivers encountered difficulties with the wheelchair's assembly and disassembly. Despite general positivity, the surveys indicated mixed satisfaction levels regarding safety, validity, and convenience, with specific issues related to frame durability, seat comfort, and control mechanisms. These findings suggest that refining the wheelchair's design and addressing user concerns could significantly enhance satisfaction and mobility services. Future efforts will include a thorough review of an advanced prototype and further satisfaction assessments.
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Affiliation(s)
- Jin Hong Kim
- Rehabilitation Medical Research Center, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Yu Ri Kim
- Rehabilitation Medical Research Center, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Mi Hyang Han
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Soul Han
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Eun Hye Jeon
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Eun Young Hwang
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Jae Won Yang
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Seon Yeong Lee
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
| | - Gangpyo Lee
- Rehabilitation Medical Research Center, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
- Department of physical and Rehabilitation Medicine, Incheon Hospital, Korea Workers' Compensation and Welfare Service, Incheon, Republic of Korea
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Hardy YM, Gaither C, Holiday-Goodman M, Little M. Creating Competencies for Providing Care in a Diverse, Equitable, and Inclusive Manner: A Delphi Technique. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100749. [PMID: 38960070 DOI: 10.1016/j.ajpe.2024.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 06/10/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Competencies related to diversity could be essential to training and assessing student pharmacists in their readiness to provide equitable and inclusive care. Such competencies are lacking in pharmacy education; therefore, this study aimed to explore the development of diversity competencies and supporting factors needed to prepare students to meet the competencies and provide patient care in a diverse, equitable, and inclusive manner. METHODS Pharmacy diversity thought leaders were invited to participate in a 3-round modified Delphi survey. Survey items were created using a Backward Design. Qualitative data were analyzed using the Constant Comparative Method. Draft competency statements were created based on the collective comments from Round 1 along with themes related to the supporting factors needed to achieve the competencies. Consensus on themes, competency statements, and edits were identified in Round 2. Additional comments and feedback on edits were gathered in Round 3. Consensus was preset at 85.7%. RESULTS Seven competency statements were created. Knowledge, skills, attitudes, behaviors, values, curricular content/pedagogy, and resources needed to prepare students to meet the competencies and support faculty would need were identified. CONCLUSION Preliminary diversity competencies and supporting factors needed were developed using the perspective of thought leaders. Further evaluation, including the development of student-appropriate competencies, testing and validation of content and assessment tools, and determining place in the pharmacy curriculum, are future steps that should be considered in the competency development process.
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Affiliation(s)
- Yolanda M Hardy
- Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy, West Palm Beach, FL, USA.
| | - Caroline Gaither
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Monica Holiday-Goodman
- The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Meg Little
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
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Zantek ND, Steiner ME, Teruya J, Kreuziger LB, Raffini L, Muszynski JA, Alexander PMA, Gehred A, Lyman E, Watt K. Recommendations on Monitoring and Replacement of Antithrombin, Fibrinogen, and Von Willebrand Factor in Pediatric Patients on Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med 2024; 25:e35-e43. [PMID: 38959358 PMCID: PMC11216379 DOI: 10.1097/pcc.0000000000003492] [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] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To derive systematic review informed, modified Delphi consensus regarding monitoring and replacement of specific coagulation factors during pediatric extracorporeal membrane oxygenation (ECMO) support for the Pediatric ECMO Anticoagulation CollaborativE. DATA SOURCES A structured literature search was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2020, with an update in May 2021. STUDY SELECTION Included studies assessed monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric ECMO support. DATA EXTRACTION Two authors reviewed all citations independently, with conflicts resolved by a third reviewer if required. Twenty-nine references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. A panel of 48 experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. We developed one weak recommendation and four expert consensus statements. CONCLUSIONS There is insufficient evidence to formulate recommendations on monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric patients on ECMO. Optimal monitoring and parameters for replacement of key hemostasis parameters is largely unknown.
