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Botana López M, Camafort Babkowski M, Campuzano Ruiz R, Cebrián Cuenca A, Gargallo Fernández M, David de Paz H, Redondo-Antón J, Artime E, Díaz-Cerezo S, Rubio de Santos M. Barriers and Strategies to Optimize the Use of Glucagon-Like Peptide 1 Receptor Agonists in People with Type 2 Diabetes and High Cardiovascular Risk or Established Cardiovascular Disease: A Delphi Consensus in Spain. Adv Ther 2024:10.1007/s12325-024-02938-2. [PMID: 39039388 DOI: 10.1007/s12325-024-02938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for glycemic control, with many also demonstrating cardiovascular (CV) benefit, in people with type 2 diabetes (T2D). This study aimed to find a consensus on the barriers and strategies for the optimal use of GLP-1 RAs in people with T2D and high CV risk or established cardiovascular disease (CVD) in Spain. METHODS A two-round Delphi survey (53 questions) was conducted among members of four national scientific societies in Spain, including physicians experienced in the management of people with T2D. The degree of consensus was evaluated with a 7-point Likert scale, establishing consensus when ≥ 70% of the panelists agreed (6-7) or disagreed (1-2). RESULTS A total of 97 physicians participated in the first round (endocrinology: 34%, family and community medicine: 21%, internal medicine: 23%, and cardiology: 23%), and 96 in the second round. The main barriers identified were: therapeutic inertia and late use of GLP-1 RAs; lack of a comprehensive approach to CV risk; lack of knowledge on the usefulness of GLP-1 RAs in CVD prevention and treatment; and economic/administrative barriers. Strategies with a highest consensus included: the need to establish simple protocols that integrate awareness of CV risk monitoring; training professionals and patients; and the use of new technologies. CONCLUSION Physicians identified clinical, healthcare, and economic/administrative barriers that limit the use of GLP-1 RAs in people with T2D and high CV risk or established CVD in Spain, highlighting the importance of integrating these therapies according to clinical practice guidelines.
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Affiliation(s)
- Manuel Botana López
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Miguel Camafort Babkowski
- Servicio de Medicina Interna, ICMiD, Hospital Clínic, Barcelona, Spain
- Departamento de Medicina, Universidad de Barcelona; CiberOBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Campuzano Ruiz
- Servicio de Cardiología, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Ana Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco, Cartagena, Spain
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Manuel Gargallo Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Madrid, y Fundación Jiménez Díaz, Madrid, Spain
| | - Héctor David de Paz
- Outcomes'10, Parque Científico, Tecnológico y Empresarial, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Castrejón I, Cano L, Cuadrado MJ, Borrás J, Galindo M, Salman-Monte TC, Amorós C, San Román C, Cabezas I, Comellas M, Muñoz A. Patient-reported outcome measures for systemic lupus erythematosus: an expert Delphi consensus to guide implementation in routine care. BMC Rheumatol 2024; 8:31. [PMID: 39010239 PMCID: PMC11251319 DOI: 10.1186/s41927-024-00401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) may result in great impact on patients' quality of life, social relationships, and work productivity. The use of patient-reported outcome measures (PROMs) in routine care could help capture disease burden to guide SLE management and optimize disease control. We aimed to explore the current situation, appropriateness, and feasibility of PROMs to monitor patients with SLE in routine care, from healthcare professionals' and patients' perspectives. METHODS A scientific committee developed a Delphi questionnaire, based on a focus group with patients and a literature review, including 22 statements concerning: 1) Use of PROMs in routine care (n = 2); 2) PROMs in SLE management (n = 13); 3) Multidisciplinary management of patients with SLE (n = 4), and 4) Aspects on patient empowerment (n = 3). Statements included in Sects. 2-4 were assessed from three perspectives: current use, appropriateness, and feasibility (with currently available resources). For each statement, panellists specified their level of agreement using a 7-point Likert scale. A consensus was reached when ≥ 70% of the panellists agreed (6,7) or disagreed (1,2) on each statement. RESULTS Fifty-nine healthcare professionals and 16 patients with SLE participated in the Delphi-rounds. A consensus was reached on the value of PROMs to improve SLE management (83%) and the key role of healthcare professionals (77%) and the need for a digital tool connected to the electronic medical record (85%) to promote and facilitate PROMs collection. PROMs most frequently used in clinical practice are pain (56%), patient's global assessment (44%) and fatigue (39%), all on visual analogue scales. Panellists agreed on the need to implement multidisciplinary consultation (79%), unify complementary tests (88%), incorporate pharmacists into the healthcare team (70%), and develop home medication dispensing and informed telepharmacy programmes (72%) to improve quality of care in patients with SLE. According to panellists, patient associations (82%) and nurses (80%) are critical to educate and train patients on PROMs to enhance patient empowerment. CONCLUSIONS Although pain, fatigue, and global assessment were identified as the most feasible, PROMs are not widely used in routine care in Spain. The present Delphi consensus can provide a road map for their implementation being key for SLE management.
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Affiliation(s)
- Isabel Castrejón
- Departamento de Medicina, Servicio de Reumatología, Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónUniversidad Complutense de Madrid, C. del Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Laura Cano
- Enfermería Reumatología, H. Regional de Málaga, Málaga, Spain
| | - María José Cuadrado
- Servicio de Reumatología, H. Clínica Universitaria de Navarra, Madrid, Spain
| | | | - Maria Galindo
- Servicio de Reumatología, H. 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | - Alejandro Muñoz
- Servicio de Reumatología, H. Universitario Virgen del Rocío, Sevilla, Spain
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Daudén E, Belinchón I, Colominas-González E, Coto P, de la Cueva P, Gallardo F, Poveda JL, Ramírez E, Ros S, Ruíz-Villaverde R, Comellas M, Lizán L. Defining well-being in psoriasis: A Delphi consensus among healthcare professionals and patients. Sci Rep 2024; 14:14519. [PMID: 38914574 PMCID: PMC11196587 DOI: 10.1038/s41598-024-64738-6] [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: 07/13/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
Psoriasis is a chronic skin disease that negatively impacts on patient's life. A holistic approach integrating well-being assessment could improve disease management. Since a consensus definition of well-being in psoriasis is not available, we aim to achieve a multidisciplinary consensus on well-being definition and its components. A literature review and consultation with psoriasis patients facilitated the design of a two-round Delphi questionnaire targeting healthcare professionals and psoriasis patients. A total of 261 panellists (65.1% patients with psoriasis, 34.9% healthcare professionals) agreed on the dimensions and components that should integrate the concept of well-being: emotional dimension (78.9%) [stress (83.9%), mood disturbance (85.1%), body image (83.9%), stigma/shame (75.1%), self-esteem (77.4%) and coping/resilience (81.2%)], physical dimension (82.0%) [sleep quality (81.6%), pain/discomfort (80.8%), itching (83.5%), extracutaneous manifestations (82.8%), lesions in visible areas (84.3%), lesions in functional areas (85.8%), and sex life (78.2%)], social dimension (79.5%) [social relationships (80.8%), leisure/recreational activities (80.3%), support from family/friends (76.6%) and work/academic life (76.5%)], and satisfaction with disease management (78.5%) [treatment (78.2%), information received (75.6%) and medical care provided by the dermatologist (80.1%)]. This well-being definition reflects patients' needs and concerns. Therefore, addressing them in psoriasis will optimise management, contributing to better outcomes and restoring normalcy to the patient's life.
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Affiliation(s)
- Esteban Daudén
- Department of Dermatology, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Hospital Universitario de La Princesa, Diego de León, 62, 28006, Madrid, Spain.
| | - I Belinchón
- Department of Dermatology, Hospital General Universitario Dr Balmis-ISABIAL-UMH, Alicante, Spain
| | | | - P Coto
- Department of Dermatology, Hospital Vital Álvarez Buylla, Mieres, Spain
| | - P de la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F Gallardo
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - J L Poveda
- Department of Pharmacy, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - E Ramírez
- Department of Pharmacy, Hospital Universitario de La Princesa, Madrid, Spain
| | - S Ros
- Departments of Dermatology and Rheumatology, and Cardiac Transplant Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Ruíz-Villaverde
- Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain
| | - M Comellas
- Outcomes'10, Castellón de la Plana, Spain
| | - Luís Lizán
- Outcomes'10, Universidad Jaume I, Castellón de la Plana, Spain
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Martínez-Moragón E, Antepara Ercoreca I, Muñoz García M, Casas Maldonado F, Calvín Lamas M, Chiner Vives E, Crespo Diz C, Díaz-Pérez D, Eguiluz Gracia I, García Gil S, González-Pérez R, Habernau Mena A, Hermida Valverde T, Jornet Montaña S, López-Carrasco V, Martínez López I, Merino-Bohórquez V, Moreno-Ancillo Á, Mínguez Cabeza AC, Monte-Boquet E, Revuelta-Herrero JL, Sánchez-Cuellar S. Patient-reported outcome measures in severe asthma: an expert consensus. J Asthma 2024; 61:619-631. [PMID: 38146964 DOI: 10.1080/02770903.2023.2297372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The study aimed to reach a consensus on the most relevant patient-reported outcomes (PROs), the corresponding measures (PROMs), and measurement frequency during severe asthma patient follow-up. METHODS Two Delphi rounds were conducted. The questionnaire was developed based on a systematic literature review, a focus group with patients, and a nominal group with experts. It assessed PROs' relevance and the appropriateness (A) and feasibility (F) of PROMs using a Likert scale (1=totally agree; 9=totally disagree). The consensus was established when ≥75% of participants agreed (1-3) or disagreed (7-9). RESULTS Sixty-three professionals (25 hospital pharmacists, 14 allergists, 13 pulmonologists, and 11 nurses) and 5 patients answered the Delphi questionnaire. A consensus was reached on all PROs regarding their relevance. Experts agreed on the use of ACT (A:95.24%; F:95.24%), mini AQLQ (A:93.65; F:79.37%), mMRC dyspnea scale (A:85.71%; F:85.71%), TAI (A:92.06%; F:85.71%), MMAS (A:75.40%; F:82%), and the dispensing register (A:96.83%; F:92.06%). Also considered suitable were: SNOT-22 (A:90.48%; F:73.80%), PSQI (A:82.54; F:63.90%), HADS (A:82.54; F:64%), WPAI (A:77.78%; F:49.20%), TSQM-9 (A:79.37; F:70.50%) and knowledge of asthma questionnaire (A:77%; F:68.80%); however, their use in clinical practice was considered unfeasible. Panelists also agreed on the appropriateness of EQ-5D, which was finally included despite being considered unfeasible (A: 84.13%; F:67.20%) in clinical practice. Agreement was reached on using ACT, TAI, mMRC, and a dispensing register every three months; mini-AQLQ and MMAS every six months; and EQ-5D every twelve months. CONCLUSION This consensus paves the way toward patient-centered care, promoting the development of strategies supporting routine assessment of PROs in severe asthma management.
