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Franklin P, Arber A, Ream E. Priorities for enhancing nurses' and social workers' competence and confidence in helping families support dependent children through parental death. A classic-Delphi survey. BMC Palliat Care 2024; 23:122. [PMID: 38760809 PMCID: PMC11102151 DOI: 10.1186/s12904-024-01452-0] [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: 05/29/2023] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Annually, approximately five per cent of dependent children - aged under eighteen years - in the United Kingdom (UK), experience parental death. Nurses and social workers caring for parents with life-limiting illnesses, including cancer, help families support their children. However, these professionals have been found to lack confidence and competence in fulfilling this role. METHODS We conducted three rounds of a classic-Delphi survey to identify and measure a panel of topic experts' consensus on the priorities and issues for nurses and social workers when supporting families and children through parental death. The Delphi survey was conducted with a panel of UK topic experts (n=43) including lead health and social care professionals (n=30), parents bereaved of a partner whilst parenting dependent children (n=6), academics (n=4) and bereaved young adults (n=3). RESULTS Ninety per cent (n=18/20) of the issues for nurses and social workers and all (7/7) of the priorities rated and ordered in the survey achieved consensus. Key priorities were 1) training in opening conversations with families about dependent children, 2) training and support for nurses and social workers to manage their own and others' emotions arising from conversations with parents about children's needs regarding parental death, and 3) increasing nurses' and social workers' knowledge of sources of information to support families before the death of a parent. CONCLUSION We identified priorities for UK nurses and social workers. Further research is needed to identify which of these nurses and social workers would benefit most from support, and how any resultant interventions could enhance confidence and competence in helping families to support children through parental death.
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Affiliation(s)
- Penny Franklin
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK.
- Department of Pastoral and Spiritual Care, Royal Devon University Healthcare NHS Foundation Trust, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, England, EX2 5DW, UK.
| | - Anne Arber
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK
| | - Emma Ream
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK
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Hwang YIJ, Hampton S, Withall AL, Snoyman P, Forsyth K, Butler T. Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age. HEALTH & JUSTICE 2024; 12:17. [PMID: 38639865 PMCID: PMC11027373 DOI: 10.1186/s40352-024-00271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND As populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The 'ageing epidemic' in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment. RESULTS A modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs. CONCLUSIONS There is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.
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Affiliation(s)
- Ye In Jane Hwang
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Stephen Hampton
- Justice Health & Forensic Mental Health Network, Matraville, NSW, 2036, Australia
| | - Adrienne Lee Withall
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Katrina Forsyth
- Health and Justice Research Network, University of Manchester, Manchester, M13 9PL, UK
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
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3
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Haruta J, Goto R. Exploring factors associated with healthcare professionals' subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels. BMJ Open 2024; 14:e081328. [PMID: 38531578 DOI: 10.1136/bmjopen-2023-081328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE The aim of this study was to explore factors associated with healthcare professionals' subjective perceptions of complex issues in primary care settings in Japan. DESIGN Cross-sectional survey conducted through a self-administered web-based questionnaire. SETTING Japan, from June to October 2020. PARTICIPANTS Healthcare professionals recruited via an email list from the Japan Primary Care Association. MEASURES The questionnaire assessed subjective perception of satisfaction, confidence and burden regarding complex issues using a 100 mm Visual Analogue Scale (VAS). Explanatory variables included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), basic demographic information, administrative experience and an organisational climate scale. This scale comprised the 'Plan, Do, See' (PDS) factor for management and the 'Do' factor in a leader-centred direction for those working under compulsion. Factors associated with subjective perceptions were analysed using binomial logistic regression analysis and Bonferroni analysis (p<0.017). RESULTS Data from 593 participants (average age of 41.2 years, including 133 nurses, 128 physicians and 120 social workers) were analysed. Median (quartile) VAS scores for satisfaction, confidence and burden were 50 (36-70), 52 (40-70) and 50 (30-66), respectively. Higher satisfaction group was significantly associated with PDS factor, Do factor and JASSIC Score. Greater confidence group associated with older age, male, Do factor, administrative experience and JASSIC Score. No factors were significantly associated with the higher perceived burden. CONCLUSION These findings reveal that interprofessional competency self-assessment influence perceptions of complex issues among healthcare professionals. Moreover, satisfaction with complex issues might be enhanced by a manageable organisational climate, while confidence might be influenced by personal attributes.
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Affiliation(s)
- Junji Haruta
- Center for General Medicine Education, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Ryohei Goto
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Davies LSC, McHugh L, Falk S, Bridge J, Amaro PF, Whiteside L, Bailey R, Webb J, Eccles CL. Clinical Trials Radiographers identifying priority challenges associated with implementing a national programme of clinical trials in the United Kingdom's first proton beam therapy centre. BJR Open 2024; 6:tzae012. [PMID: 38873402 PMCID: PMC11170212 DOI: 10.1093/bjro/tzae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives This article is an evaluation of the current trial processes within a national proton beam therapy (PBT) clinical trial service in the United Kingdom. The work within the article identifies priority challenges associated with the implementation of PBT trials with a view to improving patient trial processes. Methods The nominal group technique (NGT) was used. Five Clinical Trials Radiographers were asked the target question "what are the major challenges when implementing PBT clinical trials and facilitating PBT trial-related activities?" Participants individually and silently listed their challenges to the target question. Following this, group discussion clarified and refined responses. Participants then individually selected five challenges that they deemed most pertinent to the target question, giving a weighted score (out of 10). Individual scores were combined to provide a ranked, weighted order of challenges. Further group discussion identified improvement strategies to the highest scored challenges. Results After combining lists generated by participants, 59 challenges were identified. Group discussion eliminated 27 responses. Eighteen were merged, resulting in 14 challenges. The two challenges that ranked highest were: (i) lack of initial understanding of the responsibilities of teams and who the relevant stakeholders were, and (ii) that a national PBT service requires the provision of shared care across multi-disciplinary teams and sites. Improvement areas include the development of shared protocols, clarifying stakeholder responsibilities and improving communication between centres to streamline PBT trial processes. Conclusions This work has identified priority areas requiring development to improve the conduct of a national PBT clinical trials programme. Advances in knowledge This is the first publication to evaluate current clinical trial processes for the United Kingdom's PBT service.
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Affiliation(s)
- Lucy S C Davies
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Louise McHugh
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Sally Falk
- Proton Beam Therapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Jacqui Bridge
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Philip F Amaro
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Lee Whiteside
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Rachael Bailey
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Julie Webb
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Cynthia L Eccles
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, United Kingdom
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Willis TA, Neal RD, Walter FM, Foy R. Priorities for implementation research on diagnosing cancer in primary care: a consensus process. BMC Health Serv Res 2023; 23:1308. [PMID: 38012602 PMCID: PMC10683096 DOI: 10.1186/s12913-023-10330-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: 05/15/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The early detection and diagnosis of cancer to reduce avoidable mortality and morbidity is a challenging task in primary health care. There is a growing evidence base on how to enable earlier cancer diagnosis, but well-recognised gaps and delays exist around the translation of new research findings into routine clinical practice. Implementation research aims to accelerate the uptake of evidence by health care systems and professionals. We aimed to identify priorities for implementation research in early cancer diagnosis in primary care. METHODS We used a RAND/UCLA modified Delphi consensus process to identify and rank research priorities. We asked primary care physicians, patients and researchers to complete an online survey suggesting priorities for implementation research in cancer detection and diagnosis. We summarised and presented these suggestions to an 11-member consensus panel comprising nine primary care physicians and two patients. Panellists independently rated the importance of suggestions on a 1-9 scale (9 = very high priority; 1 = very low priority) before and after a structured group discussion. We ranked suggestions using median ratings. RESULTS We received a total of 115 suggested priorities for implementation research from 32 survey respondents (including 16 primary care professionals, 11 researchers, and 4 patient and public representatives; 88% of respondents were UK-based). After removing duplicates and ineligible suggestions, we presented 37 suggestions grouped within 17 categories to the consensus panel. Following two rounds of rating, 27 suggestions were highly supported (median rating 7-9). The most highly rated suggestions concerned diagnostic support (e.g., access to imaging) interventions (e.g., professional or patient education), organisation of the delivery of care (e.g., communication within and between teams) and understanding variations in care and outcomes. CONCLUSIONS We have identified a set of priorities for implementation research on the early diagnosis of cancer, ranked in importance by primary care physicians and patients. We suggest that researchers and research funders consider these in directing further efforts and resources to improve population outcomes.
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Affiliation(s)
- Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom.