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Affiliation(s)
- Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Marie E Steiner
- Department of Pediatrics, Divisions of Hematology and Critical Care, University of Minnesota, Minneapolis, MN
| | - Jun Teruya
- Division of Transfusion Medicine and Coagulation, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Lisa Baumann Kreuziger
- Versiti Blood Research Institute and Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Leslie Raffini
- Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Jennifer A Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and The Ohio State University of Medicine, Columbus, OH
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital, Columbus, OH
| | - Elizabeth Lyman
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital, Columbus, OH
| | - Kevin Watt
- Division of Critical Care, Department of Pediatrics and Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT
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Cashen K, Saini A, Brandão LR, Le J, Monagle P, Moynihan KM, Ryerson LM, Gehred A, Lyman E, Muszynski JA, Alexander PMA, Dalton HJ. Anticoagulant Medications: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med 2024; 25:e7-e13. [PMID: 38959355 PMCID: PMC11216397 DOI: 10.1097/pcc.0000000000003495] [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] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To derive systematic-review informed, modified Delphi consensus regarding the medications used for anticoagulation for pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE (PEACE). DATA SOURCES A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION Included studies assessed anticoagulation used in pediatric ECMO. DATA EXTRACTION Two authors reviewed all citations independently, with a third reviewer adjudicating any conflicts. Eighteen references were used for data extraction as well as for creation of recommendations. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-informed recommendations and, when evidence was lacking, expert-based consensus statements, or good practice statements for anticoagulation during pediatric ECMO. A web-based modified Delphi process was used to build consensus via the Research and Development/University of California Appropriateness Method. Consensus was based on a modified Delphi process with agreement defined as greater than 80%. Two recommendations, two consensus statements, and one good practice statement were developed, and, in all, agreement greater than 80% was reached. CONCLUSIONS There is insufficient evidence to formulate optimal anticoagulation therapy during pediatric ECMO. Additional high-quality research is needed to inform evidence-based practice for anticoagulation during pediatric ECMO.
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Affiliation(s)
- Katherine Cashen
- Division of Critical Care Medicine, Department of Pediatrics, Duke University and Duke University Health System, Durham, NC
| | - Arun Saini
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Leonardo R Brandão
- Department of Pediatrics, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
| | - Paul Monagle
- University of Melbourne, Melbourne, VIC, Australia
- Kids Cancer Centre Sydney Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Westmead Children's Hospital, Sydney, NSW, Australia
| | - Lindsay M Ryerson
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, OH
| | - Elizabeth Lyman
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Heidi J Dalton
- Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA
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Incze MA, Huebler S, Grant S, Gordon AJ. Using the Delphi Process to Prioritize an Agenda for Care Transition Research for Patients With Substance Use Disorders. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:523-528. [PMID: 38622904 DOI: 10.1177/29767342241246762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Medical hospitalizations are increasingly recognized as important opportunities to engage individuals with substance use disorders (SUD) and offer treatment. While a growing number of hospitals have instituted interventions to support the provision of SUD care during medical admissions, post-hospitalization transitions of care remain a challenge for patients and clinicians and an understudied area of SUD care. Evidence is lacking on the most effective and feasible models of care to improve post-hospitalization care transitions for people with SUD. In the absence of strong empirical evidence to guide practice and policy, consensus-based research methods such as the Delphi process can play an important role in efficiently prioritizing existing models of care for future study and implementation. We conducted a Delphi study that convened a group of 25 national interdisciplinary experts with direct clinical experience facilitating post-hospitalization care transitions for people with SUD. Our panelists rated 10 existing care transition models according to anticipated effectiveness and facility of implementation based on the GRADE Evidence to Decision framework. Qualitative data on each care model were also gathered through comments and an online moderated discussion board. Our results help establish a hierarchy of SUD care transition models to inform future study and program development.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sophia Huebler
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Adam J Gordon