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Affiliation(s)
| | | | - María Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Marta Calvín Lamas
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Eusebi Chiner Vives
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Carlos Crespo Diz
- Servicio de Farmacia, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - David Díaz-Pérez
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ibon Eguiluz Gracia
- Servicio de Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara García Gil
- Servicio de Farmacia, Hospital Universitario de Canarias, La Laguna, Spain
| | | | | | | | | | | | - Icíar Martínez López
- Servicio de Farmacia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Álvaro Moreno-Ancillo
- Servicio de Alergología, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain
| | | | - Emilio Monte-Boquet
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Noya FC, Carr SE, Thompson SC. Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:587-609. [PMID: 37556029 PMCID: PMC11078787 DOI: 10.1007/s10459-023-10275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/06/2023] [Indexed: 08/10/2023]
Abstract
Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.
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Affiliation(s)
- Farah C Noya
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia.
- Medical Education Unit, Faculty of Medicine, Universitas Pattimura, Ambon, Indonesia.
| | - Sandra E Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Australia
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Curtin M, Cruice M, Morgan G, Herman R. Assessing parent-child interaction with deaf and hard of hearing infants aged 0-3 years: An international multi-professional e-Delphi. PLoS One 2024; 19:e0301722. [PMID: 38683866 PMCID: PMC11057743 DOI: 10.1371/journal.pone.0301722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Most deaf babies are born to hearing families who do not yet have the skills to communicate effectively with their child. Adaptations to communication are important because the quality of parent-child interaction (PCI) predicts how a deaf child develops language. Teachers of Deaf children and Speech and Language Therapists support families with communication in the home. Currently, there are no assessments that appraise how a parent interacts with their deaf baby. Previous research has identified which parent behaviours and approaches are used in PCI assessments in research and practice. The current paper forms consensus on the core content and best practices of a new PCI tool for deaf children aged 0-3 years. METHODS An international sample of expert academics and practitioners (n = 83) were recruited to take part in a two-round modified electronic Delphi study. Participants were presented with 69 statements focusing on (i) which parent behaviours were important in assessment (ii) the methods to be used in PCI assessment. Participants rated the extent to which they agreed or disagreed with each statement on a five-point Likert scale and gave comments to support their response. Consensus was defined as >80% of participants rating the statement as a (4) 'highly important' or a (5) 'essential'. If consensus was not reached, participant comments were used to generate new statements which were rated in the second round. This project involved a patient and public involvement (PPI) group of hearing and deaf parents and professionals to design and guide the study. RESULTS Consensus was achieved on 52 statements and ranged from 80-99%. A further six statements were additionally included. Within the 58 statements included, 36 were parent behaviours which centred on the parent's observation of, and response to, their child's behaviour and/or language. The remaining 22 statements focused on methods used in the assessment such as parents having their PCI filmed, parents having the opportunity to review the video and assess themselves alongside a professional, and parents being involved in subsequent goal setting. CONCLUSIONS This e-Delphi presented the parent behaviours and methods of assessment to be included in a new PCI tool for deaf children. Future co-production work and acceptability and feasibility testing are discussed.
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Affiliation(s)
- Martina Curtin
- Speech and Language Therapy (Paediatrics, Community), Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Language and Communication Science, City, University of London, London, United Kingdom
| | - Madeline Cruice
- Language and Communication Science, City, University of London, London, United Kingdom
| | - Gary Morgan
- Universitat Oberta de Catalunya, Psychology and Education Sciences, Barcelona, Spain
| | - Rosalind Herman
- Language and Communication Science, City, University of London, London, United Kingdom
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Pommée T, Mbagira D, Morsomme D. French-Language Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). J Voice 2024:S0892-1997(24)00085-7. [PMID: 38582726 DOI: 10.1016/j.jvoice.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol. METHODS To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology. RESULTS The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts. CONCLUSIONS The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally.
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Affiliation(s)
- Timothy Pommée
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Déborah Mbagira
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
| | - Dominique Morsomme
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
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Gianola S, Bargeri S, Pellicciari L, Gambazza S, Rossettini G, Fulvio A, Genovese V, Benedini M, Proverbio E, Cecchetto S, Castellini G, Turolla A. Evidence-informed and consensus-based statements about SAFEty of Physical Agent Modalities Practice in physiotherapy and rehabilitation medicine (SAFE PAMP): a national Delphi of healthcare scientific societies. BMJ Open 2024; 14:e075348. [PMID: 38508626 PMCID: PMC10953005 DOI: 10.1136/bmjopen-2023-075348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE A shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based statements about the safety of PAMs. STUDY DESIGN AND SETTING A RAND-modified Delphi Rounds' survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%. RESULTS Overall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17-36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups. CONCLUSIONS The resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Rossettini
- School of Physiotherapy, Università degli Studi di Verona, Verona, Italy
- Department of Human Neurosciences, University of Roma "Sapienza Roma", Rome, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón 28670, Spain
| | - Anna Fulvio
- Associazione Italiana di Fisioterapia, Rome, Italy
| | | | | | | | - Simone Cecchetto
- Associazione Italiana di Fisioterapia, Rome, Italy
- Direction of Health Professions, APSS, 38014, Trento, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences-DIBINEM, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Graf M, Tuly R, Pednekar P, Wang C, Batt K. Gaining Consensus Around Patient Risk Groups and Prognostic Profiles to Guide CMV Management Among Patients With Allogeneic Hematopoietic Stem Cell Transplant: Insights From a Delphi Panel With Hematopoietic Stem Cell Transplant Experts. Transplant Proc 2024; 56:394-408. [PMID: 38369412 DOI: 10.1016/j.transproceed.2023.12.020] [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: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION This study aimed to characterize patient risk groups and prognostic profiles to optimize clinical decision-making and guide appropriate medical cytomegalovirus (CMV) management among patients with allogeneic hematopoietic stem cell transplant (HSCT). METHODS Between 8/2021 and 2/2022, a 3-round modified Delphi study was conducted to generate consensus among 10 international experts in HSCT and infectious diseases. Experts were asked about treatment and prognoses for patients in 7 distinct clinical scenarios. Furthermore, experts were asked to risk-stratify patients by pre-/post-transplant characteristics. Consensus around opting for/against a treatment was observed if ≥75% or <25% of experts reported ≥50% likelihood to recommend or if treatments were ranked inside/outside the top 2 options and ≥75% of experts were within 1 SD of mean ranks. RESULTS Experts agreed on several unmet needs in CMV disease management post-HSCT, particularly avoidance of treatment-limiting toxicities with conventional CMV therapy and the emergence of both refractory and drug-resistant treatment failures. Experts considered CMV viral load, resistance profile, and route of administration as critical to treatment selection. For newer CMV therapeutic options, experts listed a lack of long-term use data, concerns over potential resistance, high cost, and limited availability as challenges restricting adoption and successful patient management. CONCLUSIONS Experts achieved consensus around patient risk stratifications and factors influencing therapeutic options. Recommendations emerging from this Delphi study may support practicing physicians when confronted with challenging CMV scenarios in patients with HSCT.
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van Alphen AMIA, Krijkamp EM, Gravesteijn BY, Baatenburg de Jong RJ, Busschbach JJ. Surgical prioritization based on decision model outcomes is not sensitive to differences between the health-related quality of life values estimates of physicians and citizens. Qual Life Res 2024; 33:529-539. [PMID: 37938403 PMCID: PMC10850033 DOI: 10.1007/s11136-023-03544-5] [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] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Decision models can be used to support allocation of scarce surgical resources. These models incorporate health-related quality of life (HRQoL) values that can be determined using physician panels. The predominant opinion is that one should use values obtained from citizens. We investigated whether physicians give different HRQoL values to citizens and evaluate whether such differences impact decision model outcomes. METHODS A two-round Delphi study was conducted. Citizens estimated HRQoL of pre- and post-operative health states for ten surgeries using a visual analogue scale. These values were compared using Bland-Altman analysis with HRQoL values previously obtained from physicians. Impact on decision model outcomes was evaluated by calculating the correlation between the rankings of surgeries established using the physicians' and the citizens' values. RESULTS A total of 71 citizens estimated HRQoL. Citizens' values on the VAS scale were - 0.07 points (95% CI - 0.12 to - 0.01) lower than the physicians' values. The correlation between the rankings of surgeries based on citizens' and physicians' values was 0.96 (p < 0.001). CONCLUSION Physicians put higher values on health states than citizens. However, these differences only result in switches between adjacent entries in the ranking. It would seem that HRQoL values obtained from physicians are adequate to inform decision models during crises.
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Affiliation(s)
- Anouk M I A van Alphen
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Eline M Krijkamp
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Benjamin Y Gravesteijn
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Jan J Busschbach
- Department of Medical Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Karvandi E, Helmy A, Kolias AG, Belli A, Ganau M, Gomes C, Grey M, Griffiths M, Griffiths T, Griffiths P, Holliman D, Jenkins P, Jones B, Lawrence T, McLoughlin T, McMahon C, Messahel S, Newton J, Noad R, Raymont V, Sharma K, Sylvester R, Tadmor D, Whitfield P, Wilson M, Woodberry E, Parker M, Hutchinson PJ. Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology. BMJ Open 2023; 13:e077022. [PMID: 38070886 PMCID: PMC10729241 DOI: 10.1136/bmjopen-2023-077022] [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] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome. DESIGN This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%. SETTING Specialist outpatient services. PARTICIPANTS Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England. PRIMARY OUTCOME MEASURE A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England. RESULTS 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics. CONCLUSIONS This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.
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Affiliation(s)
- Elika Karvandi
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Angelos G Kolias
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clint Gomes
- Royal Liverpool University Hospital, Liverpool, UK
- UK Sports Institute, Liverpool, UK
| | - Michael Grey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael Griffiths
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Neurology, Alder-Hey Children's NHS Trust, Liverpool, UK
| | - Timothy Griffiths
- Department of Cognitive Neurology, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Neurology, University College London, London, UK
| | - Philippa Griffiths
- Sunderland & South Tyneside Community Acquired Brain Injury Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Peter Jenkins
- Wessex Neuroscience Centre, Southampton General Hospital, Southampton, UK
- Imperial College London, London, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University-Headingley Campus, Leeds, UK
- England Performance Unit, Rugby Football League Ltd, Leeds, UK
| | - Tim Lawrence
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Catherine McMahon
- Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Infirmary, Northern Care Alliance, Liverpool, UK
| | - Shrouk Messahel
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Joanne Newton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rupert Noad
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Kanchan Sharma
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Sylvester
- National Hospital for Neurology and Neurosurgery, London, London, UK
- Institute of Exercise and Health, University College London, London, UK
| | - Daniel Tadmor
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Medical, Leeds Rhinos Rugby League Club, Leeds, UK
| | | | - Mark Wilson
- Imperial College London, London, UK
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Woodberry
- Department of Neuropsychology, University of Cambridge, Cambridge, UK
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12
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Gibson C, Goeman D, Yates M, Pond D. Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study. Aust J Prim Health 2023; 29:643-649. [PMID: 37345268 DOI: 10.1071/py22276] [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: 07/26/2022] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Worldwide, responsibility for dementia diagnosis and management is shifting to primary care, in particular to the general practitioner (GP). It has been acknowledged that primary care nurses, working collaboratively with GPs, have a role in dementia care by utilising their unique knowledge and skills. However, there are no best-practice guidelines or care pathways to inform nurses in general practice on what best-practice dementia care comprises and how to implement this into their practice. This study identified the recommendations in the Australian guidelines for dementia management most relevant to the role of the nurse working in general practice. METHODS Seventeen experts active in clinical practice and/or research in primary care nursing in general practice participated in an online three-round Delphi study. RESULTS All 17 participants were female with a nursing qualification and experienced in general practice clinical nursing and/or general practice nursing research. Five recommendations were identified as the most relevant to the role of the nurse in general practice. These recommendations all contained elements of person-centred care: the delivery of individualised information, ongoing support, including the carer in decision-making, and they also align with the areas where GPs want support in dementia care provision. CONCLUSION This novel study identified best-practice dementia care recommendations specific to nurses in general practice. These recommendations will inform a model of care for nurses in the provision of dementia care that supports GPs and better meets the needs of people living with dementia and their carer(s).