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus Heavitree Road, Exeter, EX1 2LU, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom
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Xu SS, Tian Y, Ma YJ, Zhou YM, Tian Y, Gao R, Yang YL, Zhang L, Zhou JX. Development of a Prediction Score for Evaluation of Extubation Readiness in Neurosurgical Patients with Mechanical Ventilation. Anesthesiology 2023; 139:614-627. [PMID: 37535470 PMCID: PMC10566588 DOI: 10.1097/aln.0000000000004721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND There is no widely accepted consensus on the weaning and extubating protocols for neurosurgical patients, leading to heterogeneity in clinical practices and high rates of delayed extubation and extubation failure-related health complications. METHODS In this single-center prospective observational diagnostic study, mechanically ventilated neurosurgical patients with extubation attempts were consecutively enrolled for 1 yr. Responsive physicians were surveyed for the reasons for delayed extubation and developed the Swallowing, Tongue protrusion, Airway protection reflected by spontaneous and suctioning cough, and Glasgow Coma Scale Evaluation (STAGE) score to predict the extubation success for neurosurgical patients already meeting other general extubation criteria. RESULTS A total of 3,171 patients were screened consecutively, and 226 patients were enrolled in this study. The rates of delayed extubation and extubation failure were 25% (57 of 226) and 19% (43 of 226), respectively. The most common reasons for the extubation delay were weak airway-protecting function and poor consciousness. The area under the receiver operating characteristics curve of the total STAGE score associated with extubation success was 0.72 (95% CI, 0.64 to 0.79). Guided by the highest Youden index, the cutoff point for the STAGE score was set at 6 with 59% (95% CI, 51 to 66%) sensitivity, 74% (95% CI, 59 to 86%) specificity, 90% (95% CI, 84 to 95%) positive predictive value, and 30% (95% CI, 21 to 39%) negative predictive value. At STAGE scores of 9 or higher, the model exhibited a 100% (95% CI, 90 to 100%) specificity and 100% (95% CI, 72 to 100%) positive predictive value for predicting extubation success. CONCLUSIONS After a survey of the reasons for delayed extubation, the STAGE scoring system was developed to better predict the extubation success rate. This scoring system has promising potential in predicting extubation readiness and may help clinicians avoid delayed extubation and failed extubation-related health complications in neurosurgical patients. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Shan-Shan Xu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Juan Ma
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Min Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ran Gao
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linlin Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Katangwe-Chigamba T, Sokhi J, Family H, Al-Jabr H, Kirkdale CL, Twigg MJ. Theory-informed strategies to address factors anticipated to influence implementation and people's participation in community pharmacy-based diabetes prevention services. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100263. [PMID: 37122478 PMCID: PMC10141495 DOI: 10.1016/j.rcsop.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background Early identification of non-diabetic hyperglycaemia and implementation of diet and lifestyle changes can prevent type 2 diabetes. However, low participation in diabetes prevention services remains a problem in the UK. The community pharmacy, one of the most accessible healthcare settings in the UK, could provide one solution to improving participation. Aim To prioritize factors that could influence delivery of, and people-participation in, community pharmacy-based diabetes prevention services, and to identify strategies to facilitate successful implementation. Methods A mixed-methods, primary care-based study, comprising of two stages: 1- Prioritizing key influences of participation and delivery using a structured Nominal Group Technique with people with non-diabetic hyperglycemia, and other stakeholders; 2 - Identifying theory informed strategies to facilitate successful implementation using framework analysis. This involved mapping prioritized influences and qualitative data from the Nominal Group Technique onto the Behaviour Change Wheel theoretical framework. The study was conducted in February 2019, in Norfolk, UK and ethical approval obtained prior to research commencing. Results Fifteen participants (five people with non-diabetic hyperglycaemia, nine community pharmacy and general practice staff and one commissioner) participated. Participants prioritized "awareness" and "service integration" as key factors likely to influence participation and "the provision of information about health consequences e.g., leaflets" and "action planning e.g. general practice referral of patients to prevention services" as key strategies to facilitate participation. "Training", "staffing levels" and "workload" were amongst the key factors prioritized as most likely to influence delivery. Strategies identified to facilitate implementation included "instructions of how to perform the behaviour e.g. standard operating procedures" and "reward e.g. funding". Conclusions This research provides theory informed strategies needed to facilitate successful implementation of community pharmacy-based diabetes prevention services. The findings of this study should inform the design of future diabetes prevention services to ensure participation and sustainability.
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Affiliation(s)
- Thando Katangwe-Chigamba
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Corresponding author at: Norwich Clinical Trials Unit, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Jeremy Sokhi
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
| | - Hannah Family
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hiyam Al-Jabr
- Integrated Care Academy, University of Suffolk, Ipswich, United Kingdom
| | | | - Michael J. Twigg
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
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MacKay C, Lee L, Best K, Campbell J, Cimino SR, Cowley H, Delvin M, Dilkas S, Landry M, Marzolini S, Mayo A, Oh P, Payne M, Viana R, Totosy de Zepetnek J, Domingo A, King S, Miller WC, Robert M, Tang A, Zidarov D, Zucker-Levin A, Hitzig SL. Developing a research agenda on exercise and physical activity for people with limb loss in Canada. Disabil Rehabil 2022; 44:8130-8138. [PMID: 34843420 DOI: 10.1080/09638288.2021.2003877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE There is a lack of high-quality evidence about the effects of exercise or physical activity interventions for adults with lower limb amputations (LLAs). A planning meeting involving stakeholders (i.e., people with LLA, community advocates, health care providers, researchers) was organized to identify key research priorities related to exercise and physical activity for people with LLAs. METHODS We used a collaborative prioritized planning process with a pre-meeting survey and 2-day virtual meeting that included: identification and prioritization of challenges or gaps; identification and consolidation of solutions; and action planning. This process integrated a modified Delphi approach, including anonymous feedback in two surveys. RESULTS Thirty-five stakeholders participated. Six challenges related to exercise and physical activity for people with LLA were prioritized. One solution was prioritized for each challenge. After consolidation of solutions, participants developed five research action plans for research including: developing an on-line interface; developing and evaluating peer-support programs to support physical activity; examining integration of people with LLA into cardiac rehabilitation; development and evaluation of health provider education; and determining priority outcomes related to physical activity and exercise. CONCLUSIONS This collaborative process resulted in an action plan for amputation research and fostered collaborations to move identified priorities into action.IMPLICATIONS FOR REHABILITATIONLower limb amputations impact mobility leading to lower levels of physical activity.There are research gaps in our understanding of the effects of exercise or physical activity interventions for adults with lower limb amputations.Through a collaborative planning process, participants prioritized research directions on physical activity and exercise for people with LLA to advance research in the field.Action plans for research focused on developing online resources, peer support, cardiac rehabilitation for people with LLA, health provider education and determining priority outcomes related to physical activity and exercise.
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Affiliation(s)
- Crystal MacKay
- West Park Healthcare Centre, Toronto, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Leanna Lee
- West Park Healthcare Centre, Toronto, Canada
| | - Krista Best
- Faculté de médecine, Universite Laval, Quebec City, Canada
| | | | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Steven Dilkas
- West Park Healthcare Centre, Toronto, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mireille Landry
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital, Toronto, Canada
| | - Susan Marzolini
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Amanda Mayo
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Michael Payne
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Parkwood Institute, St. Joseph's Health Care, London, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Parkwood Institute, St. Joseph's Health Care, London, Canada
| | | | | | | | - William C Miller
- GF Strong Rehab Centre, Vancouver, Canada.,Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Maxime Robert
- Faculté de médecine, Universite Laval, Quebec City, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Diana Zidarov
- Faculté de Médecine, École de réadaptation, Université de Montréal, Montréal, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Lawson CA, Lam C, Jaarsma T, Kadam U, Stromberg A, Ali M, Tay WT, Clayton L, Khunti K, Squire I. Developing a core outcome set for patient-reported symptom monitoring to reduce hospital admissions for patients with heart failure. Eur J Cardiovasc Nurs 2022; 21:830-839. [PMID: 35404418 DOI: 10.1093/eurjcn/zvac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/29/2022]
Abstract
AIMS In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. METHODS AND RESULTS A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection.Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. CONCLUSION Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.
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Affiliation(s)
- Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
| | - Carolyn Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands.,The George Institute for Global Health, Newton, NSW, Australia
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Umesh Kadam
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna Stromberg
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
| | | | - Louise Clayton
- Department of Cardiology, University Hospitals of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
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Alghamdi AS, Alotaibi AM, Alshammari KJ, Alharbi AJ, Alrabiah RS, Hadadi AY, Albloushi MM, Alabdali AA. National research guideline for prehospital emergency medical care: A prospective Delphi-study. Saudi Med J 2022; 43:1265-1269. [PMID: 36379535 PMCID: PMC10043906 DOI: 10.15537/smj.2022.43.11.20220570] [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: 07/28/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To identify the most important research topics to establish a national research agenda and protocol for prehospital research in Saudi Arabia (KSA). METHODS A 3-round modified Delphi consensus methods were used to determine high-priority research topics. Round I included an open-ended question to list all high-priority research topics in a prehospital setting in Riyadh, KSA. Rounds II and III included ranking evaluation and consensus agreement. The included topics were listed based on the agreement of ≥70% of the experts participating in the study. The study was carried out between November 2021 and February 2022. RESULTS In total, 100 prehospital experts in KSA were invited to participate in all 3 rounds. Of these, 47 responded in round I, 34 in round II, and 39 in round III. In round I, participants submitted 278 research topics. After deduplication and sorting, 78 topics were assessed in the other 2 rounds. CONCLUSION In this modified Delphi study, an expert panel identified the top prehospital emergency medical services (EMS) care research priorities. The leading research priorities included clinical and operational ideas. The proposed 32 high-priority topics can be used to guide researchers, research networks, policymakers, and funding organizations involved in EMS.
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Affiliation(s)
- Abdulrhman S. Alghamdi
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Ahmed M. Alotaibi
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Khaled J. Alshammari
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Abdulrahman J. Alharbi
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Rayyan S. Alrabiah
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Abdulmohsen Y. Hadadi
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Mohammed M. Albloushi
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
| | - Abdullah A. Alabdali
- From the College of Applied Medical Sciences (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alghamdi, Alotaibi, Alshammari, Alharbi, Alrabiah, Hadadi, Albloushi, Alabdali), Riyadh, Kingdom of Saudi Arabia; and from the Division of Cardiovascular Sciences (Alotaibi), University of Manchester, Manchester, United Kingdom.
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Malycha J, Andersen C, Redfern OC, Peake S, Subbe C, Dykes L, Phillips A, Ludbrook G, Young D, Watkinson PJ, Flabouris A, Jones D. Protocol describing a systematic review and mixed methods consensus process to define the deteriorated ward patient. BMJ Open 2022; 12:e057614. [PMID: 36123094 PMCID: PMC9486195 DOI: 10.1136/bmjopen-2021-057614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most patients admitted to hospital recover with treatments that can be administered on the general ward. A small but important group deteriorate however and require augmented organ support in areas with increased nursing to patient ratios. In observational studies evaluating this cohort, proxy outcomes such as unplanned intensive care unit admission, cardiac arrest and death are used. These outcome measures introduce subjectivity and variability, which in turn hinders the development and accuracy of the increasing numbers of electronic medical record (EMR) linked digital tools designed to predict clinical deterioration. Here, we describe a protocol for developing a new outcome measure using mixed methods to address these limitations. METHODS AND ANALYSIS We will undertake firstly, a systematic literature review to identify existing generic, syndrome-specific and organ-specific definitions for clinically deteriorated, hospitalised adult patients. Secondly, an international modified Delphi study to generate a short list of candidate definitions. Thirdly, a nominal group technique (NGT) (using a trained facilitator) will take a diverse group of stakeholders through a structured process to generate a consensus definition. The NGT process will be informed by the data generated from the first two stages. The definition(s) for the deteriorated ward patient will be readily extractable from the EMR. ETHICS AND DISSEMINATION This study has ethics approval (reference 16399) from the Central Adelaide Local Health Network Human Research Ethics Committee. Results generated from this study will be disseminated through publication and presentation at national and international scientific meetings.