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Wright WF, Stelmash L, Betrains A, Mulders-Manders CM, Rovers CP, Vanderschueren S, Auwaerter PG. Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel. Open Forum Infect Dis 2024; 11:ofae298. [PMID: 38966848 PMCID: PMC11222709 DOI: 10.1093/ofid/ofae298] [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: 03/04/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024] Open
Abstract
Background Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are syndromes commonly used as medical diagnoses. Since the existing literature has a mixture of diagnostic approaches, developing consensus-based recommendations would be helpful for clinicians, researchers, and patients. Methods A modified Delphi process was performed from October 2022 to July 2023, involving 4 rounds of online surveys and 2 live video conferences. The panel comprised international experts recruited based on peer-reviewed published publications and studies. Results Among 50 invited experts, 26 (52.0%) agreed to participate. Twenty-three panelists completed round 1 of the survey, 21 completed rounds 2 and 3, 20 completed round 4, and 7 participated in round 5 live video discussions. Of the participants, 18 (78.3%) were academic-based clinicians and researchers, 5 (21.7%) practiced in a community-based hospital, and 6 (26.1%) were female. Consensus was reached on 5 themes: (1) incorporating epidemiologic factors, such as geographic location and travel history; (2) updated criteria for classifying FUO or IUO; (3) initial evaluation approaches; (4) a classification system for diagnoses; and (5) recommendations for judicious limitation of empiric therapies. Experts strongly disagreed with using 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography as part of the diagnostic criteria for FUO. There were mixed opinions about the importance of the temperature measurement site, the 3-week minimum illness criterion, the need for a standard definition of relapsing fevers, and the use of similar evaluation strategies for FUO and IUO. Conclusions These Delphi-generated consensus-based recommendations offer potential improvements compared with earlier definitions and a guide for clinical practice and future research.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Stelmash
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Albrecht Betrains
- General Internal Medicine department, University Hospitals Leuven, Leuven, Belgium
| | - Catharina M Mulders-Manders
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven Vanderschueren
- General Internal Medicine Department, Department of Microbiology, Immunology, and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Paul G Auwaerter
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Schöffski P, Jones RL, Agulnik M, Blay JY, Chalmers A, Italiano A, Pink D, Stacchiotti S, Valverde C, Vincenzi B, Wagner MJ, Maki R. Current unmet needs in locally advanced (unresectable) or metastatic dedifferentiated liposarcoma, the relevance of progression-free survival as clinical endpoint, and expectations for future clinical trial design: an international Delphi consensus report. ESMO Open 2024; 9:103487. [PMID: 38943735 PMCID: PMC11261277 DOI: 10.1016/j.esmoop.2024.103487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Locally advanced (unresectable) or metastatic dedifferentiated liposarcoma (DDLPS) is a common presentation of liposarcoma. Despite established diagnostic and treatment guidelines for DDLPS, critical clinical gaps remain driven by diagnostic challenges, symptom burden and the lack of targeted, safe and effective treatments. The objective of this study was to gather expert opinions from Europe and the United States on the management, unmet needs and expectations for clinical trial design as well as the value of progression-free survival (PFS) in this disease. Other aims included raising awareness and educate key stakeholders across healthcare systems. MATERIALS AND METHODS An international panel of 12 sarcoma key opinion leaders (KOLs) was recruited. The study consisted of two rounds of surveys with pre-defined statements. Experts scored each statement on a 9-point Likert scale. Consensus agreement was defined as ≥75% of experts scoring a statement with ≥7. Revised statements were discussed in a consensus meeting. RESULTS Consensus was reached on 43 of 55 pre-defined statements across disease burden, treatment paradigm, unmet needs, value of PFS and its association with overall survival (OS), and cross-over trial design. Twelve statements were deprioritised or merged with other statements. There were no statements where experts disagreed. CONCLUSION This study constitutes the first international Delphi panel on DDLPS. It aimed to explore KOL perception of the disease burden and unmet need in DDLPS, the value of PFS, and its potential translation to OS benefit, as well as the relevance of a cross-over trial design for DDLPS therapies. Results indicate an alignment across Europe and the United States regarding DDLPS management, unmet needs, and expectations for clinical trials. Raising awareness of critical clinical gaps in relation to DDLPS can contribute to improving patient outcomes and supporting the development of innovative treatments.
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Affiliation(s)
- P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven; Laboratory of Experimental Oncology, KU Leuven, Leuven; Department of Oncology, Leuven Cancer Institute, Leuven, Belgium
| | - R L Jones
- Sarcoma Unit, The Royal Marsden, London; The Institute of Cancer Research, London, UK.