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Affiliation(s)
- Caroline Gibson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; and Grampians Health, Ballarat, Vic. 3350, Australia
| | - Dianne Goeman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; and Central Clinical School, Monash University, The Alfred Centre, Melbourne, Vic. 3004, Australia
| | - Mark Yates
- Grampians Health, Ballarat, Vic. 3350, Australia; and Deakin University School of Medicine, Ballarat Clinical School, Ballarat, Vic. 3350, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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13
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Benjumea J, Ropero J, Dorronzoro-Zubiete E, Rivera-Romero O, Carrasco A. A Proposal for a Robust Validated Weighted General Data Protection Regulation-Based Scale to Assess the Quality of Privacy Policies of Mobile Health Applications: An eDelphi Study. Methods Inf Med 2023; 62:154-164. [PMID: 37591261 PMCID: PMC10878744 DOI: 10.1055/a-2155-2021] [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: 07/06/2022] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Health care services are undergoing a digital transformation in which the Participatory Health Informatics field has a key role. Within this field, studies aimed to assess the quality of digital tools, including mHealth apps, are conducted. Privacy is one dimension of the quality of an mHealth app. Privacy consists of several components, including organizational, technical, and legal safeguards. Within legal safeguards, giving transparent information to the users on how their data are handled is crucial. This information is usually disclosed to users through the privacy policy document. Assessing the quality of a privacy policy is a complex task and several scales supporting this process have been proposed in the literature. However, these scales are heterogeneous and even not very objective. In our previous study, we proposed a checklist of items guiding the assessment of the quality of an mHealth app privacy policy, based on the General Data Protection Regulation. OBJECTIVE To refine the robustness of our General Data Protection Regulation-based privacy scale to assess the quality of an mHealth app privacy policy, to identify new items, and to assign weights for every item in the scale. METHODS A two-round modified eDelphi study was conducted involving a privacy expert panel. RESULTS After the Delphi process, all the items in the scale were considered "important" or "very important" (4 and 5 in a 5-point Likert scale, respectively) by most of the experts. One of the original items was suggested to be reworded, while eight tentative items were suggested. Only two of them were finally added after Round 2. Eleven of the 16 items in the scale were considered "very important" (weight of 1), while the other 5 were considered "important" (weight of 0.5). CONCLUSION The Benjumea privacy scale is a new robust tool to assess the quality of an mHealth app privacy policy, providing a deeper and complementary analysis to other scales. Also, this robust scale provides a guideline for the development of high-quality privacy policies of mHealth apps.
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Affiliation(s)
- Jaime Benjumea
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Jorge Ropero
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | | | | | - Alejandro Carrasco
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
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14
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Pednekar P, Graf M, Tuly R, Batt K, Wang C. Gaining consensus around patient risk groups and prognostic profiles to guide CMV management among patients with solid organ transplant: Insights from a Delphi panel with SOT experts. Clin Transplant 2023; 37:e14905. [PMID: 36603193 DOI: 10.1111/ctr.14905] [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: 09/30/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study aimed to characterize patient risk groups and respective prognostic profiles to optimize clinical decision-making and guide appropriate medical cytomegalovirus (CMV) management among patients with solid organ transplant (SOT). METHODS Between September 2021 and February 2022, a three-round modified Delphi study was conducted to generate consensus among 14 international experts in virology and organ transplantation. Experts were asked about treatment and prognoses for patients in seven distinct clinical scenarios. Furthermore, experts were asked to risk-stratify patients by pre-/post-transplant characteristics. Consensus around opting for/against a treatment was observed if ≥75% or <25% of experts reported ≥50% likelihood to recommend or if treatments were ranked inside/outside the top two options and ≥75% of experts were within 1 standard deviation of the mean rank. RESULTS Experts agreed on several unmet needs in CMV disease management post-SOT, particularly avoidance of treatment-limiting toxicities with conventional CMV therapy and emergence of both primary refractory and drug resistant treatment failures. Experts considered CMV viral load, resistance profile, and route of administration as critical to treatment selection. For newer CMV therapeutic options, experts listed lack of long-term use data, concerns over potential resistance, high cost and limited availability as challenges restricting adoption, and successful patient management. CONCLUSION Experts achieved consensus around patient risk stratifications and factors influencing therapeutic options. Recommendations emerging from this Delphi study may support practicing physicians when confronted with challenging CMV scenarios in SOT patients, but additional experiences with newer anti-CMV agents are needed to re-validate expert consensus and update post-transplant CMV guidelines.
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Affiliation(s)
| | | | | | | | - Connie Wang
- Hennepin Healthcare, Minneapolis, Minnesota, USA
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15
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Abstract
The use of the Delphi technique is prevalent across health sciences research, and it is used to identify priorities, reach consensus on issues of importance and establish clinical guidelines. Thus, as a form of expert opinion research, it can address fundamental questions present in healthcare. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Advantages of the use of Delphi include anonymity, controlled feedback, flexibility for the choice of statistical analysis, and the ability to gather participants from geographically diverse areas. Areas of methodological uncertainty worthy of further discussion broadly include experts and data management. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. For data management, there are issues with data collection, defining consensus and methods of data analysis, such as percent agreement, central tendency, measures of dispersion, and inferential statistics. Overall, the use of Delphi addresses important issues present in health sciences research, but methodological issues remain. It is likely that the aggregation of future Delphi studies will eventually pave the way for more comprehensive reporting guidelines and subsequent methodological clarity.
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Affiliation(s)
- Zhida Shang
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- * Correspondence: Zhida Shang, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada (e-mail: )
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16
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Savic LC, Smith AF. How to conduct a Delphi consensus process. Anaesthesia 2023; 78:247-250. [PMID: 35816561 DOI: 10.1111/anae.15808] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 01/11/2023]
Affiliation(s)
- L C Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A F Smith
- Department of Anaesthesia, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK.,Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
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Pittelkow MM, Field SM, Isager PM, van’t Veer AE, Anderson T, Cole SN, Dominik T, Giner-Sorolla R, Gok S, Heyman T, Jekel M, Luke TJ, Mitchell DB, Peels R, Pendrous R, Sarrazin S, Schauer JM, Specker E, Tran US, Vranka MA, Wicherts JM, Yoshimura N, Zwaan RA, van Ravenzwaaij D. The process of replication target selection in psychology: what to consider? ROYAL SOCIETY OPEN SCIENCE 2023; 10:210586. [PMID: 36756069 PMCID: PMC9890109 DOI: 10.1098/rsos.210586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Increased execution of replication studies contributes to the effort to restore credibility of empirical research. However, a second generation of problems arises: the number of potential replication targets is at a serious mismatch with available resources. Given limited resources, replication target selection should be well-justified, systematic and transparently communicated. At present the discussion on what to consider when selecting a replication target is limited to theoretical discussion, self-reported justifications and a few formalized suggestions. In this Registered Report, we proposed a study involving the scientific community to create a list of considerations for consultation when selecting a replication target in psychology. We employed a modified Delphi approach. First, we constructed a preliminary list of considerations. Second, we surveyed psychologists who previously selected a replication target with regards to their considerations. Third, we incorporated the results into the preliminary list of considerations and sent the updated list to a group of individuals knowledgeable about concerns regarding replication target selection. Over the course of several rounds, we established consensus regarding what to consider when selecting a replication target. The resulting checklist can be used for transparently communicating the rationale for selecting studies for replication.
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Affiliation(s)
- Merle-Marie Pittelkow
- Department of Psychometrics and Statistics, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Sarahanne M. Field
- Centre of Science and Technology Studies, Leiden University, Leiden, the Netherlands
| | | | - Anna E. van’t Veer
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Thomas Anderson
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Scott N. Cole
- School of Education, Language and Psychology, York St John University, York, UK
| | - Tomáš Dominik
- Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Orange, CA, USA
| | | | - Sebahat Gok
- Program in Cognitive Science, Department of Instructional Systems Technology, Indiana University, Bloomington, IN, USA
| | - Tom Heyman
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Marc Jekel
- Social Psychology, University of Cologne, Cologne, Germany
| | - Timothy J. Luke
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - David B. Mitchell
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Rik Peels
- Philosophy Department and the Faculty of Religion and Theology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Rosina Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samuel Sarrazin
- Maison de santé pluridisciplinaire Pasteur, Chevilly-Larue, France
| | - Jacob M. Schauer
- Department of Preventive Medicine - Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eva Specker
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ulrich S. Tran
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Marek A. Vranka
- Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Jelte M. Wicherts
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Naoto Yoshimura
- Research Organization of Open Innovation and Collaboration, Ritsumeikan University, Osaka, Japan
- Research Fellow of the Japan Society for the Promotion of Science, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rolf A. Zwaan
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Don van Ravenzwaaij
- Department of Psychometrics and Statistics, Rijksuniversiteit Groningen, Groningen, The Netherlands
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Gravesteijn BY, van Hof KS, Krijkamp E, Asselman F, Leemans CR, van Alphen AM, van der Horst H, Widdershoven G, de Jong LB, Lingsma H, Busschbach J, de Jong RB. Minimizing population health loss due to scarcity in OR capacity: validation of quality of life input. BMC Med Res Methodol 2023; 23:31. [PMID: 36721106 PMCID: PMC9887555 DOI: 10.1186/s12874-022-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES A previously developed decision model to prioritize surgical procedures in times of scarce surgical capacity used quality of life (QoL) primarily derived from experts in one center. These estimates are key input of the model, and might be more context-dependent than the other input parameters (age, survival). The aim of this study was to validate our model by replicating these QoL estimates. METHODS The original study estimated QoL of patients in need of commonly performed procedures in live expert-panel meetings. This study replicated this procedure using a web-based Delphi approach in a different hospital. The new QoL scores were compared with the original scores using mixed effects linear regression. The ranking of surgical procedures based on combined QoL values from the validation and original study was compared to the ranking based solely on the original QoL values. RESULTS The overall mean difference in QoL estimates between the validation study and the original study was - 0.11 (95% CI: -0.12 - -0.10). The model output (DALY/month delay) based on QoL data from both studies was similar to the model output based on the original data only: The Spearman's correlation coefficient between the ranking of all procedures before and after including the new QoL estimates was 0.988. DISCUSSION Even though the new QoL estimates were systematically lower than the values from the original study, the ranking for urgency based on health loss per unit of time delay of procedures was consistent. This underscores the robustness and generalizability of the decision model for prioritization of surgical procedures.
