Application of Delphi Technique in Identification of Appropriate Screening Questions for Chronic Low Back Pain from Traditional Chinese Medicine Experts' Opinions

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

Background

Recently, measuring and benchmarking provision of healthcare services has drawn a considerable attention. This scoping review was conducted to identify, describe, and summarize studies in which the Delphi technique was used to develop quality indicators of pharmaceutical care. The study also aimed to identify activities and services that could be used to capture the impact of pharmacist in integrative medicine.

Methods

Databases were searched from inception to February 2020 using key terms that were combined using Boolean operators. Studies were included if they were relevant to development of quality indicators of pharmaceutical care with regard to medications or complementary and alternative medicine (CAM) modalities. Full text of the selected studies was imported into EndNote. Studies were screened and data were extracted into a standard extraction form.

Results

Data were extracted from 31 studies. Of those, 24 (77.4%) were related to provision of pharmaceutical services relevant to medications and 7 (22.6%) were related to provision of care using CAM modalities. Most of the studies (67.7%) were published in 2010 and beyond. Almost half of the studies (48.4%) originated from the United States, United Kingdom, and Canada. A total of 42 different activities and services that could be used as quality indicators were identified from the studies included in this review. Activities and services were related to history taking, performing reconciliations, identifying and resolving therapy problems, providing collaborative care, designing care plans, optimal performance, and continuing education.

Conclusions

Although there is an increasing interest in improving healthcare delivery, quality indicators of pharmaceutical services and those relevant to CAM provision in healthcare facilities adopting the integrated healthcare paradigm are still limited. Future studies are needed to develop validated quality indicators that could be successfully used in measuring and benchmarking quality of services in integrated healthcare facilities.

Construção e validação de um manual informativo sobre o banho no leito

OBJETIVO: Construir e validar um manual informativo sobre o banho no leito para pacientes com síndrome coronária aguda. MÉTODOS: O manual informativo foi desenvolvido com base na experiência profissional dos pesquisadores e em levantamento bibliográfico. A versão preliminar do manual foi submetida à validação de conteúdo por dez enfermeiros, utilizando a Técnica de Delphi. A versão final do manual foi validada com 35 pacientes internados na unidade coronariana e que haviam vivenciado ao menos uma vez o banho no leito utilizando escala do tipo Likert. RESULTADOS: O manual informativo foi construído contendo informações sobre o banho no leito e as razões da necessidade deste procedimento. Na primeira fase foram necessárias quatro rodadas para o consenso entre os enfermeiros. Na segunda fase, foi observada uma média de escore superior a 4, sendo considerado como validado. CONCLUSÃO: Foi construído e validado um manual informativo sobre o banho no leito para pacientes com síndrome coronária aguda.

Factor analysis on symptoms and signs of chronic low-back pain based on Traditional Chinese Medicine theory

OBJECTIVES

The objective of this study was to use factor analysis to explore patterns of symptoms and signs from patients with chronic low-back pain (CLBP) based on the Traditional Chinese Medicine (TCM) theory.

DESIGN, SETTINGS, AND SUBJECTS

A cross-sectional study was carried out among 513 patients with CLBP in four hospitals affiliated with Yunnan University of Traditional Chinese Medicine, China.

OUTCOME MEASURES

Outcome measures comprised 31 symptoms and signs on a six-level self-report questionnaire.

RESULTS

Four (4) factors were extracted. They were eventually interpreted as (1) "Qi and/or Blood Stagnation," which includes eight items such as piercing pain; activity limited by feeling of local heaviness, lumbar and flank stiffness with bending limitation and purple tongue, etc.; (2) "Cold/Damp," which has seven items (for example, Cold/Damp pain, pallid face and greasy coating, etc.); (3) a part of "Kidney Deficiency," which includes two items: "dull pain and recurrent vague pain"; (4) "Warmth/Heat," which is related to three items (namely, purple tongue, yellow tongue coating, and burning pain). The four factors accounted for 12.7%, 8.2%, 8.2%, and 7.8% of the total variance, respectively. There are seven items with uniqueness over 0.8.

CONCLUSIONS

Four (4) TCM major groups of pathophysiology could explain 37% of variance of 31 symptoms and signs of the CLBP patients. Thirteen (13) items are not groupable.