| | - M Agulnik
- City of Hope, Department of Medical Oncology & Therapeutics Research, Duarte, USA
| | - J Y Blay
- Centre Léon Bérard, University Claude Bérard, Lyon, France
| | - A Chalmers
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - A Italiano
- Institut Bergonié, Bordeaux; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - D Pink
- Department of Hematology, Oncology and Palliative Care, Helios Hospital Bad Saarow, Sarcoma Centre Berlin-Brandenburg, Bad Saarow, Germany
| | - S Stacchiotti
- Adult Mesenchymal and Rare Tumours Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Valverde
- Vall d'Hebrón University Hospital, Medical Oncology Department, Barcelona, Spain
| | - B Vincenzi
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - M J Wagner
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle; Division of Medical Oncology, University of Washington, Seattle
| | - R Maki
- Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
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Neville C, Beurskens C, Diels J, MacDowell S, Rankin S. Consensus Among International Facial Therapy Experts for the Management of Adults with Unilateral Facial Palsy: A Two-Stage Nominal Group and Delphi Study. Facial Plast Surg Aesthet Med 2024; 26:405-417. [PMID: 37922418 DOI: 10.1089/fpsam.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
Background: Nonsurgical rehabilitation of unilateral peripheral facial palsy (FP) varies globally with controversy regarding best practice. Objective: To develop facial therapist consensus regarding what should be included or excluded in rehabilitation of adults with FP of any etiology. Three clinical presentations: flaccid, paretic and synkinetic, were separately considered. Methodology: A two-stage study was conducted: a nominal group technique (NGT) to develop a questionnaire plus Delphi study. Delphi participants were recruited worldwide, through an experience-based inclusion questionnaire. The final Delphi questionnaire included 166 items for each clinical presentation covering assessment, outcome measures, and interventions, for example, education, eye care, neuromuscular retraining, and electrical modalities. Inclusion/exclusion agreement was set at 80%, indicating participant consensus. Items reaching 70-79% were deemed "near-included/near-excluded." Results: Averaged across all presentations, 24.9% of the 166 items were included, (e.g., Sunnybrook Facial Grading System, patient education and neuromuscular retraining), 26.9% of the 166 items were excluded, (e.g., gross strengthening and electrical stimulation); 48.2% were neither included nor excluded. Conclusion: This study brings together the global community's expertise as a first step toward establishing best practice for specialist facial therapy. It is hoped this will guide clinical decision making, advance research, and optimize patient outcomes in this challenging field.
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Affiliation(s)
- Catriona Neville
- Facial Palsy MDT, Queen Victoria Hospital, East Grinstead, United Kingdom
- The Facial Rehabilitation Centre Ltd, United Kingdom
| | - Carien Beurskens
- Department of Physiotherapy, Formerly of Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Sara MacDowell
- Franciscan Missionaries of Our Lady Health System, Our Lady of the Lake Regional Medical Centre, Centre for Facial Plastic Surgery, Baton Rouge, Louisiana, USA
| | - Susan Rankin
- Rankin Physiotherapy, Burnaby, British Columbia, Canada
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Rintoul NE, McMichael ABV, Bembea MM, DiGeronimo R, Patregnani J, Alexander PMA, Muszynski JA, Steffen K, Gehred A, Lyman E, Cheifetz IM. Management of Bleeding and Thrombotic Complications During Pediatric Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med 2024; 25:e66-e77. [PMID: 38959361 PMCID: PMC11216396 DOI: 10.1097/pcc.0000000000003489] [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] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To derive systematic-review informed, modified Delphi consensus regarding the management of bleeding and thrombotic complications during pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE Consensus Conference. DATA SOURCES A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION The management of bleeding and thrombotic complications of ECMO. DATA EXTRACTION Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Twelve references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. Two good practice statements, 5 weak recommendations, and 18 consensus statements are presented. CONCLUSIONS Although bleeding and thrombotic complications during pediatric ECMO remain common, limited definitive data exist to support an evidence-based approach to treating these complications. Research is needed to improve hemostatic management of children supported with ECMO.
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Affiliation(s)
- Natalie E Rintoul
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ali B V McMichael
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert DiGeronimo
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Jason Patregnani
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Barbara Bush Children's Hospital, Portland, ME
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University of Medicine, Columbus, OH
| | - Katherine Steffen
- Department of Pediatrics (Pediatric Critical Care Medicine), Stanford University, Palo Alto, CA
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Elizabeth Lyman
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Ira M Cheifetz
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
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Trialonis-Suthakharan N, Pattinson R, Tahmasebi Gandomkari N, Austin J, Janus C, Courtier N, Hewitt RM, Bundy C, Augustin M. Patient prioritisation of items to develop the Patient-Reported Impact of Dermatological Diseases measure: A global Delphi study. J Eur Acad Dermatol Venereol 2024; 38:1391-1400. [PMID: 38400660 DOI: 10.1111/jdv.19903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The Global Research on the Impact of Dermatological Diseases (GRIDD) project is developing the new Patient-Reported Impact of Dermatological Diseases (PRIDD) measure. PRIDD measures the impact of dermatological conditions on the patient's life. OBJECTIVES This study aimed to seek consensus from patients on which items to prioritize for inclusion in PRIDD. METHODS A modified, two-round Delphi study was conducted. Adults (≥18 years) with dermatological conditions were recruited. The survey consisted of a demographic's questionnaire and 263 potential impact items in six languages. Quantitative data used Likert-type ranking scales and analysed against consensus criteria. Qualitative data collected free text responses for additional feedback and a framework analysis was conducted. RESULTS 1154 people representing 90 dermatological conditions from 66 countries participated. Items were either removed (n = 79), edited (n = 179) or added (n = 2), based on consensus thresholds and qualitative feedback. Results generated the first draft of PRIDD with 27 items across five impact domains. CONCLUSION This Delphi study resulted in the draft version of PRIDD, ready for psychometric testing. The triangulated data helped refine the existing conceptual framework of impact. PRIDD has since been pilot tested with patients and is currently undergoing psychometric testing.
