The Delphi method and health research

Are we out of the woods yet? Youth-developed recommendations on recovery from the COVID-19 pandemic: A national Delphi study

OBJECTIVES

To generate concrete, youth-derived recommendations to support Canada's post-pandemic recovery from COVID-19 to support youth mental health and substance use (MHSU), economic, and educational recovery.

METHODS

Using a virtual, modified Delphi, participants rated recommendation items over three rounds, with the option to create their own recommendation items. A priori consensus was defined as ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rating items at a 6 or 7 (on a 7-point Likert scale). Items were dropped in subsequent rounds if they did not achieve consensus. Qualitative responses were analyzed using content analysis for Round 1.

RESULTS

A total of 40 youths participated in Round 1, with good retention (97.5%) in subsequent rounds. Youths achieved consensus on eight recommendations to support post-pandemic recovery. Youths endorsed post-pandemic strategies that prioritize the implementation of effective, accessible, and low-cost MHSU services in schools, workplaces, and communities; the integration of MHSU education into school lessons; increased awareness about MHSU services in schools and workplaces; and the prioritization of health and well-being in schools and workplaces.

CONCLUSION

Findings indicate the need for stronger partnerships between schools, community-based MHSU services, and hospitals, and job opportunities that pay a living wage.

Verbal Information From Parents About Stillbirth: The VIPS Study (Phase One)

BACKGROUND

In many countries, a baby's cause of death (COD) following stillbirth is informed only by case notes and pathology investigations. However, parents' understanding of their baby's COD may inform or even change the COD diagnosis. We aimed to produce a standardised co-designed interview schedule to enable parents to contribute information to improve overall understanding of the causes of stillbirth.

MATERIALS AND METHODS

Consensus for the interview schedule was sought via a two-round modified Delphi study. We recruited internationally for panel membership comprising bereaved parents, clinicians, and researchers. In Round 1, each panellist provided up to five questions to ask bereaved parents. After collation into categories, Round 2 asked panellists to rate the importance of each question category on a four-point scale.

RESULTS

Panellists (n = 126 Round 1, n = 75 Round 2) were mainly bereaved parents. In Round 1, 553 potential interview questions were generated. These were grouped into categories which were pregnancy experience, antenatal care, fetal wellbeing, maternal wellbeing, days Prior to stillbirth and perceived COD. These proposed questions and question categories were then put to panel members in Round 2. All categories achieved consensus for inclusion in the final interview schedule with positive consensus percentage scores ranging from 83% to 98%.

CONCLUSIONS

Panel membership comprising mainly bereaved parents provided a clear mandate for questions parents want to be asked. The interview schedule will soon be trialled with recently bereaved parents at a tertiary-referral maternity health service. Findings from the study will inform future research on how to include parents' voices in COD determination.

Operational procedure sharing pathway in veno-occlusive disease: a Delphi consensus-based recommendations

Background

The hepatic Veno-Occlusive Disease (VOD), also known as Sinusoidal Obstruction Syndrome (SOS), is a serious complication that can occur after high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). In Italy, the approach to VOD varies due to differences in healthcare practices and diagnostic criteria among different regions.

Aim and methods

To address this issue, a structured, multi-step Delphi consensus project was undertaken with the aim of standardizing the diagnostic and therapeutic pathways for VOD in Italian clinical practice. The project involved a methodologist, a scientific board of 10 experts, and an expert panel of 45 specialists from Italian hospital centers. This 12-month process included independent contributions, harmonization by a methodologist, and discussions through web meetings.

Results

The survey identified 15 clinical topics divided into five key areas, including pre-HSCT patient evaluation, clinical-laboratory aspects for diagnosis and therapy, integration of clinical evaluations with EBMT criteria, monitoring with imaging techniques, and adherence to guidelines for managing defibrotide therapy. Key findings include the recommendation of weekly imaging even when VOD is not clinically suspected, the importance of early diagnosis and treatment with defibrotide, and the need for a standardized approach across different centers.

Conclusion

The Delphi consensus revealed significant variability in the management of VOD across Italian centers and emphasized the necessity of a multidisciplinary approach involving hematologists, hepatologists, and radiologists. Establishing a national network for sharing best practices and utilizing advanced imaging technologies is essential for improving VOD diagnosis and treatment. The findings indicate the importance of implementing standardized protocols and continuous education to enhance patient outcomes in HSCT settings.