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Affiliation(s)
- James Malycha
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, Oxford, Oxfordshire, UK
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Chris Andersen
- Critical Care Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Oliver C Redfern
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, Oxford, Oxfordshire, UK
| | - Sandra Peake
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christian Subbe
- School of Medical Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Lukah Dykes
- Flinders University, Adelaide, South Australia, Australia
| | - Adam Phillips
- University of South Australia, Adelaide, South Australia, Australia
| | - Guy Ludbrook
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Duncan Young
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, Oxford, Oxfordshire, UK
| | - Arthas Flabouris
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daryl Jones
- Intensive Care Unit Austin Hospital, Austin Health, Heidelberg, Victoria, Australia
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12
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Maguire T, Garvey L, Ryan J, Olasoji M, Willets G. Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper. Int J Ment Health Nurs 2022; 31:1030-1038. [PMID: 35591773 PMCID: PMC9321579 DOI: 10.1111/inm.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Loretta Garvey
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jo Ryan
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Michael Olasoji
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Georgina Willets
- School of Health, Federation University Australia, Melbourne, Australia
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Joshi E, Bhatta S, Joshi SK, Mytton J. Identification of research priorities for suicide prevention in Nepal: a Delphi study. BMC Psychiatry 2022; 22:429. [PMID: 35752774 PMCID: PMC9233798 DOI: 10.1186/s12888-022-04074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal. METHODS The Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses. RESULTS Forty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as 'very important' or 'important', 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions. CONCLUSIONS This is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.
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Affiliation(s)
- Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College Public Limited, P O Box 21266, Kathmandu, Nepal.
| | - Santosh Bhatta
- grid.6518.a0000 0001 2034 5266Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK ,grid.6518.a0000 0001 2034 5266Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sunil Kumar Joshi
- grid.415089.10000 0004 0442 6252Nepal Injury Research Centre, Kathmandu Medical College Public Limited, P O Box 21266, Kathmandu, Nepal ,grid.415089.10000 0004 0442 6252Department of Community Medicine, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| | - Julie Mytton
- grid.6518.a0000 0001 2034 5266Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK ,grid.6518.a0000 0001 2034 5266Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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14
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Montesanti S, Fitzpatrick K, Fayant B, Pritchard C. Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach. BMC Health Serv Res 2022; 22:406. [PMID: 35346187 PMCID: PMC8958486 DOI: 10.1186/s12913-022-07682-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population. Methods We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB. Results Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region. Conclusions Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07682-3.
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Carretero C, Carbonnel F, Ferrante M, Knudsen T, Van Lent N, Lobo AJ, Negreanu L, Vojvodic A, Oliva S. Monitoring established Crohn's disease with pan-intestinal video capsule endoscopy in Europe: clinician consultation using the nominal group technique. Curr Med Res Opin 2021; 37:1547-1554. [PMID: 34132150 DOI: 10.1080/03007995.2021.1940910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Monitoring established Crohn's disease (CD) through a "treat-to-target" strategy aims to reduce and prevent long-term bowel damage and disability. Despite the availability of different monitoring techniques, there is a current lack of integrated evidence to guide optimal monitoring in terms of appropriate tools and timing. Pan-intestinal video capsule endoscopy (PCE) enables non-invasive and direct visualization of the entire intestinal tract with proven safety and efficacy. This study aims to generate insights on the value of PCE for monitoring established CD from the physician's perspective. METHODS The Nominal Group Technique (NGT) was used to create discussion around pre-defined research questions aimed at identifying target patient populations for PCE, benefits of PCE in terms of improving disease management, comparative benefits of PCE over standard of care, research priorities to ratify the use of PCE, and hurdles to PCE utilization. A NGT panel was held in Brussels, Belgium in October 2018 with 9 gastroenterology experts. Data were collected from multiple rankings of statements to the research questions and analyzed descriptively. RESULTS Consensus indicated that PCE is differentiated from other diagnostic tools, allowing for non-invasive and direct visualization of the luminal intestinal tract in one single procedure. Participants agreed that PCE is beneficial for mapping and grading established CD in all patients, enabling individual and tailored treatment decision-making. Time required to read PCE results was identified as the main utilization hurdle by participants. Well-designed studies are needed to confirm improved outcomes amongst patients with CD managed through a PCE-guided approach. CONCLUSIONS This study, using the NGT, generated expert opinion on the value of PCE for monitoring established CD in terms of target patient populations and benefits compared to other diagnostic modalities. Participants perceived PCE to facilitate a "treat-to-target" strategy for CD management. Further research is needed to support this value perception.
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Affiliation(s)
- Cristina Carretero
- Gastroenterology Department, University of Navarra Clinic-IdiSNA, Pamplona, Spain
| | - Franck Carbonnel
- Hôpital de Bicêtre, Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, and Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven/KU, Leuven, Belgium
| | - Torben Knudsen
- Department Medical Gastroenterology, Hospital Southwest Denmark; Department of Regional Health Research, University of Southern, Esbjerg, Denmark
| | - Nancy Van Lent
- Unit of Gastrointestinal, Medtronic Belgium, Jette, Belgium
| | - Alan J Lobo
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals and University of Sheffield, Sheffield, UK
| | - Lucian Negreanu
- Gastroenterology Department, University Hospital Bucharest, Carol Davila University of Medicine, Bucharest, Romania
| | - Ana Vojvodic
- Unit of Gastrointestinal, Medtronic Belgium, Jette, Belgium
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza - University of Rome, Rome, Italy
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Visade F, Lefebvre A, Floret E, Decaudin B, Puisieux F, Delecluse C, Beuscart JB. Proposition of a structured list of information items to be transmitted to primary caregivers after in-hospital medication optimization: a qualitative study. Acta Clin Belg 2021; 76:184-189. [PMID: 31787034 DOI: 10.1080/17843286.2019.1699689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objective: Defective transmission of drug information during the transition from hospital to home care are causes of adverse drug reactions in older patients. We aimed to reach a consensus concerning information about changes in treatment to be transmitted to primary caregivers when an older patient is discharged from hospital.Methods: A qualitative focus group study was conducted with general practitioners, geriatricians, community pharmacists, and hospital pharmacists providing care for older patients. Four steps were used to reach a focus group consensus: 1) presentation of the purpose of the focus group; 2) generation and enumeration of ideas; 3) sharing opinions about these ideas; 4) voting to create a list of ranked items. The process involved three focus groups.Results: A consensus was reached on ten items: indication for continued, discontinued, newly introduced or changed treatments and their duration; reasons for discontinuing drugs or introducing new drugs; information about re-evaluating treatments; reasons for hospital stay, significant elements and diagnosis at discharge; administrative information concerning the patient; the name of the primary care physician, and the discharging hospital unit and the physician(s) in charge; known allergies, information about liver and kidney failure; main adverse effects to monitor; date of latest blood tests; hospital admission/discharge dates.Conclusion: The consensus on the list of information items concerning changes in the treatment should be used by hospital physicians and pharmacists to ensure safe patient discharge.
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Affiliation(s)
- Fabien Visade
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Antoine Lefebvre
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Emmanuel Floret
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Bertrand Decaudin
- Univ. Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Department of pharmacology, F-59000 Lille, France
| | - François Puisieux
- CHU Lille, Department of pharmacology, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
| | - Céline Delecluse
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
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Raman S, Brown G, Long D, Gelbart B, Delzoppo C, Millar J, Erickson S, Festa M, Schlapbach LJ. Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group. CRIT CARE RESUSC 2021; 23:194-201. [PMID: 38045513 PMCID: PMC10692499 DOI: 10.51893/2021.2.oa6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. Design: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. Setting: Paediatric intensive care units in Australia and New Zealand. Participants: Medical and nursing staff working in intensive care. Main outcome measurements: Self-reported priorities for research. Results: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. Conclusions: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.
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Affiliation(s)
- Sainath Raman
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland, Children’s, Hospital, Brisbane, QLD, Australia
| | - Georgia Brown
- University of Melbourne, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Debbie Long
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland, Children’s, Hospital, Brisbane, QLD, Australia
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben Gelbart
- University of Melbourne, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Carmel Delzoppo
- University of Melbourne, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Johnny Millar
- University of Melbourne, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Simon Erickson
- Paediatric Intensive Care Unit, Perth Children’s Hospital, Perth, WA, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, Children’s Hospital Westmead, Sydney, NSW, Australia
- Kids Critical Care Research Group, Kids Research, Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Luregn J. Schlapbach
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland, Children’s, Hospital, Brisbane, QLD, Australia
- Pediatric and Neonatal Intensive Care Unit, University Children’s Hospital Zurich, and Children’s Research Center, University of Zurich, Zurich, Switzerland
| | - for the Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG)
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland, Children’s, Hospital, Brisbane, QLD, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Perth Children’s Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Children’s Hospital Westmead, Sydney, NSW, Australia
- Kids Critical Care Research Group, Kids Research, Sydney Children’s Hospitals Network, Sydney, NSW, Australia
- Pediatric and Neonatal Intensive Care Unit, University Children’s Hospital Zurich, and Children’s Research Center, University of Zurich, Zurich, Switzerland
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Abstract
Objective: To justify the allocation of human and financial resources, this study aims to identify multiple stakeholders’ views of medical education research priorities in Pakistan for the next five years. Methods: This two-stage exploratory mixed-method study was conducted from Jan 2018 to Jun 2019. A purposively selected sample of 250 faculty members, research supervisors, postgraduate students, undergraduate students and policymakers actively involved in improving Medical Education were included. In Stage-I: An exploratory open-ended questionnaire asking about Medical Education Research (MER) priorities in Pakistan for the next five years was emailed. Data were thematically analyzed to identify MER areas. In Stage-II: Another questionnaire was developed based on MER areas. The participants were asked to rate their importance on a scale of one to five. Descriptive statistics were calculated using SPSS.v.24. Results: In Stage-I, 140 participants and in Stage-II, 130 participants from different stakeholder groups responded. We identified 20 research priorities grouped under eight themes: curriculum organization, content, delivery, assessment, workplace, students, faculty and educational management. Top three research priorities were identifying needs and developing effective provisions for continuous professional development of the faculty, improving assessment and communication skills. Conclusion: The study identified top MER priority areas as continuous professional development, assessment and communication skills. Some areas unique to the current study include admissions, fostering critical thinking, Islamic values in professionalism and ethics. The study provides evidence-base for decision-making about allocating time and funds for MER in Pakistan.