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Affiliation(s)
- Nirohshah Trialonis-Suthakharan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Nasim Tahmasebi Gandomkari
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jennifer Austin
- International Alliance of Dermatology Patient Organizations, Ottawa, Ontario, Canada
| | - Christine Janus
- International Alliance of Dermatology Patient Organizations, Ottawa, Ontario, Canada
| | - Nick Courtier
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Chris Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Moynihan KM, Ryerson LM, Le J, Nicol K, Watt K, Gadepalli SK, Alexander PMA, Muszynski JA, Gehred A, Lyman E, Steiner ME. Antifibrinolytic and Adjunct Hemostatic Agents: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med 2024; 25:e44-e52. [PMID: 38959359 PMCID: PMC11216380 DOI: 10.1097/pcc.0000000000003491] [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] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To derive systematic-review informed, modified Delphi consensus regarding antifibrinolytic and adjunct hemostatic agents in neonates and children supported with extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE consensus conference. DATA SOURCES A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION Use of antifibrinolytics (epsilon-aminocaproic acid [EACA] or tranexamic acid), recombinant factor VII activated (rFVIIa), or topical hemostatic agents (THAs). DATA EXTRACTION Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Eleven references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. MEASUREMENTS AND MAIN RESULTS Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. One weak recommendation and three consensus statements are presented. CONCLUSIONS Evidence supporting recommendations for administration of antifibrinolytics (EACA or tranexamic acid), rFVIIa, and THAs were sparse and inconclusive. Much work remains to determine effective and safe usage strategies.
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Affiliation(s)
- Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Faculty of Medicine and Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Department of Pediatric Cardiac Intensive Care, Stollery Children's Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta Hospital, Edmonton, AB, Canada
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
- Ohio State University College of Medicine, Columbus, OH
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minnesota, MN
| | - Lindsay M Ryerson
- Department of Pediatric Cardiac Intensive Care, Stollery Children's Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta Hospital, Edmonton, AB, Canada
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA
| | - Kathleen Nicol
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Kevin Watt
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Samir K Gadepalli
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
- Ohio State University College of Medicine, Columbus, OH
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Elizabeth Lyman
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Marie E Steiner
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minnesota, MN
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Himebauch AS, Priest JR, Annich GM, McMullan DM, Turner DA, Muszynski JA, Alexander PMA, Paden ML, Gehred A, Lyman E, Said AS. The Influence of the Extracorporeal Membrane Oxygenation Circuit and Components on Anticoagulation Management: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med 2024; 25:e1-e6. [PMID: 38959354 PMCID: PMC11216392 DOI: 10.1097/pcc.0000000000003496] [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] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To derive systematic-review informed, modified Delphi consensus regarding the influence of extracorporeal membrane oxygenation (ECMO) circuit components on anticoagulation practices for pediatric ECMO for the Pediatric ECMO Anticoagulation CollaborativE. DATA SOURCES A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION Management of ECMO anticoagulation in the setting of different ECMO circuit components. DATA EXTRACTION Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Twenty-nine references were used for data extraction and informed recommendations, evidence-based consensus statements, and good practice statements. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements or good practice statements for the influence of ECMO circuit and components on anticoagulation management. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. One good practice statement, 2 weak recommendations, and 2 consensus statements are presented. CONCLUSIONS The incorporation of new component technologies into clinical practice has outpaced clinical investigations of anticoagulation strategies for pediatric ECMO. Future investigations should leverage academic and industrial collaborations, translational platforms, and modern biostatistical methods to improve patient outcomes.
