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Krastman P, Kraan G, van Kooij YE, Bierma-Zeinstra SMA, Runhaar J. Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study. J Hand Ther 2024:S0894-1130(23)00174-6. [PMID: 38360484 DOI: 10.1016/j.jht.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited. PURPOSE To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints. STUDY DESIGN An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed. METHODS In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario. RESULTS Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain. CONCLUSIONS This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Gerald Kraan
- Department of Orthopedic Surgery, Reinier de Graaf Groep, Delft, the Netherlands.
| | - Yara E van Kooij
- Xpert Handtherapie, Xpert Clinics, Zeist, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Zhou J, Zhang F, Wang H, Yin Y, Wang Q, Yang L, Dong B, Yuan J, Liu S, Zhao L, Luo W. Quality and efficiency of a standardized e-handover system for pediatric nursing: A prospective interventional study. J Nurs Manag 2022; 30:3714-3725. [PMID: 35066952 DOI: 10.1111/jonm.13549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 12/30/2022]
Abstract
AIM This study examined the effect on pediatric nursing handover quality and efficiency when a standardized e-handover system was implemented. BACKGROUND Handover quality is an important aspect of nursing quality management; however, handover quality among nursing staff is poor. METHODS A prospective interventional study was carried out in a general pediatrics ward from December 2019 to November 2020. The tools included a standardized e-handover system. The intervention strategies included workflow remodeling and employee training on oral handover using the standardized e-handover system. RESULTS The omission frequency of critical handover elements decreased from 47.32% to 2.94% (p < .01), among which the omission frequencies of nine out of 16 key elements significantly decreased. Integrity also showed improvement. Specifically, the integrity of five types of critical information was significantly improved, including vital signs, signs and symptoms, laboratory test results, radiologic examination results, and treatment regimen (2.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 5.00 vs. 5.00, p = .009; 3.00 vs. 4.00, p < .01, respectively). Information accuracy was 100%. Workflow and efficiency significantly improved, communication duration with patient/family during work hours significantly increased (24.00 vs. 56.00, p < .01), and prehandover preparation duration significantly decreased (32.00 vs. 2.50, p < .01). Nurse handover satisfaction showed improvement (56.88 ± 15.08 vs. 74.31 ± 9.22, p < .01). CONCLUSION The standardized e-handover system effectively improved nurse handover quality, optimized workflow, increased work efficiency, and promoted teamwork. IMPLICATIONS FOR NURSING MANAGEMENT Standardized e-handover systems have great potential for ensuring the safety of pediatric patients and improving the quality of handover.
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Affiliation(s)
- Jiali Zhou
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Fen Zhang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Hansong Wang
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China.,Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Qian Wang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Lihua Yang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Bin Dong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Jiajun Yuan
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Shijian Liu
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Wenyi Luo
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
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Hunter KE, Webster AC, Clarke M, Page MJ, Libesman S, Godolphin PJ, Aberoumand M, Rydzewska LHM, Wang R, Tan AC, Li W, Mol BW, Willson M, Brown V, Palacios T, Seidler AL. Development of a checklist of standard items for processing individual participant data from randomised trials for meta-analyses: Protocol for a modified e-Delphi study. PLoS One 2022; 17:e0275893. [PMID: 36219622 PMCID: PMC9553056 DOI: 10.1371/journal.pone.0275893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Individual participant data meta-analyses enable detailed checking of data quality and more complex analyses than standard study-level synthesis of summary data based on publications. However, there is limited existing guidance on the specific systematic checks that should be undertaken to confirm and enhance data quality for individual participant data meta-analyses and how to conduct these checks. We aim to address this gap by developing a checklist of items for data quality checking and cleaning to be applied to individual participant data meta-analyses of randomised trials. This study will comprise three phases: 1) a scoping review to identify potential checklist items; 2) two e-Delphi survey rounds among an invited panel of experts followed by a consensus meeting; and 3) pilot testing and refinement of the checklist, including development of an accompanying R-markdown program to facilitate its uptake.
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Affiliation(s)
- Kylie E. Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
| | - Angela C. Webster
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Matthew J. Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sol Libesman
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter J. Godolphin
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Mason Aberoumand
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Aidan C. Tan
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Melina Willson
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Talia Palacios
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Chung JYS, Li WHC, Ho LLK, Cheung AT, Chung JOK. Newly graduate nurse perception and experience of clinical handover. NURSE EDUCATION TODAY 2021; 97:104693. [PMID: 33278730 DOI: 10.1016/j.nedt.2020.104693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/14/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Clinical handover is challenging for newly graduated nurses. Previous studies have showed that many new graduates perform handover ineffectively and unsystematically; however, our knowledge of newly graduated nurse perceptions of handover, including barriers and challenges to handover, is incomplete. OBJECTIVES The study aimed to explore newly graduated nurse experience of clinical handover in Hong Kong public hospitals. DESIGN This was a descriptive phenomenological study. SETTING Participants were recruited from 11 public acute care hospitals in Hong Kong. PARTICIPANTS The participants were a convenience sample of 20 nurses who had graduated within the previous 12 months. METHODS Individual semi-structured interviews were conducted, and the data were analysed using content analysis. RESULTS Three themes emerged from the data: 'significance of clinical handovers,' 'feelings of frustration about clinical handover,' and 'perceived barriers to handover.' Participants perceived clinical handover as an essential nursing practice in the provision of continuous patient care. Further, some new graduates experienced stress and anxiety in clinical handover, which severely affected their quality of life. Perceived barriers to handover included inadequate professional judgement, poor ability to synthesize the important information, and unsystematic reporting. CONCLUSIONS Newly graduated nurses face challenges and encounter difficulties in performing clinical handover. Handover theory and, in particular, skills training should be introduced into the undergraduate nursing curriculum, to arm students with the confidence and competence to perform appropriate clinical handover.
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Affiliation(s)
- Jessie Yuk Seng Chung
- School of Nursing and Health Studies, The Open University of Hong Kong, Room C0925, The Open University of Hong Kong, 30 Good Shepherd Street, Ho Man Tin, Kowloon, Hong Kong.
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, HKSAR, 4/F, William WM Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, HKSAR, 4/F, William WM Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, HKSAR, 4/F, William WM Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Tacchini-Jacquier N, Hertzog H, Ambord K, Urben P, Turini P, Verloo H. An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study. JMIR Nurs 2020; 3:e17876. [PMID: 34345783 PMCID: PMC8279455 DOI: 10.2196/17876] [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: 01/17/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. OBJECTIVE This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. METHODS We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion. RESULTS The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. CONCLUSIONS This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland.
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Affiliation(s)
| | | | | | | | | | - Henk Verloo
- Valais Hospital Sion Switzerland
- Haute École Spécialisée Suisse orientale HES-SO Valais / Wallis Sion Switzerland
- Service of Old Age Psychiatry University Hospital of Lausanne Prilly Switzerland
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