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Affiliation(s)
- Sarah Ali
- Sarah Ali Assistant Registrar, Pakistan Medical and Dental Council, Islamabad, Pakistan
| | - Ahsan Sethi
- Ahsan Sethi Assistant Professor, Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. A disease state approach to the pharmacological management of Type 2 diabetes in primary care: A position statement by Primary Care Diabetes Europe. Prim Care Diabetes 2021; 15:31-51. [PMID: 32532635 DOI: 10.1016/j.pcd.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Los Angeles, CA, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, Atasehir 34752, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Michie S, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Carey RN, Bohlen LEC, Groarke HNK, Anderson NC, Zink S. Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Many global health challenges may be targeted by changing people’s behaviour. Behaviours including cigarette smoking, physical inactivity and alcohol misuse, as well as certain dietary behaviours, contribute to deaths and disability by increasing the risk of cancers, cardiovascular diseases and diabetes. Interventions have been designed to change these health behaviours with a view to reducing these health risks. However, the effectiveness of these interventions has been quite variable and further information is needed to enhance their success. More information is needed about the specific processes that underlie the effectiveness of intervention strategies.
Aim
Researchers have developed a taxonomy of 93 behaviour change techniques (i.e. the active components of an intervention that bring about behavioural change), but little is known regarding their potential mechanisms of action (i.e. the processes through which a behaviour change technique affects behaviour). We therefore aimed to examine links between behaviour change techniques and mechanisms of action.
Method
First, we conducted a literature synthesis study of 277 behaviour change intervention studies, from which we extracted information on links, described by authors, between behaviour change techniques and mechanisms of action, and identified an average of 10 links per intervention report. Second, behaviour change experts (n = 105) were engaged in a three-round consensus study in which they discussed and rated their confidence in the presence/absence of ‘links’ and ‘non-links’ between commonly used behaviour change techniques (n = 61) and a set of mechanisms of action (n = 26). Ninety links and 460 ‘non-links’ reached the pre-set threshold of 80% agreement. To enhance the validity of these results, a third study was conducted that triangulated the findings of the first two studies. Discrepancies and uncertainties between the studies were included in a reconciliation consensus study with a new group of experts (n = 25). The final results identified 92 definite behaviour change technique–mechanism of action links and 465 definite non-links. In a fourth study, we examined whether or not groups of behaviour change techniques used together frequently across interventions revealed shared theoretical underpinnings. We found that experts agreed on the underlying theory for three groups of behaviour change techniques.
Results
Our results are potentially useful to policy-makers and practitioners in selecting behaviour change techniques to include in behaviour change interventions. However, our data do not demonstrate that the behaviour change techniques are effective in targeting the mechanism of action; rather, the links identified may be the ‘best bets’ for interventions that are effective in changing mechanisms of action, and the non-links are unlikely to be effective. Researchers examining effectiveness of interventions in either primary studies or evidence syntheses may consider these links for further investigation.
Conclusion
To make our results usable by researchers, practitioners and policy-makers, they are available in an online interactive tool, which enables discussion and collaboration (https://theoryandtechniquetool.humanbehaviourchange.org/); accessed 1 March 2020. This work, building on previous work to develop the behaviour change technique taxonomy, is part of an ongoing programme of work: the Human Behaviour Change Project (www.humanbehaviourchange.org/; accessed 1 March 2020).
Funding
This project was funded by the Medical Research Council via its Methodology Panel: ‘Developing methodology for designing and evaluating theory-based complex interventions: an ontology for linking behaviour change techniques to theory’ (reference MR/L011115/1).
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Affiliation(s)
- Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | | | - Marijn de Bruin
- Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Michael P Kelly
- Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Rachel N Carey
- Centre for Behaviour Change, University College London, London, UK
| | - Lauren EC Bohlen
- Centre for Behaviour Change, University College London, London, UK
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Hilary NK Groarke
- Department of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Niall C Anderson
- Centre for Behaviour Change, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Silje Zink
- Centre for Behaviour Change, University College London, London, UK
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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21
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Setting the surgical wound care agenda across two healthcare districts: A priority setting approach. Collegian 2020. [DOI: 10.1016/j.colegn.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Lovegrove J, Fulbrook P, Miles S. International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study. Int Wound J 2020; 17:1112-1127. [PMID: 33591631 PMCID: PMC7948917 DOI: 10.1111/iwj.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive-care-specific risk-assessment-scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2-hours of admission; 8-hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate- and high-risk patients should receive: a reactive mattress support surface and a heel off-loading device. High-risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure-redistributing cushion for sitting. Repositioning is required at least 4-hourly for low-risk, and 2-hourly for moderate- and high-risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sandra Miles
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
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23
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Connell LE, Carey RN, de Bruin M, Rothman AJ, Johnston M, Kelly MP, Michie S. Links Between Behavior Change Techniques and Mechanisms of Action: An Expert Consensus Study. Ann Behav Med 2020; 53:708-720. [PMID: 30452535 PMCID: PMC6636885 DOI: 10.1093/abm/kay082] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior. PURPOSE To elicit expert consensus on links between BCTs and MoAs. METHODS In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links. RESULTS Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1-4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as "definite" links, 464 (29.2 per cent) as "definitely not" links, and 1,032 (65.1 per cent) as "possible" or "unsure" links. No "definite" links were identified for 10 BCTs (e.g., "Action Planning" and "Behavioural Substitution") and for six MoAs (e.g., "Needs" and "Optimism"). CONCLUSIONS The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies.
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Affiliation(s)
- Lauren E Connell
- Centre for Behaviour Change, University College London, London.,Department of Kinesiology, University of Rhode Island, Kingston
| | - Rachel N Carey
- Centre for Behaviour Change, University College London, London
| | - Marijn de Bruin
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen
| | | | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen
| | - Michael P Kelly
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge
| | - Susan Michie
- Centre for Behaviour Change, University College London, London
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24
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Greenwood D, Steinke D, Martin S, Tully MP. Meeting patient expectations: Development of an Emergency Department Pharmacist Practitioner service specification. Res Social Adm Pharm 2020; 17:S1551-7411(19)30564-9. [PMID: 34756404 DOI: 10.1016/j.sapharm.2020.08.016] [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: 05/31/2019] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergency Department Pharmacist Practitioners (EDPPs) undertake both 'traditional' clinical pharmacy work, e.g. check prescriptions, and 'practitioner' work, e.g. perform clinical examinations. A recent study found a large variation in the extent and type of care provided. Whilst variation allows services to be tailored to local needs, it is important that care meets the minimum standards that are safe, effective, patient-centred, timely, efficient, and equitable. OBJECTIVE(S) To develop an EDPP service specification based on views of professional and patient stakeholders, primarily to support providers with delivery of high quality services. METHODS Patients, ED pharmacists and other ED healthcare professionals developed standards guided by the Institute of Medicine's quality domains. A panel of six ED pharmacists suggested and agreed on themes that should be included in the service specification. Additional themes were identified through interviews with eight patients who had been cared for by EDPPs as to their expectations of the service. Finally, a multidisciplinary expert panel of healthcare professionals and researchers reviewed and refined the service specification. RESULTS ED pharmacists developed 36 themes with consensus achieved for 25. Additional themes from the patient interviews concerned the communication and behaviour of EDPPs rather than specific clinical activities undertaken. Whilst patients were happy to be cared for by an EDPP working within their competence, for certain conditions (e.g. major trauma) they wanted a doctor as their main care provider. An evidence-based EDPP service specification of 52 criteria grouped into 4 categories was produced: direct patient care (29); other activities (10); general approach (10); and service structures (3). CONCLUSIONS As the product of both patient and expert input, EDs could align existing or newly developed services to the specification. Whether or not the specification actually improves the quality of EDPP services requires investigation, as does the absolute quality impact of services.
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Affiliation(s)
- Daniel Greenwood
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Sandra Martin
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Mary P Tully
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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25
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Gesesew HA, Ward P, Woldemichael K, Lyon P, Mwanri L. Policy and practice suggestions to improve performance on the UNAIDS 90-90-90 targets: Results from a nominal group technique with HIV experts in Southwest Ethiopia. Health Expect 2020; 23:1326-1337. [PMID: 32761685 PMCID: PMC7696206 DOI: 10.1111/hex.13115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023] Open
Abstract
Objective This paper aims to evaluate the potential solutions to address negative outcomes of HIV care and treatment, that were proposed by HIV care providers, researchers and HIV programme managers in Southwest Ethiopia. Methods A nominal group technique (NGT) was conducted with 25 experts in December 2017 in Jimma, Southwest Ethiopia. The NGT process included (a) an analysis of the previously qualitative study conducted with various Ethiopian HIV stakeholders who proposed possible solutions for HIV care and treatment; (b) recruitment of a panel of HIV experts in policy and practice to rate the proposed solutions in Ethiopia before a discussion (first round rating); (c) discussion with the panel of experts on the suggested solutions; and (d) conducting a second round of rating of proposed solutions. Content analysis and Wilcoxon signed rank test were applied to analyse the data. Results Eighteen of the 25 invited panel of experts participated in the NGT. The following proposed solutions were rated and discussed as relevant, feasible and acceptable. In order of decreasing importance, the solutions were as follows: filling gaps in legislation, HIV self‐testing, the teach‐test‐link‐trace strategy, house‐to‐house HIV testing, community antiretroviral therapy (ART) groups, providing ART in private clinics and providing ART at health posts. Conclusions The current study findings suggested that, to address HIV negative outcomes, priority solutions could include mandatory notification of partner's HIV status, HIV self‐testing and the involvement of peer educators on the entire HIV care programme.