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Affiliation(s)
- Adam S Himebauch
- Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John R Priest
- Department of Respiratory Care, ECMO Program, Boston Children's Hospital, Boston, MA
| | - Gail M Annich
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - David A Turner
- American Board of Pediatrics, Chapel Hill, NC
- Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, NC
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Matthew L Paden
- Division of Pediatric Critical Care, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, OH
| | - Elizabeth Lyman
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, OH
| | - Ahmed S Said
- Division of Pediatric Critical Care, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, MO
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Taylor C, Mitchell C, Kaneko H, Foley B, Shaw J. Review of the Australian nurse teacher professional practice standards: An e-Delphi study. Nurse Educ Pract 2024; 79:104045. [PMID: 38991261 DOI: 10.1016/j.nepr.2024.104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/30/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIM The aim of the study was to review the 2010 Australian nurse teacher professional practice standards ('the Standards') to see if they were still relevant to current nursing educator practice in any practice setting, such as academia or clinical settings. BACKGROUND It has been over 10 years since 'the Standards have been reviewed. Nurse education practice has met many challenges in the past decade, so it is timely to evaluate whether the Standards are still relevant to nursing educators today. DESIGN A modified Delphi technique was used for this study. METHODS Delphi surveys were used to obtain consensus on the relevance of the Standards' statements to any nursing educator. Links to two electronic surveys were sent to an expert panel of nursing educator leaders. Also, two online focus groups of nursing educators from any practice setting or level of experience were held. Results from the first survey and focus groups led to word changes and additional statements, which were included in the second Delphi survey. RESULTS Forty participants responded to the first survey and 38 to the second. Fifteen nursing educators attended the focus groups. There was ≥85 % agreement on all statements in the first survey. with similar high agreement responses in the second survey. Changes in the Standards included language used around culture, inclusion of 'sustainability of the program' and 'demonstrates knowledge and expertise in teaching and educational practice'. CONCLUSIONS The Australian nurse teacher professional practice standards remain highly relevant to nursing educators across all practice settings. In response to feedback from nursing educators some changes to language and additional standard statements were included in the revised standards.
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Affiliation(s)
- Christine Taylor
- School of Nursing and Midwifery, Western Sydney University, NSW, Australia; NSW Centre for Evidence-Based Health Care: A Joanna Briggs Institute Affiliated Centre, Rydalmere, NSW, Australia.
| | - Creina Mitchell
- School of Nursing and Midwifery, Griffith University, QLD, Australia
| | - Hellen Kaneko
- Queensland Digital Academy, Queensland Health, QLD, Australia
| | - Belinda Foley
- The Tweed Hospital, Northern NSW Local Health District, NSW, Australia
| | - Julie Shaw
- Department of Nursing and Allied Health, Swinburne University of Technology, VIC, Australia
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Alexander PMA, Bembea MM, Cashen K, Cheifetz IM, Dalton HJ, Himebauch AS, Karam O, Moynihan KM, Nellis ME, Ozment C, Raman L, Rintoul NE, Said AS, Saini A, Steiner ME, Thiagarajan RR, Watt K, Willems A, Zantek ND, Barbaro RP, Steffen K, Vogel AM, Almond C, Anders MM, Annich GM, Brandão LR, Chandler W, Delaney M, DiGeronimo R, Emani S, Gadepalli SK, Garcia AV, Haileselassie B, Hyslop R, Kneyber MCJ, Baumann Kreuziger L, Le J, Loftis L, McMichael ABV, McMullan DM, Monagle P, Nicol K, Paden ML, Patregnani J, Priest J, Raffini L, Ryerson LM, Sloan SR, Teruya J, Yates AR, Gehred A, Lyman E, Muszynski JA. Executive Summary: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE) Consensus Conference. Pediatr Crit Care Med 2024; 25:643-675. [PMID: 38959353 PMCID: PMC11216385 DOI: 10.1097/pcc.0000000000003480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To present recommendations and consensus statements with supporting literature for the clinical management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus conference. DATA SOURCES Systematic review was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial meetings of international, interprofessional experts in the management ECMO for critically ill children. STUDY SELECTION The management of ECMO anticoagulation for critically ill children. DATA EXTRACTION Within each of eight subgroup, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. DATA SYNTHESIS A systematic review was conducted using MEDLINE, Embase, and Cochrane Library databases, from January 1988 to May 2021. Each panel developed evidence-based and, when evidence was insufficient, expert-based statements for the clinical management of anticoagulation for children supported with ECMO. These statements were reviewed and ratified by 48 PEACE experts. Consensus was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 23 recommendations, 52 expert consensus statements, and 16 good practice statements covering the management of ECMO anticoagulation in three broad categories: general care and monitoring; perioperative care; and nonprocedural bleeding or thrombosis. Gaps in knowledge and research priorities were identified, along with three research focused good practice statements. CONCLUSIONS The 91 statements focused on clinical care will form the basis for standardization and future clinical trials.