Development and validation of a brief assessment of normative health and health-related social needs using the Simple Segmentation Tool

OBJECTIVES

Population segmentation provides a promising solution to address patients' complex needs to provide "whole person" care. The primary objective of this study is to create an expert-based algorithm based on combinations of medical and social characteristics derived from the Simple Segmentation Tool (SST), that are indicative of high value health and health-related social service (HASS) needs for an elderly population. The secondary objective was to examine the association between failing to meet the HASS needs 3-months post hospital discharge suggested by the algorithm and adverse outcomes over the ensuing year.

DESIGN & SETTING

Based on a parsimonious set of 10 patient characteristics identified in the SST, a representative expert panel was engaged using the Modified Appropriateness Methodology (MAM). A prospective study was then performed on patients admitted to the Singapore General Hospital, using HASS needs identified at discharge and met needs at 3 months post-discharge follow-up of services received, to assess whether unmet needs were associated with higher adverse outcomes in the year following discharge. The primary outcome of interest was time to all-cause mortality over 12-months post-discharge and was assessed with Cox regression analysis.

RESULTS

The MAM exercise resulted in 12 normatively defined high value services, using a combination of patients' medical and social characteristics based on the SST, as well as a list of means of providing those service needs. The all-cause mortality hazard ratio of having at least one unmet need versus having all needs met for individuals deemed to be chronically symptomatic at discharge was 1.949, (95% CI: 0.99 - 3.84, and p = 0.05), while for those who were either healthy or only had asymptomatic chronic conditions the all-cause mortality ratio of having at least one unmet need versus having all needs met was 0.28 (95% CI = 0.06-1.27 and p-value = 0.10). The hazard ratio for ED visits and hospital readmission were above one but did not reach level of 95% confidence level.

CONCLUSION

The SST methodology provides a practical way to assess HASS needs that are predictive of mortality when needs are not met. It could serve as a screening tool to identify individuals who are likely to benefit from detailed care planning and follow-up.

A qualitative study of how clinicians reach agreement in perioperative pathway development: the Consensus Model for Standardising Healthcare

BACKGROUND

Variation in perioperative care persists globally. Consensus discussions may facilitate standardisation, yet the processes used to reach agreement are poorly understood. This study aimed to develop a model for conducting local consensus discussions when implementing standardised perioperative pathways. Specifically, we 1) describe how local consensus discussions are operationalised; 2) identify what guides decision making and consensus between clinicians; and 3) formulate explanatory mechanisms and identify determinants that facilitate consensus discussions.

METHODS

A qualitative, modified grounded theory study was conducted in one private hospital in metropolitan Sydney, Australia. Thirty-one participants from clinical disciplines and hospital management/leadership were included. Data were collected from nine semi-structured interviews and 16 h of participant observations during consensus development or implementation meetings. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Interviews and field notes were recorded and transcribed verbatim. Data were analysed using coding, constant comparison, detailed memo writing and data interpretation.

RESULTS

Seven individual and contextual factors crucial for building consensus, and eight mechanisms for reaching agreement were identified and integrated into a conceptual model. Seeking evidence to support decision-making emerged as the primary driver of consensus. Strong research evidence in support of a pathway component facilitated swift agreement. Where there was ambiguous evidence for a pathway component, clinicians based their decisions on a desire for professional autonomy, consideration of how their peers practice, patient preferences, practices from external organisations, or the feasibility of implementing the pathway component.

CONCLUSIONS

The Consensus Model for Standardising Healthcare provides a map for healthcare organisations seeking to conduct local consensus discussions to reduce variation in care. Our findings advance our understanding of how local consensus discussions are conducted and factors that impact success when standardising care amongst clinicians.

Psychological well-being, resilience, self-determination and grit: The 'novelty' role in physical education classes

INTRODUCTION

In recent years, the incorporation of novelty as a psychological need and the study of the frustration of needs have become a recurring theme in the research on psychological needs in the educational environment. Currently, there are two scales available to assess the frustration of basic psychological needs (FBN) in the context of Physical Education. The objectives of the study are (a) to analyse the factor structures of both scales to compare them with each other and (b) to analyse the effect of FBN on resilience, grit and each of the motivational regulations.