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Affiliation(s)
- Benjamin Y. Gravesteijn
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands ,Department of Obstetrics & Gynaecology, OLVG, Amsterdam, Netherlands
| | - Kira S. van Hof
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline Krijkamp
- grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus University Medical Center, currently employed by the Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Franck Asselman
- grid.509540.d0000 0004 6880 3010Strategy & Innovation department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - C. René Leemans
- grid.12380.380000 0004 1754 9227Department of Otolaryngology – Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Anouk M.I.A. van Alphen
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henriëtte van der Horst
- grid.509540.d0000 0004 6880 3010Department of general practice, Amsterdam University Medical Centers Vrije Universiteit, Amsterdam, Netherlands
| | - Guy Widdershoven
- grid.12380.380000 0004 1754 9227Department of Ethics, Law and Humanities, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Hester Lingsma
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan Busschbach
- grid.5645.2000000040459992XDepartment of Medical Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rob Baatenburg de Jong
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Dhillon MK, Rafi-Ul-Shan PM, Amar H, Sher F, Ahmed S. Flexible Green Supply Chain Management in Emerging Economies: A Systematic Literature Review. GLOBAL JOURNAL OF FLEXIBLE SYSTEMS MANAGEMENT 2022; 24:1-28. [PMID: 37519431 PMCID: PMC9638205 DOI: 10.1007/s40171-022-00321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/06/2022] [Indexed: 08/01/2023]
Abstract
The purpose of this research is to synthesize the fragmented extant knowledge on flexible and green supply chain management (FGSCM) in the context of emerging economies and to unearth research gaps to motivate future research. We adopted a novel structured systematic literature review by triangulating a systematic literature review, text mining, and network analysis. Institutional theory and contingency theory were employed to analyze the results of the review. The results show that, firstly, research on FGSCM in emerging economies, despite its importance, is immature compared to general FGSCM literature. Second, the specificities of strategies and practices that distinguish this topic in emerging economies are discussed and the drivers and barriers are identified with respect to sources of institutional pressure. Third, a research framework for FGSCM in emerging economies is developed and 12 gaps for future research are identified. This study has exclusively developed a research framework for FGSCM in an emerging economy which has received the least consideration in the literature and practice. The framework was developed to synthesize the existing literature and to identify the research gaps to inspire future research.
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Affiliation(s)
| | - P. M. Rafi-Ul-Shan
- University for the Creative Arts, Epsom, KT18 5BE UK
- Cardiff Metropolitan University, Cardiff, CF5 2YB UK
| | - H. Amar
- University of Westminster, London, NW1 5LS UK
| | - F. Sher
- Nottingham Trent University, Nottingham, NG1 4FQ UK
| | - S. Ahmed
- University of West of Scotland, Paisley, PA1 2BE UK
- King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
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McLeod C, Smyth AR, Messer M, Schultz A, Wood J, Norman R, Blyth CC, Webb S, Elliott Z, Van Devanter D, Stephenson AL, Tong A, Snelling TL. Protocol for establishing a core outcome set for evaluation in studies of pulmonary exacerbations in people with cystic fibrosis. BMJ Open 2022; 12:e056528. [PMID: 36153014 PMCID: PMC9511571 DOI: 10.1136/bmjopen-2021-056528] [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: 11/30/2022] Open
Abstract
INTRODUCTION Pulmonary exacerbations are associated with increased morbidity and mortality in people with cystic fibrosis (CF). There is no consensus about which outcomes should be evaluated in studies of pulmonary exacerbations or how these outcomes should be measured. Outcomes of importance to people with lived experience of the disease are frequently omitted or inconsistently reported in studies, which limits the value of such studies for informing practice and policy. To better standardise outcome reporting and measurement, we aim to develop a core outcome set for studies of pulmonary exacerbations in people with CF (COS-PEX) and consensus recommendations for measurement of core outcomes. METHODS AND ANALYSIS Preliminary work for development of COS-PEX has been reported, including (1) systematic reviews of outcomes and methods for measurement reported in existing studies of pulmonary exacerbations; (2) workshops with people affected by CF within Australia; and (3) a Bayesian knowledge expert elicitation workshop with health professionals to ascertain outcomes of importance. Here we describe a protocol for the additional stages required for COS-PEX development and consensus methods for measurement of core outcomes. These include (1) an international two-round online Delphi survey and (2) consensus workshops to review and endorse the proposed COS-PEX and to agree with methods for measurement. ETHICS AND DISSEMINATION National mutual ethics scheme approval has been provided by the Child and Adolescent Health Service Human Research Ethics Committee (RGS 4926). Results will be disseminated via consumer and research networks and peer-reviewed publications. This study is registered with the Core Outcome Measures in Effectiveness Trials database.
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Affiliation(s)
- Charlie McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Alan Robert Smyth
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Mitch Messer
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Andre Schultz
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jamie Wood
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Steve Webb
- Intensive Care Unit, St John of God Health Care, West Perth, Western Australia, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zoe Elliott
- Consumer representative, University of Nottingham, Nottingham, UK
| | | | - Anne L Stephenson
- Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Thomas L Snelling
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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21
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Mhajabin S, Banik G, Islam MS, Islam MJ, Tahsina T, Ahmed FU, Islam MU, Mannan MA, Dey SK, Sharmin S, Mehran F, Khan M, Ahmed A, Al Sabir A, Sultana S, Ahsan Z, Rubayet S, George J, Karim A, Shahidullah M, El Arifeen S, Rahman AE. Newborn signal functions in Bangladesh: Identification through expert consultation and assessment of readiness among public health facilities. J Glob Health 2022. [PMCID: PMC9480864 DOI: 10.7189/jogh.12.04079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to identify a set of newborn signal functions (NSFs) that can categorize health facilities and assist policymakers and health managers in appropriately planning and adequately monitoring the progress and performance of health facilities delivering newborn health care in Bangladesh and similar low-income settings. Methods A modified Delphi method was used to identify a set of NSFs and a cross-sectional health facility assessment among the randomly selected facilities was conducted to test them in public health facilities in Bangladesh. In the modified Delphi approach, three main steps of listing, prioritizing, and testing were followed to identify the set of NSFs. Then, to finalize the set of NSFs and its variables, a total of five Delphi workshops and three rounds of Delphi surveys were conducted. Finally, 205 public health facilities located in 41 randomly selected districts were assessed for the availability and readiness of finalized NSFs using the updated tool of Bangladesh Health Facility Survey (BHFS) 2017. Results Twenty NSFs were identified and finalized, nine of which were categorized as primary NSFs, 13 as basic NSFs, 18 as comprehensive NSFs, and 20 as advanced NSFs. Almost all district hospitals (DHs), Upazila health complexes (UHCs,) and maternal and child welfare centres (MCWCs) performed the primary NSFs in the last three months. However, around one-third of the union health and family welfare centres (UH&FWCs) and very few community clinics (CCs) performed them during the same period. The basic, comprehensive, and advanced NSF readiness was inadequate and inappropriate across all types of facilities, including DHs and UHCs. Conclusions In the absence of internationally or nationally agreed-upon NSFs to measure a health facility's service availability and readiness for providing newborn care, this study becomes the first to identify and finalize a set of NSFs and to incorporate relevant variables in the health facility assessment tool which can be used to monitor the availability and readiness of a newborn care facility. The identified NSFs can also be adapted for the countries with similar contexts and can serve as a standard base to determine a global set of NSFs.
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Affiliation(s)
- Shema Mhajabin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Goutom Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Government of Bangladesh Ministry of Health and Family Welfare, Bangladesh
| | - Md Jahurul Islam
- Directorate General of Health Services, Government of Bangladesh Ministry of Health and Family Welfare, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Farid Uddin Ahmed
- Directorate General of Family Planning, Ministry of Health & Family Welfare, Bangladesh
| | - Mushair Ul Islam
- Directorate General of Health Services, Government of Bangladesh Ministry of Health and Family Welfare, Bangladesh
| | - Md Abdul Mannan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | | | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Shahin Sultana
- National Institute of Population Research and Training, Dhaka, Bangladesh
| | | | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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22
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Çalışkan SA, Demir K, Karaca O. Artificial intelligence in medical education curriculum: An e-Delphi study for competencies. PLoS One 2022; 17:e0271872. [PMID: 35862401 PMCID: PMC9302857 DOI: 10.1371/journal.pone.0271872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background Artificial intelligence (AI) has affected our day-to-day in a great extent. Healthcare industry is one of the mainstream fields among those and produced a noticeable change in treatment and education. Medical students must comprehend well why AI technologies mediate and frame their decisions on medical issues. Formalizing of instruction on AI concepts can facilitate learners to grasp AI outcomes in association with their sensory perceptions and thinking in the dynamic and ambiguous reality of daily medical practice. The purpose of this study is to provide consensus on the competencies required by medical graduates to be ready for artificial intelligence technologies and possible applications in medicine and reporting the results. Materials and methods A three-round e-Delphi survey was conducted between February 2020 and November 2020. The Delphi panel accorporated experts from different backgrounds; (i) healthcare professionals/ academicians; (ii) computer and data science professionals/ academics; (iii) law and ethics professionals/ academics; and (iv) medical students. Round 1 in the Delphi survey began with exploratory open-ended questions. Responses received in the first round evaluated and refined to a 27-item questionnaire which then sent to the experts to be rated using a 7-point Likert type scale (1: Strongly Disagree—7: Strongly Agree). Similar to the second round, the participants repeated their assessments in the third round by using the second-round analysis. The agreement level and strength of the consensus was decided based on third phase results. Median scores was used to calculate the agreement level and the interquartile range (IQR) was used for determining the strength of the consensus. Results Among 128 invitees, a total of 94 agreed to become members of the expert panel. Of them 75 (79.8%) completed the Round 1 questionnaire, 69/75 (92.0%) completed the Round 2 and 60/69 (87.0%) responded to the Round 3. There was a strong agreement on the 23 items and weak agreement on the 4 items. Conclusions This study has provided a consensus list of the competencies required by the medical graduates to be ready for AI implications that would bring new perspectives to medical education curricula. The unique feature of the current research is providing a guiding role in integrating AI into curriculum processes, syllabus content and training of medical students.
