Prognostic indicators for children and young people at the end of life: A Delphi study

Measuring the Capability of Biological Incident Rescue Teams in China: A Fuzzy Analytic Hierarchy Process Based Model - Tianjin Municipality, China, 2022-2023

Introduction

The swift advancement of biotechnology has presented both opportunities and challenges to our society, thrusting biosafety to the forefront of concern. Consequently, the evaluation of rescue capabilities in the event of a bioterrorism incident becomes of paramount importance. Currently, there is a notable absence of specific measurement criteria and a comprehensive evaluation system. This paper aims to establish a systematic approach towards assessing emergency response capabilities in the context of bioterrorism incidents.

Methods

We employed an enhanced Delphi methodology to establish an index evaluation framework. Subsequently, the weight of the judgment matrix was ascertained via the application of the fuzzy comprehensive evaluation approach. This led to the creation of a fuzzy comprehensive evaluation model for bioterrorism rescue capability.

Results

A modified Delphi study was conducted involving 11 experts across two rounds, achieving a response rate of 100%. The Kendall coordination coefficients recorded in the first and second rounds were 0.303 and 0.632, respectively (P<0.05). Upon comprehensive analysis involving score, coefficient of variation, and full score ratio, we distinguished five primary indicators and 25 secondary indicators. Subsequently, an evaluation model was developed based on the Analytic Hierarchy Process (AHP) tailored to assess the response to a rescue from bioterrorism.

Discussion

The expert panel confirmed consensus on all aspects of the model, validating its comprehensive content. The succeeding course of action involves converting the assessment model to a measurable scale, affirming its functionality, and implementing it in practical evaluation tasks to further enhance the capabilities of the biological incident rescue team.

Face-Validated Quality Indicators for Appropriateness of End-of-Life Care in Children with Serious Illness: A Study Using the RAND/University of California at Los Angeles Appropriateness Method

OBJECTIVE

To develop and face-validate population-level indicators for potential appropriateness of end-of-life care, for children with cancer, neurologic conditions, and genetic/congenital conditions, to be applied to administrative health data containing medication and treatment variables.

STUDY DESIGN

Modified RAND/University of California at Los Angeles appropriateness method. We identified potential indicators per illness group through systematic literature review, scoping review, and expert interviews. Three unique expert panels, a cancer (n = 19), neurology (n = 21), and genetic/congenital (n = 17) panel, participated in interviews and rated indicators in individual ratings, group discussions, and second individual ratings. Each indicator was rated on a scale from 1 to 9 for suitability. Consensus was calculated with the interpercentile range adjusted for symmetry formula. Indicators with consensus about unsuitability were removed, those with consensus about suitability were retained, and those with lack of consensus deliberated in the group discussion. Experts included pediatricians, nurses, psychologists, physiotherapists, pharmacologists, care coordinators, general practitioners, social workers from hospitals, care teams, and general practice.

RESULTS

Literature review and expert interviews yielded 115 potential indicators for cancer, 111 for neurologic conditions, and 99 for genetic/congenital conditions. We combined similar indicators, resulting in respectively 36, 32, and 33 indicators per group. Expert scoring approved 21 indicators for cancer, 24 for neurologic conditions, and 23 for genetic/congenital conditions.

CONCLUSIONS

Our indicators can be applied to administrative data to evaluate appropriateness of children's end-of-life care. Differences from adults' indicators stress the specificity of children's end-of-life care. Individual care and remaining aspects, such as family support, can be evaluated with complementary tools.

Developing a tool for measuring the disaster resilience of healthcare rescuers: a modified Delphi study

BACKGROUND

Disaster resilience is an essential personal characteristics of health rescue workers to respond to disasters in an effective manner, and maintain a state of adaptation after deployment. It is essential for disaster managers to recruit, assess, and prepare healthcare rescuers with this characteristic. A specific tool for measuring the disaster resilience of healthcare rescuers has yet to be devised.

OBJECTIVE

The purpose of this study was to establish the content validity of a tool for measuring the disaster resilience of disaster rescue workers.