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Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, SA, Australia.,Epidemiology, Mekelle University, Mekelle, Ethiopia
| | - Paul Ward
- Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Pamela Lyon
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Lillian Mwanri
- Public Health, Flinders University, Adelaide, SA, Australia
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26
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Dewinter J, van der Miesen AIR, Holmes LG. INSAR Special Interest Group Report: Stakeholder Perspectives on Priorities for Future Research on Autism, Sexuality, and Intimate Relationships. Autism Res 2020; 13:1248-1257. [PMID: 32588542 PMCID: PMC7496808 DOI: 10.1002/aur.2340] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/14/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
The number of empirical studies on sexuality and intimate relationships in autistic people has grown over the last years with the increasing awareness that sexuality and intimate relationships are an important part of life and well-being for autistic people. Further, expression and enjoyment of sexuality is a fundamental, basic human right. This paper reports on needs for future research in this area based on the input of autistic adults, researchers, and other stakeholders (e.g., parents and professionals). Utilizing the nominal group technique, 65 individuals participated in eight groups in which they brainstormed on research questions they deemed most important. Responses were categorized into themes and ranked according to importance based on the level of priority attributed by participants. Findings suggest that future research should focus on developing ways to support sexual and relationship well-being and getting a better understanding of sexuality and relationships in autistic people. Also, attention was drawn to the need for studying the influence of stereotypical societal views, and stigma. Finally, the importance of participatory research to include perspectives of autistic people in research and practice was stressed. LAY SUMMARY: Sexuality and romantic relationships are part of daily life for most people, including autistic people. For this study, groups of autistic people, professionals, and autism researchers discussed which research on autism, sexuality, and relationships is needed and can help autistic adolescents and adults. The group discussions revealed that more research is needed on how to support well-being relating to romantic relationships and sexuality in autistic people and how the people around them can contribute to this. Therefore, we also need to learn more about how autistic people of all ages and throughout their lives experience sexuality and relationships. Finally, the need for attention to the role of stereotypical ideas and stigma about autism, sexuality, and relationships was pointed out. Attention to the experiences of autistic people can help professionals, researchers, and policy makers to offer and organize attuned support and do relevant research. Autism Res 2020, 13: 1248-1257. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.
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Affiliation(s)
- Jeroen Dewinter
- GGzEEindhovenThe Netherlands
- Tranzo, Scientific Center for Care and WellbeingTilburg UniversityTilburgThe Netherlands
| | - Anna I. R. van der Miesen
- Department of Child and Adolescent PsychiatryCenter of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
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27
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Froud R, Amundsen PA, Bartys S, Battie M, Burton K, Foster NE, Johnsen TL, Pincus T, Reneman MF, Smeets RJEM, Sveinsdottir V, Wynne-Jones G, Underwood M. Opportunities and challenges around adapting supported employment interventions for people with chronic low back pain: modified nominal group technique. Disabil Rehabil 2020; 43:2750-2757. [PMID: 32008399 DOI: 10.1080/09638288.2020.1716863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify and rank opportunities and challenges around adapting supported employment interventions for people with chronic low back pain (LBP). METHODS Delegates from an international back and neck research forum were invited to join an expert panel. A modified nominal group technique (NGT) was used with four stages: silent generation, round robin, clarification, and ranking. Ranked items were reported back and ratified by the panel. RESULTS Nine experienced researchers working in the fields related to LBP and disability joined the panel. Forty-eight items were generated and grouped into 12 categories of opportunities/challenges. Categories ranked most important related respectively to policy and legislation, ensuring operational integration across different systems, funding interventions, and managing attitudes towards work and health, workplace flexibility, availability of "good" work for this client group, dissonance between client and system aims, timing of interventions, and intervention development. CONCLUSIONS An expert panel believes the most important opportunities/challenges around adapting supporting employment interventions for people with chronic LBP are facilitating integration/communication between systems and institutions providing intervention components, optimising research outputs for informing policy needs, and encouraging discussion around funding mechanisms for research and interventions. Addressing these factors may help improve the quality and impact of future interventions.Implications for rehabilitationInteraction pathways between health, employment, and social systems need to be improved to effectively deliver intervention components that necessarily span these systems.Research-policy communication needs to be improved by researchers and policy makers, so that research outputs can be consumed by policy makers, and so that researchers recognise the gaps in knowledge needed to underpin policy.Improvements in research-policy communication and coordination would facilitate the delivery of research output at a time when it is likely to make the most impact on policy-making.Discussion and clarification surrounding funding mechanisms for research and interventions may facilitate innovation generally.
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Affiliation(s)
- Robert Froud
- Institute of Health Sciences, Kristiania University College, Oslo, Norway.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Pål André Amundsen
- Institute of Health Sciences, Kristiania University College, Oslo, Norway
| | - Serena Bartys
- Centre for Applied Research in Health, School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Michele Battie
- Faculty of Health Sciences, School of Physical Therapy, Western's Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Kim Burton
- Centre for Applied Research in Health, School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Tone Langjordet Johnsen
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway.,NORCE Norwegian Research Centre, Bergen, Norway
| | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Michiel F Reneman
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands, and CIR Revalidatie, Eindhoven, the Netherlands
| | | | - Gwenllian Wynne-Jones
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire, Coventry, UK
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28
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Michie S, Carey RN, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Connell LE. From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action. Ann Behav Med 2019; 52:501-512. [PMID: 27401001 PMCID: PMC6367898 DOI: 10.1007/s12160-016-9816-6] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions. Purpose This research aims to develop and test a methodology for linking BCTs to their mechanisms of action. Methods Study 1 (published explicit links): Hypothesised links between 93 BCTs (from the 93-item BCT taxonomy, BCTTv1) and mechanisms of action will be identified from published interventions and their frequency, explicitness and precision documented. Study 2 (expert-agreed explicit links): Behaviour change experts will identify links between 61 BCTs and 26 mechanisms of action in a formal consensus study. Study 3 (integrated matrix of explicit links): Agreement between studies 1 and 2 will be evaluated and a new group of experts will discuss discrepancies. An integrated matrix of BCT-mechanism of action links, annotated to indicate strength of evidence, will be generated. Study 4 (published implicit links): To determine whether groups of co-occurring BCTs can be linked to theories, we will identify groups of BCTs that are used together from the study 1 literature. A consensus exercise will be used to rate strength of links between groups of BCT and theories. Conclusions A formal methodology for linking BCTs to their hypothesised mechanisms of action can contribute to the development and evaluation of behaviour change interventions. This research is a step towards developing a behaviour change ‘ontology’, specifying relations between BCTs, mechanisms of action, modes of delivery, populations, settings and types of behaviour.
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Affiliation(s)
- Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rachel N Carey
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | | | | | - Lauren E Connell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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29
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Burns KEA, Misak C, Herridge M, Meade MO, Oczkowski S. Patient and Family Engagement in the ICU. Untapped Opportunities and Underrecognized Challenges. Am J Respir Crit Care Med 2019; 198:310-319. [PMID: 29624408 DOI: 10.1164/rccm.201710-2032ci] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The call for meaningful patient and family engagement in health care and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. In this article, we review the rationale and the current state of patient and family engagement in patient care and research in the ICU. We identify opportunities to strengthen engagement in patient care by promoting greater patient and family involvement in care delivery and supporting their participation in shared decision-making. We also identify challenges related to patient willingness to engage, barriers to participation, participant risks, and participant expectations. To advance engagement, clinicians and researchers can develop the science behind engagement in the ICU context and demonstrate its impact on patient- and process-related outcomes. In addition, we provide practical guidance on how to engage, highlight features of successful engagement strategies, and identify areas for future research. At present, enormous opportunities remain to enhance engagement across the continuum of ICU care and research.
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Affiliation(s)
- Karen E A Burns
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and.,3 Department of Clinical Epidemiology and Biostatistics and
| | - Cheryl Misak
- 4 Department of Philosophy, University of Toronto, Toronto, Ontario, Canada; and
| | - Margaret Herridge
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and
| | - Maureen O Meade
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon Oczkowski
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Cappuccio A, Bugliaro F, Caimmi SME, Caldarelli V, Caminiti L, D'Auria E, di Palmo E, Duse M, Fiocchi AG, Gesualdo F, Kantar A, Lombardi E, Lucania A, Marchiani M, Marini MG, Marseglia G, Montera MC, Novembre EM, Pellegrini G, Piacentini G, Policreti A, Santamaria F. Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma. Ital J Pediatr 2019; 45:31. [PMID: 30832703 PMCID: PMC6399976 DOI: 10.1186/s13052-019-0623-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON’ T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma.