METHOD

The study included 1439 high school students (M = 15.03 years; SD = 1.24). The majority of participants were Caucasian 83.4%, African 9.7%, South American 6.1% and Asian 0.8%. The analyses used to examine the factor structure of the scales were exploratory and confirmatory factor analysis, reliability analysis and discriminant validity analysis. Hierarchical linear regression analysis was used to analyse the relationship of FBN.

RESULTS

Each of the scales showed greater robustness in its factor structure and reliability (2023, Physical Education and Sport Pedagogy, 1) scale: χ2/gl = 3.62; CFI = .92; NFI = .92; RMSEA = .061; (2020, Revista de Psicología del Deporte, 29, 91) scale: χ2/gl = 2.67; CFI = .96; NFI = .96; RMSEA = .048, SRMR = .037). Additionally, FBN was positively related to less self-determined motivational regulations, while it was negatively related to grit, resilience and more self-determined motivational regulations.

CONCLUSION

Finally, the results highlighted that the (2020, Revista de Psicología del Deporte, 29, 91) scale, showing greater factorial robustness, obtained greater robustness in the relationships with the variables studied.

A patient reported outcome measure for rectal cancer patients eligible for organ preservation: Development and validation of a Watch-and-Wait module for the Assessment of Burden of disease in ColoRectal Cancer (ABCRC) tool

AIM

The Assessment of Burden of ColoRectal Cancer (ABCRC)-tool is an integrated tool, developed in conjunction with colorectal cancer (CRC) patients, that measures the experienced burden of disease and lifestyle parameters and visualizes the results. To provide tailored follow-up care for watch-and-wait (WW) patients, in line with their specific needs and preferences, a WW module for the ABCRC-tool was developed. In this paper we describe the development and validation process of the WW module.

METHODS

This study followed a multistep approach. First, a three-round Delphi survey was conducted with both patients and healthcare professionals (HP). Participants were asked to score common RC outcomes that emerged from qualitative interviews with patients and a targeted literature review. Based on included items, appropriate questions were formulated. Reliability was tested by assessing test-retest reliability, defined by Intra Class Correlation. Construct validity was evaluated by hypothesis testing.

RESULTS

A total of 128 participants (75 patients and 53 HP) from four countries (UK, Brazil, Portugal and Netherlands) participated in the Delphi survey which included 41 items. After the consensus meeting seven outcomes and appropriate questions (including anxiety, fear of recurrence, fear of surgery, fear of stoma, fecal incontinence, urgency and happiness) were included in the WW module. Validity and reliability testing was completed by 50 Dutch WW patients. The ABCRC-WW module demonstrated sound construct validity and reliability.

CONCLUSION

This study demonstrates good psychometric properties of the ABCRC-WW tool. This tool has the potential to facilitate patient-clinician communication, enhance patients' understanding of their condition, and enable individualized care through direct feedback.

Developing and validating a HEalthCare NAvigation Competency (HECNAC) Scale for refugees in the United States

The complex healthcare system in the United States (US) poses significant challenges for people, particularly minorities such as refugees. Refugees often encounter additional layers of challenges to healthcare navigation due to unfamiliarity with the system, limited health literacy, and language barriers. Despite their challenges, it is difficult to identify the gaps as few tools exist to measure navigation competency among this population and many conventional tools assume English proficiency, making them inadequate for refugees and other immigrants. To address this gap, this study developed and validated a HEalthCare NAvigation Competency (HECNAC) Scale tailored to refugees' needs. The scale development process followed three phases: domain identification through a literature review and stakeholder interviews (n = 15), content validation through the Delphi method (2 rounds, n = 12), and face validity assessment via cognitive interviews (2 rounds, n = 4). Based on a literature review and stakeholder interviews, the initial version of the scale was developed, including ten domains and 47 items. An introductory email concerning the scale and the Delphi process was subsequently sent to 21 eligible experts, including staff from refugee resettlement agencies, health care providers serving refugee communities, and refugees. Twelve experts completed the two rounds of the Delphi, resulting in a consensus on 39 items. After conducting cognitive interviews with 4 Afghan refugees, the scale was finalized with ten domains and 35 items. The finalized scale captures multifaceted aspects of healthcare navigation crucial for refugees, organized into domains such as health system knowledge, insurance, making an appointment, transportation, preparing for a visit, in the clinic, interpretation, medicine, medical bills, and preventive care. Overall, the HECNAC Scale represents a significant step towards understanding and assessing refugees' competencies in navigating the US healthcare system. It has the potential to guide tailored interventions and standardized training curricula and ultimately mitigate persistent barriers faced by refugees in accessing healthcare services.