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Affiliation(s)
- S. Ayhan Çalışkan
- Department of Medical Education, Ege University Faculty of Medicine, Izmir, Türkiye
- * E-mail:
| | - Kadir Demir
- Department of Management Information Systems, Izmir Democracy University Faculty of Economics and Administrative Sciences, Izmir, Türkiye
| | - Ozan Karaca
- Department of Medical Education, Ege University Faculty of Medicine, Izmir, Türkiye
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Expert consensus for a national essential antidote list: E-Delphi method. PLoS One 2022; 17:e0269456. [PMID: 35709136 PMCID: PMC9202922 DOI: 10.1371/journal.pone.0269456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. In order to assist hospitals to reduce costs and improve patient care, an essential antidote list can be used as an initial foundation for securing sufficient antidote availability at healthcare institutions. The aim of our study is to generate a nationally relevant essential antidote list for emergency care hospitals in Kuwait using the e-Delphi method by establishing consensus through a multidisciplinary expert group of healthcare providers. An electronic survey with 47 essential antidotes was developed. The e-Delphi method was used, with three rounds of voting, to determine expert consensus on an essential antidote list for hospitals in Kuwait. A purposive sample of healthcare professionals from governmental and private hospitals were selected for this study (n = 30). Consensus was gained if ≥75% of the expert panel agreed on the inclusion of the antidote, without any strong disagreements. Round 1 of the e-Delphi resulted in 41 antidotes reaching consensus and seven new antidotes suggested by the expert panel. Round 2 had two antidotes (out of seven newly suggested ones) reaching consensus. Round 3 was a confirmatory round, where the expert group agreed on their previous rounds’ opinions. This resulted in the development of an essential antidote list with 43 antidotes. The optimal approach for ensuring adequate availability of antidotes is continuous monitoring of local poisoning incidence and antidote requirements through collaborations between academic researchers and emergency care clinicians. The development of an essential antidote list, with expert consensus, is one of the initial steps in securing a foundation for appropriate provision of antidotes at all healthcare institutions. This is the first study that the authors are aware of that demonstrates that the e-Delphi technique can consolidate recommendations of experts in emergency medicine to provide a list of essential antidotes.
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Pommée T, Balaguer M, Mauclair J, Pinquier J, Woisard V. Criteria for creating new standard reading passages for the assessment of speech and voice: A Delphi consensus study. CLINICAL LINGUISTICS & PHONETICS 2022:1-20. [PMID: 35694961 DOI: 10.1080/02699206.2022.2080589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Standard reading passages allow for the study of the integrated functions of speech and voice components in contextual, running speech, with target stimuli in a controlled environment. In both clinical practice and research, these texts provide rapid insight into the characteristics of the patient's speech, with fewer hesitations than in conversational speech and better predictability by the evaluator. Although a plethora of texts exist in different languages, they present various limitations. A specifically created standardised text in each language allowing for an ecological assessment of speech and voice functions, meeting most required criteria for standard speech and voice assessment and adapted to the target language's cultural and linguistic specificities, would therefore be an interesting option. However, no guidelines exist for the creation of such a reading passage. This article describes the international Delphi consensus study carried out to identify a minimal set of criteria to take into account when creating standard reading passages for an overall speech and voice assessment in adolescents and adults. This survey was conducted in three consecutive rounds; forty experts participated in the first round, with a total dropout of 17% from round 1 to round 3. It results in a minimal set of ten criteria which were selected by a majority of the experts and were rated as most important. This set contains five phoneme-level, two word-level, two sentence-level criteria and one global-level criterion. It can be used as a general guideline for the creation of standard reading passages in Indo-European Romance and Germanic languages such as English, French and German. The construction of a new reading passage in French following this guideline is briefly described.
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Affiliation(s)
- Timothy Pommée
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Mathieu Balaguer
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
- ENT Department, University Hospital of Toulouse Larrey, Toulouse, France
| | - Julie Mauclair
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Julien Pinquier
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Virginie Woisard
- ENT Department, University Hospital of Toulouse Larrey, Toulouse, France
- Oncorehabilitation unit, University Cancer Institute of Toulouse Oncopole, Toulouse, France
- Laboratoire Octogone Lordat, Jean Jaurès University Toulouse II, Toulouse, France
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Westland H, Page SD, van Rijn M, Aryal S, Freedland KE, Lee C, Strömberg A, Vellone E, Wiebe DJ, Jaarsma T, Riegel B. Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study. Heart Lung 2022; 56:40-49. [PMID: 35709644 DOI: 10.1016/j.hrtlng.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions. OBJECTIVE To create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms. METHODS A two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis. RESULTS A total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors. CONCLUSIONS The list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands.
| | | | - Michelle van Rijn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands
| | - Subhash Aryal
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | | | - Christopher Lee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Barbara Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Hung CH, Wang YM, Huang CY, Lin CH. Developing of Multidimensional Perspectives Checklist of Professionalism for Undergraduate Occupational Therapy Students in Assistive Technology Service: Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7028. [PMID: 35742274 PMCID: PMC9222639 DOI: 10.3390/ijerph19127028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023]
Abstract
Professionalism is a critical attribute that occupational therapy students must establish throughout education, especially in the context of assistive technology (AT). This study aimed to construct a multidimensional perspectives checklist (MPC) from the stakeholders to reflect professionalism development in the AT service courses. Fifteen experts in AT clinical practice and educators (N = 15) consented to and completed three rounds of the Delphi survey. Data were qualitatively analyzed to form a preliminary checklist in the first round. In rounds two and three, participants rated their level of agreement with the MPC items. A descriptive analysis of consensus was performed. Thirty items were classified into five subscales (teachers, therapists, patients, peers, learners) and fit into a framework with three dimensions and seven categories. After the Delphi survey, the MPC achieved high consensus, convergence, and stability. Two additional categories of professionalism emerged in the study, namely aesthetic and personal characteristics and reflection. The MPC developed in this study reflects the perspectives of various stakeholders in occupational therapy practice, providing helpful information for students to prepare themselves. Therefore, the MPC could contribute to expanding and developing the scope of professionalism in occupational therapy, especially in AT service.
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Affiliation(s)
- Chia-Hui Hung
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Occupational Therapy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yu-Ming Wang
- Department of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan;
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Cheng-Yi Huang
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chung-Hui Lin
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Occupational Therapy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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27
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Escudero-Vilaplana V, Bernal E, Casado G, Collado-Borrell R, Diez-Fernández R, Fernández Román AB, Folguera C, González-Cortijo L, Herrero-Fernández M, Marquina G, Martínez Nieto C, Rodríguez MA, Rubio AR, Sanmartin-Fenollera P, Vazquez Castillo MJ, Comellas M, Guerra EM. Defining a Standard Set of Patient-Reported Outcomes for Patients With Advanced Ovarian Cancer. Front Oncol 2022; 12:885910. [PMID: 35664764 PMCID: PMC9159390 DOI: 10.3389/fonc.2022.885910] [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: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Advanced ovarian cancer (AOC) and its treatment cause several symptoms and impact on patients’ health-related quality of life (HRQoL). We aim to reach a consensus on the most relevant patient-reported outcome (PROs), the corresponding measures (PROMs), and measurement frequency during AOC patients’ follow-up from patients’ and healthcare professionals’ (HCP) perspective. Methods The project comprised five steps: 1) a literature review, 2) a focus group with patients, 3) a nominal group with HCP, 4) two round-Delphi consultations with patients and HCP, and 5) a final meeting with HCP. Delphi questionnaire was elaborated based on literature review, focus group (n=5 patients), and nominal group (n=16 HCP). The relevance of each PRO and the appropriateness (A) and feasibility (F) of the proposed PROM were assessed (Likert scale 1=strongly agree; 9=strongly disagree). The consensus was reached when at least 75% of the panelists rated it as ‘relevant’, ‘appropriate’, or ‘feasible’ (score 7-9). Results A total of 56 HCP [51.8% Hospital Pharmacy; 41.1% Oncology; 3.6% Nursing; and 3.6% Psycho-oncology; mean time in specialty 12.5 (8.0) years] and 10 AOC patients [mean time diagnosis 5.4 (3.0) years] participated in the 1st round. All PROs achieved consensus regarding their relevance, except dry skin (58.0%). Agreement was reached for PRO-CTCAE to be used to assess fatigue (A:84.9%; F:75.8%), neuropathy (A:92.4%; F:77.3%), diarrhea (A:87.9%; F:88.7%), constipation (A:86.4%; F:75.8%), nausea (A:89.4%; F:75.8%), insomnia (A:81.8%; F:88.7%), abdominal bloating (A:82.2%; F:82.2%) and sexuality (A:78.8%; F:88.6%); EQ-5D to determine patients’ HRQoL (A:87.9%; F:80.3%), pain (A:87.9%; F:75.8%) and mood (A:77.7%; F:85.5%); to assess treatment adherence the Morisky-Green (A:90.9%; F:84.9%) and the dispensing register (A:80.3%; F:80.3%) were chosen. It was agreed to note in the medical record whether the patient’s treatment preferences had been considered during decision-making (A:78.8%; F:78.8%) and to use a 5-point Likert scale to assess treatment satisfaction (A:86.4%; F:86.4%). Panelists agreed (A:92.4%; F: 77.3%) to collect these PROs (1) at the time of diagnosis/relapse; (2) one month after starting treatment/change therapeutic strategy; (3) every three months during the 1st-year of treatment; and later (4) every six months until treatment completion/change. Conclusions The consensus reached represents the first step towards including the patient’s perspective in AOC follow-up. The standardized collection of PROs in clinical practice may contribute to optimizing the follow-up of these patients and thus improving the quality of care.
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Affiliation(s)
| | - Elsa Bernal
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Casado
- Hospital Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Carlos Folguera
- Hospital Pharmacy, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Lucía González-Cortijo
- Breast and Gynecological Tumor Unit, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | | | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico san Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | - Ana Rosa Rubio
- Hospital Pharmacy, Hospital Universitario de Toledo, Toledo, Spain
| | | | | | | | - Eva Maria Guerra
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Gattrell WT, Hungin AP, Price A, Winchester CC, Tovey D, Hughes EL, van Zuuren EJ, Goldman K, Logullo P, Matheis R, Harrison N. ACCORD guideline for reporting consensus-based methods in biomedical research and clinical practice: a study protocol. Res Integr Peer Rev 2022; 7:3. [PMID: 35672782 PMCID: PMC9171734 DOI: 10.1186/s41073-022-00122-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/09/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Structured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus - for example, not clearly explaining the definition of consensus, or not stating how consensus group panellists were selected - can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner. METHODS The ACCORD (ACcurate COnsensus Reporting Document) project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration (E&E) document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice. DISCUSSION The ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes.