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Affiliation(s)
| | | | | | | | - Valeria Caldarelli
- Pediatric Clinic, Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy
| | - Lucia Caminiti
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Emanuela di Palmo
- Pediatric Clinic, Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Marzia Duse
- Department of Pediatrics and child Neuropsychiatry, University Sapienza, Rome, Italy
| | | | | | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi University and Research Hospitals, Ponte San Pietro-Bergamo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University Hospital, Florence, Italy
| | - Anna Lucania
- Pediatria ospedale dei bambini arnas civico, Palermo, Italy
| | | | - Maria Giulia Marini
- Healthcare Area, ISTUD Foundation, Via Vittor Pisani 28, 20128, Milan, Italy
| | - Gianluigi Marseglia
- Pediatric Clinic of the University of Pavia - IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Carmela Montera
- Department. of Medicine, Unit of Allergology and Clinic Immunology, AOU S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Guido Pellegrini
- U.O. of Pediatric and Neonatology, Hospital City of Sesto San Giovanni (MI), ASST Nord Milano, Milan, Italy
| | | | | | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Consensus research priorities for facial palsy: A Delphi survey of patients, carers, clinicians and researchers. J Plast Reconstr Aesthet Surg 2018; 71:1777-1784. [DOI: 10.1016/j.bjps.2018.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/27/2018] [Indexed: 11/22/2022]
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Dagenais C, Degroote S, Otmani Del Barrio M, Bermudez-Tamayo C, Ridde V. Establishing research priorities in prevention and control of vector-borne diseases in urban areas: a collaborative process. Infect Dis Poverty 2018; 7:85. [PMID: 30173663 PMCID: PMC6120077 DOI: 10.1186/s40249-018-0463-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/18/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In 2015, following a call for proposals from the Special Programme for Research and Training in Tropical Diseases (TDR), six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted. Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps, as well as needs and opportunities for future research. Based on the research findings of the scoping reviews, a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed. METHODS Members of the six research teams responsible for the "VEctor boRne DiseAses Scoping reviews" (VERDAS) consortium's scoping reviews met for 2 days with decision-makers from Colombia, Brazil, Peru, Pan-American Health Organization, and World Health Organization. A total of 11 researchers and seven decision-makers (from ministries of health, city and regional vector control departments, and vector control programs) completed the concept mapping, answering the question: "In view of the knowledge synthesis and your own expertise, what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?" Participants rated each statement on two scales from 1 to 5, one relative to 'priority' and the other to 'policy relevance', and grouped statements into clusters based on their own individual criteria and expertise. RESULTS The final map consisted of 12 clusters. Participants considered those entitled "Equity", "Technology", and "Surveillance" to have the highest priority. The cluster considered the most important concerns equity issues, confirming that these issues are rarely addressed in research on vector-borne diseases. On the other hand, the "Population mobility" and "Collaboration" clusters were considered to be the lowest priority but remained identified by participants as research priorities. The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters. Some issues were not addressed during the brain-storming. This is the case for governance and for access and quality of care. CONCLUSIONS Based on this work, and adopting a participatory approach, the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.
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Affiliation(s)
- Christian Dagenais
- Department of Psychology, University of Montreal, Pavillon Marie-Victorin, Bureau C-355, C. P. 6128, succursale Centre-ville., Montreal, QC H3C 3J7 Canada
| | - Stéphanie Degroote
- University of Montreal Public Health Research Institute, Montreal, QC Canada
| | - Mariam Otmani Del Barrio
- Vector, Environment and Society Unit, Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Clara Bermudez-Tamayo
- Andalusian School of Public Health, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Valéry Ridde
- University of Montreal Public Health Research Institute, Montreal, QC Canada
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
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Phillips R, Williams D, Bowen D, Morris D, Grant A, Pell B, Sanders J, Taylor A, Choy E, Edwards A. Reaching a consensus on research priorities for supporting women with autoimmune rheumatic diseases during pre-conception, pregnancy and early parenting: A Nominal Group Technique exercise with lay and professional stakeholders. Wellcome Open Res 2018; 3:75. [PMID: 30191184 PMCID: PMC6092904 DOI: 10.12688/wellcomeopenres.14658.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/01/2023] Open
Abstract
Background:Women with autoimmune rheumatic diseases (ARDs) find it difficult to get information and support with family planning, pregnancy, and early parenting. A systematic approach to prioritising research is required to accelerate development and evaluation of interventions to meet the complex needs of this population. Methods:A Nominal Group Technique (NGT) exercise was carried out with lay and professional stakeholders (n=29). Stakeholders were prepared for debate through presentation of available evidence. Stakeholders completed three tasks to develop, individually rank, and reach consensus on research priorities: Task 1 - mapping challenges and services using visual timelines; Task 2 - identifying research topics; Task 3 - individually ranking research topics in priority order. Results of the ranking exercise were fed back to the group for comment. Results:The main themes emerging from Task 1 were the need for provision of information, multi-disciplinary care, and social and peer support. In Task 2, 15 research topics and 58 sub-topics were identified around addressing the challenges and gaps in care identified during Task 1. In Task 3, a consensus was reached on the ten research topics that should be given the highest priority. These were individually ranked, resulting in the following order of priorities (from 1 - highest to 10 - lowest): 1. Shared decision-making early in the care pathway; 2. Pre-conception counseling; 3. Information about medication use during pregnancy/breastfeeding; 4. Personalised care planning; 5. Support for partners/family members; 6. Information about local support/disease specific issues; 7. Shared decision-making across the care pathway; 8. Peer-support; 9. Social inequalities in care, and; 10. Guidance on holistic/alternative therapies. Conclusions:This systematic approach to identification of research priorities from a multi-disciplinary and lay perspective indicated that activities should focus on development and evaluation of interventions that increase patient involvement in clinical decision-making, multi-disciplinary models of care, and timely provision of information.
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Affiliation(s)
| | - Denitza Williams
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bethan Pell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Green J, Jester R, McKinley R, Pooler A. Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template. Br J Community Nurs 2018; 23:S20-S30. [PMID: 29799794 DOI: 10.12968/bjcn.2018.23.sup6.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked.
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Affiliation(s)
- Julie Green
- Queen's Nurse, Royal College of Nursing Professional Nursing Committee member, Royal College of Nursing District Nurse Forum Chair and member of the Association of District Nurse Educators Director of Postgraduate Studies and Senior Lecturer, Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG
| | - Rebecca Jester
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Robert McKinley
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Alison Pooler
- Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
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Michie S, Carey RN, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Connell LE. From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action. Ann Behav Med 2018; 52:501-512. [PMID: 27401001 DOI: 10.17863/cam.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions. PURPOSE This research aims to develop and test a methodology for linking BCTs to their mechanisms of action. METHODS Study 1 (published explicit links): Hypothesised links between 93 BCTs (from the 93-item BCT taxonomy, BCTTv1) and mechanisms of action will be identified from published interventions and their frequency, explicitness and precision documented. Study 2 (expert-agreed explicit links): Behaviour change experts will identify links between 61 BCTs and 26 mechanisms of action in a formal consensus study. Study 3 (integrated matrix of explicit links): Agreement between studies 1 and 2 will be evaluated and a new group of experts will discuss discrepancies. An integrated matrix of BCT-mechanism of action links, annotated to indicate strength of evidence, will be generated. Study 4 (published implicit links): To determine whether groups of co-occurring BCTs can be linked to theories, we will identify groups of BCTs that are used together from the study 1 literature. A consensus exercise will be used to rate strength of links between groups of BCT and theories. CONCLUSIONS A formal methodology for linking BCTs to their hypothesised mechanisms of action can contribute to the development and evaluation of behaviour change interventions. This research is a step towards developing a behaviour change 'ontology', specifying relations between BCTs, mechanisms of action, modes of delivery, populations, settings and types of behaviour.
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Affiliation(s)
- Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rachel N Carey
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | | | | | - Lauren E Connell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Barker J, Kimball AB, William Tebbey P, Sterry W. A Strategic Approach to Setting the Research Agenda in Psoriasis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553031117a00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research into all the relevant facets of disease characteristics—including epidemiology, genetics, and pathogenesis—has historically yielded important insights that result in a progression of understanding as well as advances in treatment of disease. Certainly psoriasis can be highlighted as an example of a disease that through history has benefitted from the integration of serendipitous observation and defined research strategy, an interaction that has resulted in dramatically improved clinical comprehension and management of the condition. Despite this progress, major gaps still exist in our understanding of the different elements of the disease that could be used to guide the medical community's approach to research. Traditionally, medical research is organized along geopolitical and departmental divisions. This structure tends to impede collaboration in a multidisciplinary manner or by multiple organizations working congruently. To overcome this impediment, the objective of this International Psoriasis Council initiative was to leverage the available knowledge to highlight the key research needs in psoriasis and to convene appropriate experts, without regard for geography or research specialty, to make major strides in improving the overall outcomes for psoriasis patients.
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Affiliation(s)
| | - Alexa Boer Kimball
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Wolfram Sterry
- Department of Dermatology and Allergy, Charité University Hospital, Berlin, Germany
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Sharma T, Choudhury M, Rejón-Parrilla JC, Jonsson P, Garner S. Using HTA and guideline development as a tool for research priority setting the NICE way: reducing research waste by identifying the right research to fund. BMJ Open 2018. [PMID: 29523564 PMCID: PMC5855177 DOI: 10.1136/bmjopen-2017-019777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) was established in 1999 and provides national guidance and advice to improve health and social care. Several steps in the research cycle have been identified that can support the reduction of waste that occurs in biomedical research. The first step in the process is ensuring appropriate research priority setting occurs so only the questions that are needed to fill existing gaps in the evidence are funded. This paper summarises the research priority setting processes at NICE. METHODS NICE uses its guidance production processes to identify and prioritise research questions through systematic reviews, economic analyses and stakeholder consultations and then highlights those priorities by engagement with the research community. NICE also highlights its methodological areas for research to ensure the appropriate development and growth of the evidence landscape. RESULTS NICE has prioritised research questions through its guidance production and methodological work and has successfully had several research products funded through the National Institute for Health Research and Medical Research Council. This paper summarises those activities and results. CONCLUSIONS This activity of NICE therefore reduces research waste by ensuring that the research it recommends has been systematically prioritised through evidence reviews and stakeholder input.