METHODS

A modified Delphi approach was employed. Experts in disaster work and research were invited to rate the domains and items of a prototype tool for measuring disaster resilience in healthcare rescue workers. The panel of experts rated the relevance of the items using a 4-point Likert scale. The median and interquartile range, as well as the level of agreement, were calculated for each item using the Kendall coefficient W, to assess the consensus of the experts. The content validity index (CVI) was calculated to assess the content validity of this tool.

RESULTS

A total of 22 and 21 experts were involved in the first and second rounds of this modified Delphi study (response rate of 91.7 and 95.5%), respectively. After two rounds of expert query, an eight-domain and 27-item disaster resilience measuring tool was established. The median range of all of the included items was 3.50 to 4.00 and the interquartile range was 0.00 to 1.00, and all items achieved ≥85% agreement. The Kendall coordination coefficient W was 0.21 and 0.33 in the first and second rounds, respectively, with P < 0.01. The I-CVI ranged from 0.85 to 1.0, while the S-CVI/UA and S-CVI /Ave were 0.69 and 0.97, respectively.

CONCLUSION

Consensus was reached on a disaster resilience measuring tool covering 27 items. The content validity of this tool for measuring the disaster resilience of healthcare rescuers was excellent. This tool is validated and ready to be tested in a pilot study to assess its psychometric properties.

Achieving Consensus on Principles of Good Practice for School Health in Independent Schools: A Delphi Study

BACKGROUND

Although the 8 components of the coordinated school health (CSH) framework have been implemented to various degrees in the nation's public schools, principles of good practice (PGPs) to guide health promotion efforts in independent schools do not exist. The purpose of this study was to generate PGPs and rate their feasibility of implementation.

METHODS

A modified Delphi process was used to generate PGPs for school health in independent schools and develop consensus regarding their feasibility of implementation. A working group of 6 independent school health professionals (ISHPs) was convened to propose draft PGPs based on the CSH framework. The proposed PGPs were then reviewed by a national and geographically diverse expert panel of 10 school health researchers and 23 ISHPs that completed 3 Delphi rounds to achieve consensus on the PGPs. Of 33 participants originally invited to participate, 27 completed the Delphi process.

RESULTS

A total of 27 panelists rated 67 PGPs, provided 399 comments, and achieved consensus using interquartile range on 56 (84%) of the proposed PGPs, 41 of which were rated feasible and 15 somewhat feasible.

CONCLUSION

This study has generated empirical support for the feasibility of PGPs for school health in independent schools.

Prioritisation of future research topics in paediatric palliative care in Ireland: a Delphi study

This paper reports the findings from a Delphi Study undertaken to identify the research priorities in children's palliative care in Ireland. Palliative care for children is a small and highly specialised field of healthcare that focuses on improving the quality of life of children living with, or dying from, a life-limiting condition. Ideally, support for children requiring palliative care begins at the time of diagnosis, which for many children with life-limiting conditions can be from birth. There is a notable overlap between the needs of children requiring palliative care and those with disabilities and other complex care needs, resulting in care being provided by a range of voluntary and statutory agencies. As a new specialty, there is a need to develop an evidence-based approach to providing children's palliative care. In order to do this in a systematic way, identification of the research priorities in children's palliative care within Ireland is required.

Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study

Ensuring that people living in nursing homes (NHs) are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care. In practice the majority of current NH indicators of quality care are derived from information that is routinely collected on NH residents using the RAI-Minimum Data Set (MDS). In this regard, issues that are more tangible to resident dignity such as being treated with respect, compassion, and having opportunities to engage with others are not adequately captured in current NH quality of care indicators. An initial set of markers was created by conducting an integrative literature review of existing markers and indicators of dignity in the NH setting. A modified Delphi process was used to prioritize essential dignity-conserving care markers for use by NH providers, based on factors such as the importance to fostering a culture of dignity, the impact it may have on the residents, and how achievable it is in practice. Through this consensus building technique, we were able to develop a comprehensive set of markers that capture the range and diversity of important dignity-conserving care strategies for use in NHs. The final 10 markers were judged as having high face validity by experts in the field and have explicit implications for enhancing the provision of daily dignified care to NH residents. These markers make an important addition to the traditional quality indicators used in the NH setting and as such, bridge an important gap in addressing the psychosocial and the less easily quantified needs of NH residents.