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Affiliation(s)
- Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine Cashen
- Department of Pediatrics, Duke Children's Hospital, Duke University, Durham, NC
| | - Ira M Cheifetz
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Heidi J Dalton
- Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Oliver Karam
- Division of Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA
- Division of Critical Care Medicine, Yale School of Medicine, New Haven, CT
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marianne E Nellis
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell, New York, NY
| | - Caroline Ozment
- Division of Critical Care Medicine, Department of Pediatrics, Duke University and Duke University Health System, Durham, NC
| | - Lakshmi Raman
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Natalie E Rintoul
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ahmed S Said
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Arun Saini
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Marie E Steiner
- Department of Pediatrics, Divisions of Hematology and Critical Care, University of Minnesota, Minneapolis, MN
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kevin Watt
- Division of Clinical Pharmacology, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Ariane Willems
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Katherine Steffen
- Department of Pediatrics (Pediatric Critical Care Medicine), Stanford University, Palo Alto, CA
| | - Adam M Vogel
- Departments of Surgery and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Christopher Almond
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA
| | - Marc M Anders
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Gail M Annich
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leonardo R Brandão
- Department of Pediatrics, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wayne Chandler
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Megan Delaney
- Division of Pathology and Lab Medicine and Transfusion Medicine, Children's National Hospital, Washington, DC
- Departments of Pathology and Pediatrics, The George Washington University Health Sciences, Washington, DC
| | - Robert DiGeronimo
- Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Sitaram Emani
- Department of Cardiovascular Surgery, Boston Children's Hospital, and Department of Surgery, Harvard Medical School, Boston, MA
| | - Samir K Gadepalli
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robert Hyslop
- Heart Institute, Children's Hospital of Colorado, Aurora, CO
| | - Martin C J Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisa Baumann Kreuziger
- Versiti Blood Research Institute and Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
| | - Laura Loftis
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ali B V McMichael
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - D Michael McMullan
- Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, WA
| | - Paul Monagle
- University of Melbourne, and Kids Cancer Centre Sydney Children's Hospital, and Murdoch Children's Research Institute, and Royal Children's Hospital Melbourne Australia, Melbourne, VIC, Australia
| | - Kathleen Nicol
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Matthew L Paden
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jason Patregnani
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Barbara Bush Children's Hospital, Portland, ME
| | - John Priest
- Department of Respiratory Care, Boston Children's Hospital, Boston MA
| | - Leslie Raffini
- Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Lindsay M Ryerson
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Steven R Sloan
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
- CSL Behring, King of Prussia, PA
| | - Jun Teruya
- Division of Transfusion Medicine and Coagulation, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Andrew R Yates
- Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH
| | - Alison Gehred
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Elizabeth Lyman
- Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, Columbus, OH
| | - Jennifer A Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and The Ohio State University of Medicine, Columbus, OH
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Sousa Filho LF, Farlie MK, Haines T, Borrelli B, Carroll C, Mathews C, Ribeiro DC, Fritz JM, Underwood M, Foster NE, Lamb SE, Sanchez ZM, Malliaras P. Developing an international consensus Reporting guideline for intervention Fidelity in Non-Drug, non-surgical trials: The ReFiND protocol. Contemp Clin Trials 2024; 142:107575. [PMID: 38750951 DOI: 10.1016/j.cct.2024.107575] [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: 02/07/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials. METHODS The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline. DISCUSSION The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research.
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Affiliation(s)
| | - Melanie K Farlie
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA.
| | | | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.; University Hospitals of Coventry and Warwickshire, Coventry, UK.
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia; School of Medicine, Keele University, Keele, UK.
| | - Sarah E Lamb
- University of Exeter, St Luke's Campus, Exeter, UK.
| | - Zila M Sanchez
- Department of Preventive Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Peter Malliaras
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
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