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Affiliation(s)
- Tarang Sharma
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenahgen, Denmark
| | - Moni Choudhury
- Science Policy and Research, National Institute for Health and Care Excellence, London, UK
| | | | - Pall Jonsson
- Science Policy and Research, National Institute for Health and Care Excellence, Manchester, UK
| | - Sarah Garner
- Science Policy and Research, National Institute for Health and Care Excellence, London, UK
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Rice DB, Cañedo-Ayala M, Turner KA, Gumuchian ST, Malcarne VL, Hagedoorn M, Thombs BD. Use of the nominal group technique to identify stakeholder priorities and inform survey development: an example with informal caregivers of people with scleroderma. BMJ Open 2018; 8:e019726. [PMID: 29500214 PMCID: PMC5855214 DOI: 10.1136/bmjopen-2017-019726] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The nominal group technique (NGT) allows stakeholders to directly generate items for needs assessment surveys. The objective was to demonstrate the use of NGT discussions to develop survey items on (1) challenges experienced by informal caregivers of people living with systemic sclerosis (SSc) and (2) preferences for support services. DESIGN Three NGT groups were conducted. In each group, participants generated lists of challenges and preferred formats for support services. Participants shared items, and a master list was compiled, then reviewed by participants to remove or merge overlapping items. Once a final list of items was generated, participants independently rated challenges on a scale from 1 (not at all important) to 10 (extremely important) and support services on a scale from 1 (not at all likely to use) to 10 (very likely to use). Lists generated in the NGT discussions were subsequently reviewed and integrated into a single list by research team members. SETTING SSc patient conferences held in the USA and Canada. PARTICIPANTS Informal caregivers who previously or currently were providing care for a family member or friend with SSc. RESULTS A total of six men and seven women participated in the NGT discussions. Mean age was 59.8 years (SD=12.6). Participants provided care for a partner (n=8), parent (n=1), child (n=2) or friend (n=2). A list of 61 unique challenges was generated with challenges related to gaps in information, resources and support needs identified most frequently. A list of 18 unique support services was generated; most involved online or in-person delivery of emotional support and educational material about SSc. CONCLUSIONS The NGT was an efficient method for obtaining survey items directly from SSc caregivers on important challenges and preferences for support services.
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Affiliation(s)
- Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Mara Cañedo-Ayala
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Stephanie T Gumuchian
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, California, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University and the University of California, San Diego, California, USA
| | - Mariët Hagedoorn
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Stakeholder Engagement in Trial Design: Survey of Visitors to Critically Ill Patients Regarding Preferences for Outcomes and Treatment Options during Weaning from Mechanical Ventilation. Ann Am Thorac Soc 2017; 13:1962-1968. [PMID: 27598009 DOI: 10.1513/annalsats.201606-445oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Stakeholder engagement in research is expected to provide unique insights, make research investments more accountable and transparent, and ensure that future research is applicable to patients and family members. OBJECTIVES To inform the design of a trial of strategies for weaning from mechanical ventilation, we sought to identify preferences of patient visitors regarding outcome and treatment measures. METHODS We conducted an interviewer-administered questionnaire of visitors of critically ill patients in two family waiting rooms serving three intensive care units (ICUs) in Toronto, Canada. Respondents rated the importance of general and ventilation-related outcomes in two hypothetical scenarios (before a first spontaneous breathing trial, and after a failed spontaneous breathing trial) and selected a preferred technique for the breathing trials. With regard to the patient they were visiting, respondents identified the most important outcome to them at ICU admission, during the ICU stay, and at ICU discharge. MEASUREMENTS AND MAIN RESULTS We analyzed 322 questionnaires (95.5% response rate). All outcomes were highly rated (average range: 7.82-9.74). Across scenarios, outcomes rated as most important were ICU and hospital survival (9.72, 9.70), avoiding complications (9.45), quality of life (9.394), patient comfort (9.393), and returning to previous living arrangements (9.31). Overall, the most important ventilation-related outcomes were being ventilator-free (8.95), avoiding reintubation (8.905), and passing a spontaneous breathing trial (8.903). Passing a spontaneous breathing trial assumed greater importance after an initial failed attempt. "Time to event" outcomes were less important to visitors. We did not identify a preferred spontaneous breathing trial technique. Although ICU survival was the most important outcome at ICU admission and during the ICU stay, visitors rated quality of life higher than hospital survival at ICU discharge. CONCLUSIONS Visitors to critically ill patients prioritized two general outcomes (ICU and hospital survival) and three ventilation-related outcomes (being ventilator free, avoiding reintubation, passing a spontaneous breathing trial), and valued avoiding complications, maintaining quality of life, comfort, and returning to previous living arrangements. The outcomes preferences of the survey respondents evolved temporally during the ICU stay.
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Burns KEA, Rizvi L, Charteris A, Laskey S, Bhatti SB, Chokar K, Choong KLM. Characterizing Citizens' Preferences for Engagement in Patient Care and Research in Adult and Pediatric Intensive Care Units. J Intensive Care Med 2017; 35:170-178. [PMID: 28901207 DOI: 10.1177/0885066617729127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Engagement promotes and supports the active participation of patients and families in health care and research to strengthen their influence on decision-making. We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU). METHODS Interviewers administered questionnaires to visitors in 3 adult ICUs and 1 pediatric ICU. RESULTS We surveyed 202 (adult [n = 130] and pediatric [n = 72]) visitors. Adults and pediatric visitors prioritized 3 patient care topics (family involvement in rounds, improving communication between family members and health-care providers, and information transmission between health-care practitioners during patient transfers) and 2 research topics (evaluating prevention and recovery from critical illness). Preferred engagement activities included sharing personal experiences, identifying important topics and outcomes, and finding ways to make changes that respected their needs. Both respondent groups preferred to participate by completing electronic surveys or comment cards and answering questions on a website. Few respondents (<5%) wanted to participate in committees that met regularly. Although adult and pediatric respondents identified common facilitators and barriers to participation, they ranked them differently. Although both groups perceived engagement to be highly important, adult respondents were significantly less confident that their participation would impact care (7.6 ± 2.2 vs 8.3 ± 1.8; P = .01) and research (7.3 ± 2.4 vs 8.2 ± 2.0; P = .01) and were significantly less willing to participate in care (5.6 ± 2.9 vs 6.7 ± 3.0; P = .007) and research (4.7 ± 3.0 vs ± 5.8 ± 3.0; P = .02). CONCLUSIONS Adult and pediatric visitors expressed comparable engagement preferences, identified similar facilitators and barriers, and rated engagement highly. Adult visitors were significantly less confident that their participation would be impactful and were significantly less willing to engage in care and research.
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Affiliation(s)
- Karen E A Burns
- Interdepartmental Division of Critical Care, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,St. Michael's Hospital, Toronto, Ontario, Canada.,The Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Leena Rizvi
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Charteris
- Department of Health Studies, the University of Toronto, Toronto, Canada
| | - Samuel Laskey
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Saima B Bhatti
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | | | - Karen L M Choong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
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Gunn H, Endacott R, Haas B, Marsden J, Freeman J. Development of a balance, safe mobility and falls management programme for people with multiple sclerosis. Disabil Rehabil 2017; 40:2857-2866. [PMID: 28783979 DOI: 10.1080/09638288.2017.1362041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme. MATERIALS AND METHODS Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n = 15) and providers (n = 19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically. RESULTS Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time. Key recommendations were: Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important. Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy. Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential. Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience. CONCLUSIONS Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach. Implications for Rehabilitation People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls. Programme design should support self-efficacy and flexible engagement. Adequate support and funding are seen as essential by both service users and providers.
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Affiliation(s)
- Hilary Gunn
- a School of Health Professions , Plymouth University , Plymouth , UK
| | - Ruth Endacott
- b School of Nursing and Midwifery , Plymouth University , Plymouth , UK
| | - Bernhard Haas
- a School of Health Professions , Plymouth University , Plymouth , UK
| | - Jonathan Marsden
- a School of Health Professions , Plymouth University , Plymouth , UK
| | - Jennifer Freeman
- a School of Health Professions , Plymouth University , Plymouth , UK
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Burns KEA, Devlin JW, Hill NS. Patient and Family Engagement in Designing and Implementing a Weaning Trial: A Novel Research Paradigm in Critical Care. Chest 2017; 152:707-711. [PMID: 28687380 DOI: 10.1016/j.chest.2017.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022] Open
Abstract
The call for meaningful patient and family engagement in research has recently gained considerable momentum. This article defines patient and family engagement broadly and specifically in clinical research. Using a multicenter, North American weaning trial as an exemplar, we describe our early experiences as clinical researchers with patient and family engagement. The role of our Patient and Family Advisory Committee in trial design and implementation is illustrated. Through our experiences, we share our insights regarding the perceived opportunities and also highlight some challenges associated with engaging patients and family engagement in critical care research. Although "engagement science" is in its infancy, engaging patients and families in research holds promise as a novel research paradigm that will not only provide new insights into the questions, methods, and outcomes used in ICU research, but it will also make investments in research more accountable and ensure a strong "patient- and family-centered focus" of our research.
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Affiliation(s)
- Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, MA; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
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Williams A, Sell D, Oulton K, Wilson N, Wray J, Gibson F. Identifying research priorities with nurses at a tertiary children's hospital in the United Kingdom. Child Care Health Dev 2017; 43:211-221. [PMID: 27704589 DOI: 10.1111/cch.12340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/20/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
AIM The objective of this study was to undertake a research priority setting exercise with the aim of maximizing efficiency and impact in research activity undertaken by nurses at one children's tertiary healthcare institution by ensuring the clinical staff directly shaped a coherent, transparent and consensus driven nurse-led research agenda. BACKGROUND In Round 1, the research topics of 147 nurses were elicited using a modified nominal group technique as the consensus method. The number of participants in the 24 separate discussions ranged from 3 to 21, generating lists of between 6 and 23 topics. In Round 2, nurses from the clinical areas ranked topics of importance resulting in a set of four to five priorities. In Round 3, the divisional heads of nursing consulted with staff in all of their clinical areas to each finalize their five divisional priorities. The Nursing Research Working Group discussed and refined the divisions' priorities and voted on the final list to agree the top five research priorities for the organization. RESULTS A total of 269 research topics were initially generated. Following three rounds of ranking and prioritizing, five priorities were agreed at Divisional level, and from these, the five top organizational priorities were selected. These were (i) understanding and improving all aspects of the patient journey through the hospital system; (ii) play; (iii) staff wellbeing, patient care and productivity; (iv) team work - linking to a more efficient service; and (v) supporting parents/parent pathway. CONCLUSIONS Divisional priorities have been disseminated widely to clinical teams to inform a patient-specific nurse-led research agenda. Organizational priorities agreed upon have been disseminated through management structures and processes to ensure engagement at all levels. A subgroup of the Nursing Research Working Group has been delegated to take this work forward so that the agreed priorities continue to contribute towards shaping nurse-led research activity, thereby going some way to inform and embed an evidence-based culture of inquiry.