Design, implementation and evaluation of value-based payment models: a Delphi study

BACKGROUND

This study explores the facilitating and inhibiting factors in the design/development, implementation, and applicability/evaluation of value-based payment models of integrated care. The Delphi technique was used to reach consensus among a panel of (inter)national experts on these factors.

METHODS

An expert panel of 15 members participated in a three-round Delphi study. Factors from experts and literature were used to compile a list of 40 facilitators and 40 inhibitors. Afterwards, experts were asked to rate the importance of these factors using a 5-point Likert scale.

RESULTS

Eight facilitating (e.g., transparency, communication, and trust among involved stakeholders) and seven inhibiting factors (e.g., lack of motivation and engagement among involved stakeholders) achieved full consensus. Timely availability of data and an integrated information technology system for data registration (a facilitator) were the only factors achieving full consensus through a very high agreement.

CONCLUSIONS

Adequate outcome measures, targets, benchmarks, and incentives are important in value-based payment models. The less quantifiable items, such as strong leadership, transparency, communication and trust, and motivation and engagement of the involved stakeholders, are also important for successful adoption of these models and promote high-quality care at lower or equal costs.

Creating a food environment scoring index for online food delivery outlets: Delphi study with Australian nutrition and public health professionals

AIMS

This study aimed to develop a scoring index for the healthfulness of food outlet menu offerings available through Australian delivery platforms.

METHODS

The Delphi method was employed to achieve consensus among a panel of Australian nutrition and public health experts regarding the food environment scores assigned to online food outlets, classified by type. From previous studies and scoping of delivery platforms, 36 food outlet types were identified. Australian nutrition and public health experts were recruited to complete an online Delphi survey to score the healthfulness of these outlets using a scale from -10 (least healthful) to +10 (most healthful), based on typical menu offerings. The first round of the survey was opened for approximately 5 weeks in July to August 2023, and the second round was opened for 2 weeks in September 2023. The mean food environment score, minimum and maximum awarded food environment score, and SD for each outlet type, and coefficient of variation was calculated after each survey round to provide a measure of the spread of the data around the mean and the degree of consistency in the distribution of responses. Following the second survey round, results were assessed for consensus among the participants.

RESULTS

Fifty-four participants completed the round one survey, and n=14 completed round two. The majority of online food delivery outlet types received a food environment score of less than +5, and were considered 'less healthful.' Participants scored greengrocers as the most healthful outlet type (mean food environment score of 8.83 ± 0.37) and liquor selling stores as the least healthful (score of -8.10 ± 1.14). The group reached consensus after two survey rounds due to decreases in the standard deviations of mean food environment scores.

CONCLUSIONS

This study provides an expert-informed tool, the DIGIASSESS tool, that can be easily applied by researchers, policy makers, health workers and public health professionals to understand the rapidly evolving online food delivery environment, including changes over time and areas for potential intervention.

Australian Particle Therapy Clinical Quality Registry (ASPIRE) protocol (TROG 21.12): a multicentre prospective study on patients with rare tumours, treated with radiation therapy

INTRODUCTION

In 2020, the Australian Medical Services Advisory Committee (MSAC) recommended new proton beam therapy (PBT) item numbers be added to the Medicare Benefits Schedule. During the MSAC 1638 application process, MSAC recognised the uncertainties inherent in the cost-utility modelling of PBT. To address these uncertainties, MSAC proposed the establishment of a national registry with the intention to gather evidence to validate the claim of PBT's superior toxicity outcomes and cost-effectiveness compared with conventional photon radiation therapy.