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Affiliation(s)
| | | | - Amy Price
- Stanford Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, CA, USA
| | | | - David Tovey
- Journal of Clinical Epidemiology, Sussex, UK
| | | | | | - Keith Goldman
- Global Medical Affairs, AbbVie, North Chicago, IL, USA
| | - Patricia Logullo
- Centre for Statistics in Medicine (CSM), University of Oxford, and EQUATOR Network UK Centre, Oxford, UK
| | - Robert Matheis
- International Society for Medical Publication Professionals, New York, NY, USA
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Usability, acceptability, and implementation strategies for the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm: a Delphi study. Support Care Cancer 2022; 30:7407-7418. [PMID: 35614154 DOI: 10.1007/s00520-022-07164-6] [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] [Received: 03/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Oncology guidelines recommend participation in cancer rehabilitation or exercise services (CR/ES) to optimize survivorship. Yet, connecting the right survivor, with the right CR/ES, at the right time remains a challenge. The Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm was developed to enhance CR/ES clinical decision-making and facilitate access to CR/ES. We used Delphi methodology to evaluate usability, acceptability, and determine pragmatic implementation priorities. METHODS Participants completed three online questionnaires including (1) simulated case vignettes, (2) 4-item acceptability questionnaire (0-5 pts), and (3) series of items to rank algorithm implementation priorities (potential users, platforms, strategies). To evaluate usability, we used Chi-squared test to compare frequency of accurate pre-exercise medical clearance and CR/ES triage recommendations for case vignettes when using EXCEEDS vs. without. We calculated mean acceptability and inter-rater agreement overall and in 4 domains. We used the Eisenhower Prioritization Method to evaluate implementation priorities. RESULTS Participants (N = 133) mostly represented the fields of rehabilitation (69%), oncology (25%), or exercise science (17%). When using EXCEEDS (vs. without), their recommendations were more likely to be guideline concordant for medical clearance (83.4% vs. 66.5%, X2 = 26.61, p < .0001) and CR/ES triage (60.9% vs. 51.1%, X2 = 73.79, p < .0001). Mean acceptability was M = 3.90 ± 0.47; inter-rater agreement was high for 3 of 4 domains. Implementation priorities include 1 potential user group, 2 platform types, and 9 implementation strategies. CONCLUSION This study demonstrates the EXCEEDS algorithm can be a pragmatic and acceptable clinical decision support tool for CR/ES recommendations. Future research is needed to evaluate algorithm usability and acceptability in real-world clinical pathways.
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Woodcock E. Barriers and Facilitators to Automated Self-Scheduling: Consensus from a Delphi Panel of Key Stakeholders. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1m. [PMID: 35440921 PMCID: PMC9013230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Automated self-scheduling may benefit healthcare organizations, yet uptake has been slow. The aim of this study was to develop a consensus statement regarding the organizational-level determinants of implementation success based on the collective knowledge of experts. A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by healthcare organizations. A panel of 53 experts representing 41 academic health systems identified barriers and facilitators involving the organization's inner and outing settings, as well as the characteristics of the intervention and the individuals engaged in the solution. Offering convenience for patients is the leading enabler for organizations to implement the technology. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact. OBJECTIVE The aim of this study was to develop a consensus statement regarding the determinants of implementation success based on the collective knowledge of experts working in the field. METHODS A Delphi panel was constructed based on selected participants employed by academic health systems and experienced with self-scheduling implementation. Panelists were recruited based on participation in an educational event that featured the topic. Purposive and snowball sampling were used. Panelists participated in surveys collected over three rounds. An 80 percent agreement among panelists and interquartile range (IQR) <1 determined the barriers and facilitators. The top-10 determinants were presented in rank order. RESULTS Between January 6, 2021, and May 26, 2021, 53 panelists representing 41 academic health systems participated in three rounds of surveys to reach consensus on the barriers and facilitators to implementation of self-scheduling by healthcare organizations in the United States. In round one, panelists documented 530 determinants. In round two, the determinants were grouped into 72 barriers and 85 facilitators, each of which participants rated on a five-point Likert scale. Fifteen determinants met the 80 percent threshold and 1.0 IQR. The final round concluded with a top-10, rank-ordered listing of determinants (seven facilitators and three barriers) that also incorporated a median rating score using five-point Likert scale. CONCLUSION A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by academic health systems. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact.
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Pommée T, Balaguer M, Mauclair J, Pinquier J, Woisard V. Intelligibility and comprehensibility: A Delphi consensus study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:21-41. [PMID: 34558145 DOI: 10.1111/1460-6984.12672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. AIMS To draw up a more consensual definition of intelligibility and comprehensibility and to define which assessment methods relate to both concepts, as part of their definition. METHODS & PROCEDURES A three-round modified Delphi consensus study was carried out among clinicians, researchers and lecturers engaged in activities in speech disorders. OUTCOMES & RESULTS Forty international experts from different fields (mainly clinicians, linguists and computer scientists) participated in the elaboration of a comprehensive definition of intelligibility and comprehensibility and their assessment. While both concepts are linked and contribute to functional human communication, they relate to two different reconstruction levels of the transmitted speech material. Intelligibility refers to the acoustic-phonetic decoding of the utterance, while comprehensibility relates to the reconstruction of the meaning of the message. Consequently, the perceptual assessment of intelligibility requires the use of unpredictable speech material (pseudo-words, minimal word pairs, unpredictable sentences), whereas comprehensibility assessment is meaning and context related and entails more functional speech stimuli and tasks. CONCLUSION & IMPLICATIONS This consensus study provides the scientific and clinical communities with a better understanding of intelligibility and comprehensibility. A comprehensive definition was drafted, including specifications regarding the tasks that best fit their assessment. The outcome has implications for both clinical practice and scientific research, as the disambiguation improves communication between professionals and thereby increases the efficiency of patient assessment and care and benefits the progress of research as well as research translation. WHAT THIS PAPER ADDS What is already known on the subject Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. What this paper adds to existing knowledge This consensus study allowed for a more consensual and comprehensive definition of intelligibility and comprehensibility and their assessment, for clinicians and researchers. The terminological disambiguation helps to improve communication between experts in the field of speech disorders and thereby benefits the progress of research as well as research translation. What are the potential or actual clinical implications of this work? Unambiguous communication between professionals, for example, in a multidisciplinary team, allows for the improvement in the efficiency of patient care. Furthermore, this study allowed the assessment tasks that best fit the definition of both intelligibility and comprehensibility to be specified, thereby providing valuable information to improve speech disorder assessment and its standardization.
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Affiliation(s)
- Timothy Pommée
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Mathieu Balaguer
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
- ENT Department, University Hospital of Toulouse Larrey, Toulouse, France
| | - Julie Mauclair
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Julien Pinquier
- IRIT, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Virginie Woisard
- ENT Department, University Hospital of Toulouse Larrey, Toulouse, France
- Oncorehabilitation Unit, University Cancer Institute of Toulouse Oncopole, Toulouse, France
- Laboratoire Octogone Lordat, Jean Jaurès University Toulouse II, Toulouse, France
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Veeranki SP, Pednekar P, Graf M, Tuly R, Recht M, Batt K. A Delphi Consensus Approach for Difficult-to-Treat Patients with Severe Hemophilia A without Inhibitors. J Blood Med 2021; 12:913-928. [PMID: 34707422 PMCID: PMC8544791 DOI: 10.2147/jbm.s334852] [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: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction Over the past decade, there has been an increase in novel therapeutic options to treat hemophilia A. It is still unclear how these novel treatments are used in the management of patients with hemophilia A, particularly those with challenging clinical scenarios who are typically excluded in clinical trials. Purpose This study aimed to understand the areas of consensus and disagreement among hematologists regarding the preferences toward therapeutic approaches for difficult-to-treat patients with severe hemophilia A without inhibitors. Patients and Methods During February-June 2020, a three-round modified Delphi study was conducted to generate consensus among 13 US experts in the field of hemophilia. Experts were asked about their preferences toward therapeutic options for patients with challenging clinical situations, including age-related morbidities (eg, myocardial infarction, joint arthropathy), increasing demand for high-impact physical activities, early onset osteoporosis, and newborns with hemophilia A. Consensus was defined as ≥75% agreement between the panelists. Results Consensus was reached on many, but not all cases, leaving uncertainty about appropriateness of therapeutic approaches for some patients where clinical evidence is not available or driven by physicians' or patients' preferences toward therapeutic options. A majority of panelists preferred FVIII replacement therapy rather than emicizumab prophylaxis for the challenging cases presented due to established evidence on safety, efficacy, and level of bleed protection for FVIII treatment. Conclusion Recommendations emerging from this study may help guide practicing hematologists in the management of challenging hemophilia A cases. Future studies are needed to address treatment options in the clinical cases where no consensus was reached.
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Affiliation(s)
| | | | | | | | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, NY, USA.,The Hemophilia Center, Oregon Health & Science University, Portland, OR, USA
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Krikheli L, Carey LB, Erickson S, Carey-Sargeant CL, Ann Mathisen B. Recommendations for speech-language pathologists in paediatric palliative care teams (ReSP 3CT): An international modified Delphi study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:486-496. [PMID: 33625295 DOI: 10.1080/17549507.2020.1866073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: There is emerging recognition within the literature that speech-language pathologists (SLPs) have a role in the provision of paediatric palliative care (PPC). SLPs, however, experience unique challenges when working with this vulnerable young cohort of patients, their families and multidisciplinary teams. This study aims to develop practice recommendations based on best available evidence.Method: A modified Delphi technique was utilised to develop group consensus over a series of survey rounds. Statements for voting were synthesised by critically reviewing recurring themes from previous studies, involving (i) a scoping literature review, (ii) an online survey, and (iii) interview data. Nine participants were recruited using consecutive sampling from the interview phase related to this study.Result: Twenty-one statements were voted upon over two survey rounds (100% response rate). Agreement levels of ≥70% across all statements were reached after the first round. There was a significant correlation between rating a statement as "essential" and a strong level of agreement (p < 0.0001). Intraparticipant agreement between rounds is also reported.Conclusion: The 21 statements form Recommendations for Speech-Language Pathologists in Paediatric Palliative Care Teams (ReSP3CT). The statements will support SLPs working within PPC to promote advocacy, professional development and enhance team involvement in this developing field.
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Affiliation(s)
- Lillian Krikheli
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Lindsay Brian Carey
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Shane Erickson
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christa Lynn Carey-Sargeant
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
- School of Audiology and Speech Pathology, Faculty of Dentistry, Medicine and Health Sciences, University of Melbourne, Parkville, Victoria, Australia, and
| | - Bernice Ann Mathisen
- Discipline of Speech Pathology, School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia
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Morris ME, Brusco N, Woods J, Myles PS, Hodge A, Jones C, Lloyd D, Rovtar V, Clifford A, Atkinson V. Protocol for implementation of the 'AusPROM' recommendations for elective surgery patients: a mixed-methods cohort study. BMJ Open 2021; 11:e049937. [PMID: 34531213 PMCID: PMC8449982 DOI: 10.1136/bmjopen-2021-049937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Incorporating patient-reported outcome measures (PROMs) into usual care in hospitals can improve safety and quality. Gaps exist in electronic PROM (ePROM) implementation recommendations, including for elective surgery. The aims are to: (1) understand barriers and enablers to ePROM implementation in hospitals and develop Australian ePROM implementation recommendations (AusPROM); (2) test the feasibility and acceptability of the Quality of Recovery 15 item short-form (QoR-15) PROM for elective surgery patients applying the AusPROM and (3) establish if the QoR-15 PROM has concurrent validity with the EQ-5D-5L. METHODS AND ANALYSIS Phase I will identify staff barriers and facilitators for the implementation of the AusPROM recommendations using a Delphi technique. Phase II will determine QoR-15 acceptability for elective surgery patients across four pilot hospitals, using the AusPROM recommendations. For phase II, in addition to a consumer focus group, patients will complete brief acceptability surveys, incorporating the QoR-15, in the week prior to surgery, in the week following surgery and 4 weeks postsurgery. The primary endpoint will be 4 weeks postsurgery. Phase III will be the national implementation of the AusPROM (29 hospitals) and the concurrent validity of the QoR-15 and generic EQ-5D-5L. This protocol adopts the Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trials Protocols guidelines. ETHICS AND DISSEMINATION The results will be disseminated via public forums, conferences and peer-reviewed journals. Ethics approval: La Trobe University (HEC20479). TRIAL REGISTRATION NUMBER ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III).