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Affiliation(s)
- A Williams
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N Wilson
- Practice Nurse Educator, Neurosciences, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - F Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Children's Nursing, London South Bank University, London, UK
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Smith E, Ross FM, Mackenzie A, Masterson A. Developing a service-user framework to shape priorities for nursing and midwifery research. J Res Nurs 2016. [DOI: 10.1177/136140960501000101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many people believe, and government policy recommends, that service users should be involved more in research agenda setting. This paper helps to provide a way of undertaking this, drawing on the approach used in a national research priority setting exercise for nursing and midwifery service delivery and organisation. A framework of service-user expectations for nursing and midwifery services was developed through a process of focus group discussions. Thirty-two participants were recruited from Community Health Councils (CHCs) because of their formal role in linking to health providers and as advocates of local communities. Discussions focused on the main gaps in nursing and midwifery services, priority areas for improvement and ways of involving service users in these developments. Nine broad expectations for nursing and midwifery services were identified and were used as a framework for the alignment of professional stakeholder data and literature and policy analysis. This enabled five priority areas for research to be identified that were important to all of these groups. Targeted sampling, information giving prior to the focus groups, careful explanation of confidentiality and the purpose of the exercise and facilitation skills were important for developing a framework that covered the wide breadth of the topic area. The process also raised important questions for nursing and midwifery research. Conceptual difficulties about balancing service-user control and researcher influence, and the authenticity of the data in representing diversity, were limitations of the approach. A final report is available at www.sdo.lshtm.ac.uk/nursingandmidwifery.
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Affiliation(s)
| | - Fiona M. Ross
- Nursing Research Unit, Primary Care Kingës College, London
| | - Ann Mackenzie
- Faculty of Health and Social Care Sciences, Kingston University and St. Georgeës Hospital Medical School
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Farre A, Wood V, McDonagh JE, Parr JR, Reape D, Rapley T. Health professionals' and managers' definitions of developmentally appropriate healthcare for young people: conceptual dimensions and embedded controversies. Arch Dis Child 2016; 101:628-33. [PMID: 26945026 PMCID: PMC5245734 DOI: 10.1136/archdischild-2015-309473] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 02/14/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES We aimed to (i) explore how health professionals and managers who work with young people seek to define developmentally appropriate healthcare (DAH), (ii) identify the range of conceptual dimensions present in their definitions and (iii) explore the controversies embedded in their characterisations of DAH. METHODS A qualitative multisite ethnographic study was conducted across three hospitals in England. We undertook face-to-face semi-structured interviews with health professionals and managers; and non-participant observation in clinics, wards and meetings. Anonymised field notes and interview transcripts were analysed using thematic analysis. The theme 'conceptualisations of DAH' was then further analysed, and the resulting themes categorised to form conceptual dimensions. RESULTS We recruited 192 participants and conducted 65 interviews (41 with health professionals and 24 with managers) and approximately 1600 hours of non-participant observations (involving 103 health professionals and 72 managers). Despite the wide range of definitions provided by participants, five conceptual dimensions of DAH were identified: (i) biopsychosocial development and holistic care, (ii) acknowledgement of young people as a distinct group, (iii) adjustment of care as the young person develops, (iv) empowerment of the young person by embedding health education and health promotion and (v) interdisciplinary and interorganisational work. Also, some controversies were identified within most dimensions. CONCLUSIONS This study illustrates the lack of a generalised definition of DAH for young people among UK health professionals and managers, and presents a set of five core dimensions that can inform future research to help define and evaluate DAH for young people.
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Affiliation(s)
- Albert Farre
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Victoria Wood
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Janet E McDonagh
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie Reape
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Wallace SJ, Worrall L, Rose T, Le Dorze G, Cruice M, Isaksen J, Kong APH, Simmons-Mackie N, Scarinci N, Gauvreau CA. Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF. Disabil Rehabil 2016; 39:1364-1379. [DOI: 10.1080/09638288.2016.1194899] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Sarah J. Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Guylaine Le Dorze
- Centre for Interdisciplinary Research in Rehabilitation of Montreal, School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
| | - Madeline Cruice
- School of Health Sciences, City University, London, United Kingdom
| | - Jytte Isaksen
- Department of Language and Communication, University of Southern Denmark, Odense, Denmark
| | - Anthony Pak Hin Kong
- Department of Communication Sciences and Disorders, The University of Central Florida, Orlando, FL, USA
| | - Nina Simmons-Mackie
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond, LA, USA
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Christine Alary Gauvreau
- Centre for Interdisciplinary Research in Rehabilitation of Montreal, School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
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Mc Sharry J, Fredrix M, Hynes L, Byrne M. Prioritising target behaviours for research in diabetes: Using the nominal group technique to achieve consensus from key stakeholders. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:14. [PMID: 29062515 PMCID: PMC5611575 DOI: 10.1186/s40900-016-0028-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/23/2016] [Indexed: 06/07/2023]
Abstract
PLAIN ENGLISH SUMMARY The behaviour of people with diabetes (e.g. taking medication) and the behaviour of doctors and other healthcare professionals (e.g. checking patients' blood sugar) are important. Our research group wanted to select one patient behaviour and one healthcare professional behaviour as topics to research in Ireland. Patients and healthcare professionals are not usually asked to help decide on research topics. In this study, we wanted to bring together patients, healthcare professionals and policy makers to help us decide on the most important target behaviours for research in diabetes in Ireland. We worked with 24 participants, including people with diabetes, diabetes healthcare professionals and policy makers. First, participants suggested behaviours they thought were important to target for research in diabetes. Participants then attended a meeting and ranked which of the behaviours were the most important and discussed the results of the rankings as a group. We identified the most highly ranked patient and healthcare professional behaviours. The top ranked behaviour for people with Type 1 diabetes was to 'take insulin as required' and for people with Type 2 diabetes was to 'attend and engage with structured education programmes'. 'Engage in collaborative goal setting with patients' was the top ranked behaviour for healthcare professionals. Our study shows it is possible for researchers to work with people with diabetes, healthcare professionals and policy makers to decide on research topics. The top ranked behaviours will now be researched by our group in Ireland. ABSTRACT Background Working with patients, healthcare providers, and policy makers to prioritise research topics may enhance the relevance of research and increase the likelihood of translating research findings into practice. The aim of the present study was to work with key stakeholders to identify, and achieve consensus on, the most important target behaviours for research in diabetes in Ireland. Methods Twenty-four participants, including people with diabetes, diabetes healthcare professionals and policy makers, took part in a nominal group technique consensus process. Through an online survey, participants generated lists of important target behaviours in three areas: managing Type 1 diabetes, managing Type 2 diabetes and preventing Type 2 diabetes. Participants then attended a research prioritisation meeting and ranked target behaviours in two rounds, with group discussion between ranking rounds. For each of the three key areas, the six top ranked behaviours relevant to people with diabetes and healthcare professionals were identified. Results In most cases, the most highly ranked behaviour was the same for Ranking 1 and Ranking 2 and consensus increased in relation to endorsement of top ranked behaviours. However, some behaviours did change position between rankings. The top behaviour relevant to people with Type 1 diabetes was 'taking insulin as required' and for people with Type 2 diabetes was 'attending and engaging with structured education programmes'. 'Engage in collaborative goal setting with patients' was the top ranked behaviour relevant to healthcare professionals for managing both Type 1 and Type 2 diabetes. For preventing Type 2 diabetes, 'engage in healthy behaviours as a family' was the highest ranked population behaviour and 'attend and engage with behaviour change training' was the highest ranked professional behaviour. Conclusions It is possible to work with a diverse group of stakeholders to inform the diabetes research agenda. The priorities identified were co-produced by key stakeholders, including patients, healthcare professionals and policy makers, and will inform the development of a programme of behavioural research in diabetes in Ireland. The study also provides a worked example of a research prioritisation process using the nominal group technique, and identified limitations, which may be useful for other researchers.
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Affiliation(s)
- Jennifer Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, University Road, Galway, Ireland
| | - Milou Fredrix
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, University Road, Galway, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, University Road, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, University Road, Galway, Ireland
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Abstract
Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how 'consensus' is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of 'experts.' Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.
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Affiliation(s)
- Sara S McMillan
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Michelle King
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Mary P Tully
- Manchester Pharmacy School, University of Manchester, Oxford Road, Manchester, UK.
- Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.
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How to use the nominal group and Delphi techniques. Int J Clin Pharm 2016; 38:655-62. [PMID: 26846316 PMCID: PMC4909789 DOI: 10.1007/s11096-016-0257-x] [Citation(s) in RCA: 437] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/17/2016] [Indexed: 11/13/2022]
Abstract
Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how ‘consensus’ is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of ‘experts.’ Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.
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Abstract
OBJECTIVES Excellence in clinical care coupled with basic and applied research reflects the maturation of a medical subspecialty, advances that field, and provides objective data for identifying best practices. PICUs are uniquely suited for conducting translational and clinical research. In addition, multiple investigations have reported that a majority of parents are interested in their children's participation in clinical research, even when the research offers no direct benefit to their child. However, such activity may generate ethical conflict with bedside care providers trying to acutely identify the best approach for an individual critically ill child. Ultimately, this conflict may diminish enthusiasm for the generation of scientific evidence that supports the application of evidence-based medicine into PICU clinical standard work. Accordingly this review endeavors to provide an overview of current state PICU clinical research strengths, liabilities, opportunities, and barriers and contrast this with an established pediatric hematology-oncology iterative research model that constitutes a learning healthcare system. DATA SOURCES, DATA EXTRACTION, AND DATA SYNTHESIS Narrative review of medical literature published in English. CONCLUSIONS Currently, most PICU therapy is not evidence based. Developing a learning healthcare system in the PICU integrates clinical research into usual practice and fosters a culture of evidence-based learning and continual care improvement. As PICU mortality has significantly decreased, identification and validation of patient-centered, clinically relevant research outcome measures other than mortality is essential for future clinical trial design. Because most pediatric critical illness may be classified as rare diseases, participation in research networks will facilitate iterative, collaborative, multiinstitutional investigations that over time identify the best practices to improve PICU outcomes. Despite real ethical challenges, critically ill children and their families should have the opportunity to participate in translational/clinical research whenever feasible.
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