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Affiliation(s)
- Meg E Morris
- Victorian Rehabilitation Centre, Healthscope Limited, Melbourne, Victoria, Australia
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, Victoria, Australia
| | - Natasha Brusco
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Woods
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Paul S Myles
- Anaesthesia and Perioperative Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anita Hodge
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Cathy Jones
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Damien Lloyd
- Healthscope Limited, Melbourne, Victoria, Australia
| | | | - Amanda Clifford
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Gambardella A, Tinuper P, Acone B, Bonanni P, Coppola G, Perucca E. Selection of antiseizure medications for first add-on use: A consensus paper. Epilepsy Behav 2021; 122:108087. [PMID: 34175662 DOI: 10.1016/j.yebeh.2021.108087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION When monotherapy used alone or sequentially fails to achieve seizure control, a trial of combination therapy may be considered. OBJECTIVE To define optimal criteria to guide choice of an antiseizure medication (ASM) for use as first add-on. METHODS A standardized Delphi procedure was applied to produce a list of consensus statements. First, an Expert Board consisting of 5 epileptologists agreed on a set of 46 statements relevant to the objective. The statements were then finalized through an iterative process by a Delphi Panel of 84 Italian pediatric and adult neurologists with expertise in the management of epilepsy. Panel members provided anonymous ratings of their level of agreement with each statement on a 9-point Likert scale. RESULTS Consensus, defined as agreement by at least 80% of Panel members, was reached for 36 statements. Medication-related factors considered to be important for drug selection included efficacy, tolerability and safety, interaction potential, mechanism of action, and ease of use. The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized. CONCLUSIONS Choice of an ASM for first add-on requires consideration of many factors, many of which also apply to choose initial treatment. Factors more specifically relevant to add-on use include drug interaction potential and the preference for an ASM with a different mechanism of action.
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Affiliation(s)
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Paolo Bonanni
- IRCCS Eugenio Medea Scientific Institute, Epilepsy Unit, Conegliano, Italy
| | - Giangennaro Coppola
- Department of Medicine, Surgery, Odontoiatry, Medical School of Salerno, University of Salerno, Italy
| | - Emilio Perucca
- Division of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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Gondi S, Ellis S, Gupta M, Ellerbeck E, Richter K, Burns J, Gupta A. Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study. PLoS One 2021; 16:e0255578. [PMID: 34415946 PMCID: PMC8378703 DOI: 10.1371/journal.pone.0255578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. METHODS We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. RESULTS All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. CONCLUSION PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.
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Affiliation(s)
- Saahith Gondi
- Department of Biology, Wake Forest University, Winston-Salem, NC, United States of America
| | - Shellie Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Mallika Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Kimber Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jeffrey Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
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Meershoek AJA, de Waard DD, Trappenburg J, Zeebregts CJ, Bulbulia R, Kappelle JLJ, de Borst GJ. Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study. Eur J Vasc Endovasc Surg 2021; 62:350-357. [PMID: 34312072 DOI: 10.1016/j.ejvs.2021.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/16/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE No dedicated studies have been performed on the optimal management of patients with an acute stroke related to carotid intervention nor is there a solid recommendation given in the European Society for Vascular Surgery guideline. By implementation of an international expert Delphi panel, this study aimed to obtain expert consensus on the optimal management of in hospital stroke occurring during or following CEA and to provide a practical treatment decision tree. METHODS A four round Delphi consensus study was performed including 31 experts. The aim of the first round was to investigate whether the conceptual model indicating the traditional division between intra- and post-procedural stroke in six phases was appropriate, and to identify relevant clinical responses during these six phases. In rounds 2, 3, and 4, the aim was to obtain consensus on the optimal response to stroke in each predefined setting. Consensus was reached in rounds 1, 3, and 4 when ≥ 70% of experts agreed on the preferred clinical response and in round 2 based on a Likert scale when a median of 7 - 9 (most adequate response) was given, IQR ≤ 2. RESULTS The experts agreed (> 80%) on the use of the conceptual model. Stroke laterality and type of anaesthesia were included in the treatment algorithm. Consensus was reached in 17 of 21 scenarios (> 80%). Perform diagnostics first for a contralateral stroke in any phase, and for an ipsilateral stroke during cross clamping, or apparent stroke after leaving the operation room. For an ipsilateral stroke during the wake up phase, no formal consensus was achieved, but 65% of the experts would perform diagnostics first. A CT brain combined with a CTA or duplex ultrasound of the carotid arteries should be performed. For an ipsilateral intra-operative stroke after flow restoration, the carotid artery should be re-explored immediately (75%). CONCLUSION In patients having a stroke following carotid endarterectomy, expedited diagnostics should be performed initially in most phases. In patients who experience an ipsilateral intra-operative stroke following carotid clamp release, immediate re-exploration of the index carotid artery is recommended.
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Affiliation(s)
- Armelle J A Meershoek
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, the Netherlands
| | - Djurre D de Waard
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, the Netherlands
| | - Jaap Trappenburg
- Julius Centre for Health Sciences and Primary Care, Utrecht University, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, the Netherlands
| | | | - Jaap L J Kappelle
- Department of Neurology, University Medical Centre Utrecht, Utrecht University, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, the Netherlands.
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Niederberger M, Köberich S. Coming to consensus: the Delphi technique. Eur J Cardiovasc Nurs 2021; 20:692-695. [PMID: 34245253 DOI: 10.1093/eurjcn/zvab059] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
Delphi techniques are used in health care and nursing to systematically bring together explicit and implicit knowledge from experts with a research or practical background, often with the goal of reaching a group consensus. Consensus standards and findings are important for promoting the exchange of information and ideas on an interdisciplinary and transdisciplinary basis, and for guaranteeing comparable procedures in diagnostic and therapeutic approaches. Yet, the development of consensus standards using Delphi techniques is challenging because it is dependent on the willingness of experts to participate and the statistical definition of consensus.
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Affiliation(s)
- Marlen Niederberger
- Department of Research Methods in Health Promotion and Prevention, University of Education Schwaebisch Gmuend, Schwäbisch, Gmünd, Germany
| | - Stefan Köberich
- Nursing Direction, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Dey T, Ononge S, Weeks A, Benova L. Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016. BMJ Glob Health 2021; 6:bmjgh-2020-004230. [PMID: 33888487 PMCID: PMC8070850 DOI: 10.1136/bmjgh-2020-004230] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Progress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016. Methods We analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care. Results Data from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64). Conclusion In Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.
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Affiliation(s)
- Teesta Dey
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Sam Ononge
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - Andrew Weeks
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Development of an Assessment Tool of Menstrual-Cycle-Related Signs and Symptoms Based on Thai Traditional Medicine Principles for Evaluation of Women's Health. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9977773. [PMID: 34093723 PMCID: PMC8163529 DOI: 10.1155/2021/9977773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Background Utilization of Thai traditional medicine (TTM) was considered in menstrual-cycle-related signs and symptoms (MCSs) to evaluate women's health. TTM clinicians diagnosed the MCSs by signs, symptoms, and associated factors of patients including a physical examination to find patterns of imbalance elements and the origin of the disorder to optimize treatment. Thus, the purpose of this study was to develop a new assessment tool, the menstrual-cycle-related signs and symptoms questionnaire (MCSQ) based on TTM principles for evaluation of women's menstrual health. Methods The items and components of the MCSQ were adjusted by TTM expert consensus using the Delphi technique. The content validity of the MCSQ was quantified by the content validity index (CVI). MCSQ were examined by construct validity and internal consistency reliability using exploratory factor analysis (EFA) and Cronbach's α coefficient, respectively. Results : All 19 experts (100%) responded to the questionnaires in the three rounds of the Delphi technique. The MCSQ showed high content validity of individual items (I-CVI = 0.83-1.00) and high overall content validity of the questionnaire (S-CVI/AVE = 0.98). Overall, 429 of 432 participants completed the questionnaire (99.31%). After factor analysis, the final MCSQ was divided into two sections, which consisted of 49 items. The first had 23 items focusing on the MCSs. And, the second had 14 items of personal and medical data including 12 items of associated factors. Cronbach's α coefficient of the final MCSQ was 0.87, and that of each component was between 0.32 and 0.82. Conclusions This study reports a new MCS questionnaire tool, which was developed from TTM knowledge to evaluate women's health. This questionnaire showed an acceptable level of validity and reliability. Thus, it is also expected to be useful in clinical practice and ongoing research on evaluation of women's health.
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Ekawati FM, Licqurish S, Gunn J, Brennecke S, Lau P. Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings. BMC Pregnancy Childbirth 2021; 21:269. [PMID: 33794799 PMCID: PMC8017638 DOI: 10.1186/s12884-021-03735-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03735-3.
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Affiliation(s)
- Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia. .,Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia
| | - Shaun Brennecke
- University of Melbourne Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia.,Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia
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Tchouaket Nguemeleu E, Boivin S, Robins S, Sia D, Kilpatrick K, Brousseau S, Dubreuil B, Larouche C, Parisien N. Development and validation of a time and motion guide to assess the costs of prevention and control interventions for nosocomial infections: A Delphi method among experts. PLoS One 2020; 15:e0242212. [PMID: 33180833 PMCID: PMC7660509 DOI: 10.1371/journal.pone.0242212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.
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Affiliation(s)
| | - Sandra Boivin
- Centre Intégré de Santé et de Services de Sociaux des Laurentides, Direction de la Santé Publique, Saint-Jérôme, Québec, Canada
| | - Stephanie Robins
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Drissa Sia
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sylvain Brousseau
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Bruno Dubreuil
- Institut de Cardiologie, Montreal Heart Institute, Montréal, Québec, Canada
| | - Catherine Larouche
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay, Lac-Saint-Jean, Québec, Canada
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Niederberger M, Spranger J. Delphi Technique in Health Sciences: A Map. Front Public Health 2020; 8:457. [PMID: 33072683 PMCID: PMC7536299 DOI: 10.3389/fpubh.2020.00457] [Citation(s) in RCA: 335] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives: In health sciences, the Delphi technique is primarily used by researchers when the available knowledge is incomplete or subject to uncertainty and other methods that provide higher levels of evidence cannot be used. The aim is to collect expert-based judgments and often to use them to identify consensus. In this map, we provide an overview of the fields of application for Delphi techniques in health sciences in this map and discuss the processes used and the quality of the findings. We use systematic reviews of Delphi techniques for the map, summarize their findings and examine them from a methodological perspective. Methods: Twelve systematic reviews of Delphi techniques from different sectors of the health sciences were identified and systematically analyzed. Results: The 12 systematic reviews show, that Delphi studies are typically carried out in two to three rounds with a deliberately selected panel of experts. A large number of modifications to the Delphi technique have now been developed. Significant weaknesses exist in the quality of the reporting. Conclusion: Based on the results, there is a need for clarification with regard to the methodological approaches of Delphi techniques, also with respect to any modification. Criteria for evaluating the quality of their execution and reporting also appear to be necessary. However, it should be noted that we cannot make any statements about the quality of execution of the Delphi studies but rather our results are exclusively based on the reported findings of the systematic reviews.
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Affiliation(s)
- Marlen Niederberger
- Department of Research Methods in Health Promotion and Prevention, University of Education Schwaebisch Gmuend, Schwäbisch Gmünd, Germany
| | - Julia Spranger
- Department of Research Methods in Health Promotion and Prevention, University of Education Schwaebisch Gmuend, Schwäbisch Gmünd, Germany
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Hatakeyama Y, Fujita S, Iida S, Nagai Y, Shimamori Y, Ayuzawa J, Hirao T, Onishi R, Seto K, Matsumoto K, Hasegawa T. Prioritization of patient safety health policies: Delphi survey using patient safety experts in Japan. PLoS One 2020; 15:e0239179. [PMID: 32941481 PMCID: PMC7497979 DOI: 10.1371/journal.pone.0239179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 09/01/2020] [Indexed: 11/19/2022] Open
Abstract
Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. “Human resources interventions,” “professional education and training,” “medication management/reconciliation protocols,” “pay-for performance (P4P) schemes and financing for safety,” “digital technology solutions to improve safety,” and “hand hygiene initiatives” were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (β = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.
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Affiliation(s)
| | | | - Shuhei Iida
- All Japan Hospital Association, Tokyo, Japan
- Nerima General Hospital, Tokyo, Japan
- Institute for Healthcare Quality Improvement, Tokyo Healthcare Foundation, Tokyo, Japan
| | - Yoji Nagai
- All Japan Hospital Association, Tokyo, Japan
- Hitachinaka General Hospital, Hitachinaka, Ibaraki, Japan
| | | | - Junko Ayuzawa
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Hirao
- Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Ryo Onishi
- Toho University School of Medicine, Tokyo, Japan
| | - Kanako Seto
- Toho University School of Medicine, Tokyo, Japan
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Development of Key Performance Indicators for Capturing Impact of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: A Delphi Consensus Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7527543. [PMID: 32714418 PMCID: PMC7334769 DOI: 10.1155/2020/7527543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Background The current study was performed to develop a consensus-based core inventory of key performance indicators (KPIs) to be used in capturing the impact of pharmaceutical care in healthcare facilities that employ integrative medicine paradigm in Palestine. Methods A panel of healthcare professionals and risk/quality assurance managers was composed employing a judgmental sampling technique. The study tool was a questionnaire. Views and opinions of the panelists on the roles of pharmacists in caring for patients admitted to or visiting healthcare facilities that employ integrative medicine were collected using 11 statements. An initial inventory of activities and services that potentially can be used as KPIs was compiled from the literature and interviews with key contact experts in the domain. Three iterative Delphi rounds were conducted among the panelists (n = 50) to achieve formal consensus on the KPIs that should be used. The consensus-based KPIs were ordered by the scores of the panelists. Results A total of 8 consensus-based KPIs were developed. The KPIs related to the number of problems related to medications and complementary and alternative medicine (CAM) that were resolved by pharmacists and CAM practitioners (p < 0.0001), number of patients for whom reconciliations were documented (p < 0.0001), number of patients receiving direct, comprehensive, and/or collaborative care (p < 0.0001), and number of patients for whom pharmacists and CAM practitioners were involved in implementing a therapeutic plan (p < 0.05) were rated significantly higher than the KPI (#8) related to the participation in multi-healthcare provider discussions/deliberations. Conclusions Consensus-based KPIs that can be used in capturing the impact of evidence-based CAM and pharmaceutical care of patients in healthcare facilities that employ integrative medicine paradigm were developed. Future studies are still needed to investigate if implementing these KPIs might promote evidence-based CAM and pharmaceutical care in healthcare facilities that employ the integrative medicine paradigm.
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Varndell W, Fry M, Lutze M, Elliott D. Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review. Int Emerg Nurs 2020; 56:100867. [PMID: 32238322 DOI: 10.1016/j.ienj.2020.100867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
AIM To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice. BACKGROUND Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined. DESIGN Systematic literature review. DATABASES AND DATA TREATMENT A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review. RESULTS Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied. CONCLUSION Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick 2031, NSW, Australia; Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Director Research and Practice Development Nursing and Midwifery Directorate NSLHD, Level 7 Kolling Building, Royal North Shore Hospital, St Leonards 2065, NSW, Australia.
| | - Matthew Lutze
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Nursing Practice and Informatics, NSW Ministry of Health, St Leonards 2065, NSW, Australia; School of Nursing, University of Sydney, Camperdown 2050, NSW, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
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A Theoretical Research Framework of Future Sustainable Urban Freight Transport for Smart Cities. SUSTAINABILITY 2020. [DOI: 10.3390/su12051975] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This paper aims to construct a theoretical research framework for sustainable urban freight transport (SUFT) from the perspectives of future urban development and distribution innovations, and appropriate research methods are discussed, as well. Urban freight transport plays a critical role in the promotion of sustainable and livable cities. According to the literature review, considerable research on SUFT has focused on resolving some specific problems with a short-term perspective. The existence of an urban freight transport strategy is noted, which should be embedded in an overall sustainable development strategy with a long-term perspective (approximately 20–30 years). Nevertheless, considerable research has paid scant attention to the long-term planning of SUFT. Given this, this paper contributes to the closure of this gap. First, this paper presents a systematic literature review (SLR) to highlight published papers involving foresight research within the past 16 years (2003–2018). This step contributes to the understanding of research methods that can be used in foresight research. Subsequently, this paper discusses the impacts of both urban development and distribution innovations on future SUFT, and these effects are used to select the appropriate methods to construct the theoretical research framework. Finally, the theoretical research framework of long-term planning for SUFT is developed on the basis of two future perspectives: the trends of urban development and the application of urban distribution innovations. This framework is intended to provide an approach to designing sustainable urban logistics, taking into account urban development and distribution innovations.
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Williams MT, Lewthwaite H, Brooks D, Jensen D, Abdallah SJ, Johnston KN. Chronic Breathlessness Explanations and Research Priorities: Findings From an International Delphi Survey. J Pain Symptom Manage 2020; 59:310-319.e12. [PMID: 31655188 DOI: 10.1016/j.jpainsymman.2019.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Explanations provided by health professionals may underpin helpful or harmful symptom beliefs and expectations of people living with chronic breathlessness. OBJECTIVES This study sought perspectives from health professionals with clinical/research expertise in chronic breathlessness on priority issues in chronic breathlessness explanations and research. METHODS Authors (n = 74) of publications specific to chronic breathlessness were invited to a three-round Delphi survey. Responses to open-ended questions (Round 1 "What is important to: include/avoid when explaining chronic breathlessness; prioritize in research?") were transformed to Likert scale (1-9) items for rating in subsequent rounds. A priori consensus was defined as ≥70% of respondents rating an item as important (Likert rating 7-9) and interquartile range ≤2. RESULTS Of the 31 Round 1 respondents (nine countries, five professional disciplines), 24 (77%) completed Rounds 2 and 3. Sixty-three items met consensus (include n = 28; avoid n = 9; research n = 26). Explanations of chronic breathlessness should use patient-centered communication; acknowledge the distress, variability, and importance of this sensation; emphasize current management principles; clarify maladaptive beliefs and expectations; and avoid moral culpability and inappropriate reassurance. Research priorities included the need 1) for a comprehensive understanding of breathlessness science; 2) to optimize, explore, and develop effective interventions, both pharmacological and nonpharmacological; and 3) determine effective models of care including strategies for education and training of health professionals and people caring for, or living with, chronic breathlessness. CONCLUSION These consensus-based concepts for chronic breathlessness explanations and research provide a starting point for conversations between patients, carers, clinicians, and researchers within the chronic breathlessness community.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation And Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Hayley Lewthwaite
- Innovation, Implementation And Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, Canada
| | - Sara J Abdallah
- Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, Canada
| | - Kylie N Johnston
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Jiang Q, Zeng W, Yu J, Liu H, Mao M, Li Y. Development of the First Value Assessment Index System for Off-Label Use of Antineoplastic Agents in China: A Delphi Study. Front Pharmacol 2020; 11:771. [PMID: 32612526 PMCID: PMC7308466 DOI: 10.3389/fphar.2020.00771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To develop the first value assessment index system for off-label use of antineoplastic agents in China. METHODS A modified two-round Delphi method was employed to establish consensus within a field to reach agreement via a questionnaire or doing interview among a multidisciplinary panel of experts by collecting their feedback to inform the next round, exchanging their individual knowledge, experience, and opinions anonymously, and resolving uncertainties. RESULTS Expert's positive coefficient was 94.74% in the first round and 100.00% in the second round. In the first round, expert's authority coefficient for a majority of 61 indicators was ≥ 0.80 (85.2%, ranging from 0.70 to 0.89, mean=0.84) and coefficient of variation for all the 61 indicators was ≥ 22% (ranging from 11.67% to 21.74%, mean=17.4%). In two rounds, the mean expert's authority coefficient raised to 0.85 (ranging from 0.75 to 0.90), and coefficient of variation for all indicators was < 20% (ranging from 10.49% to 19.71%, mean=15.97%). The P-values of Kendall's W test were all < 0.001 for each round. At the end of two rounds, W-value for concordance was 0.395 (χ2=347.494, P<0.0001). The final value assessment index system comprised of eight domains, 21 subdomains, and 56 indicators. The weight and combination weight of each domain were 0.4211 for therapeutic value, 0.1678 for source and type of evidence, 0.0961 for public feedback/comments, 0.0894 for novelty in drug discovery, 0.0689 for grading of evidence recommendation, 0.0578 for consistency of evidence results, 0.0561 for disease burden, and 0.0428 for ratio of composition/integration. CONCLUSION Use of Delphi method to develop the proposed value assessment index system was found scientific and credible. This value assessment index system is highly appropriate for off-label use of antineoplastic agents in China.
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Affiliation(s)
- Qian Jiang
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zeng
- Department of Chronic Disease Prevention, Chengdu Center for Diseases Control and Prevention, Chengdu, China
| | - Jiajie Yu
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Liu
- Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mian Mao
- Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Youping Li
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Youping Li,
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Shawahna R. Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study. BMC Med Inform Decis Mak 2019; 19:216. [PMID: 31703675 PMCID: PMC6842153 DOI: 10.1186/s12911-019-0928-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs. METHODS A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process. RESULTS Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient's identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis. CONCLUSIONS In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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