METHODS AND ANALYSIS

The Australian Particle Therapy Clinical Quality Registry is a prospective, observational, longitudinal registry collecting national data on paediatric, adolescent young adult and adult patients with rare tumours receiving any form of radiation therapy for a defined group of diseases, specified by the MSAC 1638 Public Summary Document. Eligible patients undergoing radiation therapy at participating institutions will be provided with information about the registry, including the opt-out procedure. The registry has no enrolment cap and will persist either indefinitely or until the conclusion of the study.The study design was informed by the Australian Metadata Online Repository and contains a core set of minimum data elements. Representing baseline participant demographics, assessment, diagnosis and treatment; incorporating radiation and systemic therapies, with a specific focus on long-term follow-up, treatment toxicities and specific organ-at-risk testing.

ETHICS AND DISSEMINATION

There will be no identifying data used in any reports or presentations of data. Additionally, all identifiable data will be safeguarded according to standard practices and available only to the host institution submitting the data to the registry. Aggregated data for the purposes of research will be stripped of identifiers. The registry has been approved under the National Mutual Agreement by the Central Adelaide Local Health Network Human Research Ethics Committee-HREC: 2021/HRE00394.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000026729p.

How to assess doctor managers' managerial attitude: results from an e-Delphi process

BACKGROUND

Since the 1990s, healthcare systems in many Western countries, including Italy, have undergone significant reforms, transforming organizational models and structures to meet the growing demand for healthcare services efficiently. This transformation has introduced new managerial roles for doctors-managers, particularly at the midlevel, creating "doctor-manager" positions that involve both clinical and managerial responsibilities. However, doctor-managers often struggle to balance these dual roles due to a lack of formal managerial training and the inherent conflict between clinical and economic objectives. This study aims to define new evaluation dimensions that can enhance the existing scale and develop a new tool to assess the necessary components of the managerial attitude dimension required by doctor-managers in the current Italian healthcare system.

METHODS

This study updated Cicchetti's 2005 scale to reflect the changes that have occurred in healthcare organizations over the past 20 years, focusing on the evolving roles and challenges of middle healthcare managers. A scoping review was conducted to explore the existing literature, resulting in the identification and analysis of 24 key articles. Thematic analysis, facilitated by NVivo software, identified 171 items related to managerial attitude. These items were further refined, resulting in a 61-item Health Middle Manager Competencies Scale. The scale was evaluated by a Delphi panel through an e-survey, and Cronbach's alpha was used to assess reliability.

RESULTS

The final Competencies Scale for Middle Managers of Health consists of 61 items, validated by the Delphi panel of experts. The panel reached consensus on the relevance and significance of each item, confirming the scale's reliability with an acceptable Cronbach alpha. The new scale captures various dimensions of the competencies essential for middle managers in healthcare settings.

CONCLUSION

The study provides insights into the dimensions of doctor managerial attitude and contributes to the update of Cicchetti's Scale to develop a new tool that assesses all the necessary components now required within the managerial attitude dimension.

The potential of Logistics 4.0 technologies: a case study through business intelligence framing by applying the Delphi method

Introduction

The growing competitiveness and the importance of data availability for organizations have created a demand for intelligent information systems capable of analyzing data to support strategy and decision-making. Organizations are generating more and more data due to new technologies associated with Industry 4.0 and Logistics 4.0, making it essential to transform this data into relevant information to streamline decision-making processes. This paper examines the influence of these technologies on gaining a competitive advantage, specifically in a logistics company, which is scarce in the literature.

Methods

A case study was conducted in a Portuguese company using the Delphi method with 61 participants-employees who use the company's integrated BI tool daily. The participants were presented with a questionnaire via the online platform Welphi, requiring qualitative responses to various statements based on the literature review and the results of semi-structured meetings with the company.

Results

The study aimed to identify areas where employees believe more investment/ development is needed to optimize processes and improve the use of the BI tool in the future. The results indicate that BI is a crucial technology when aligned with a company's objectives and needs, highlighting the necessity of top management's involvement in optimizing the BI tool. Encouraging employees to use the BI tool emerged as a significant factor, underscoring the importance of leadership in innovative projects to achieve greater competitive advantage for the company.

Discussion

This study aims to understand the importance of Business Intelligence (BI) and how its functionalities should be adapted according to a company's strategy and objectives to optimize decision-making processes. Thereby, the discussion focused on the essential role of BI technologies in leveraging the company's competitive advantage.

Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review

AIMS

To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.

DESIGN

Systematic review.

DATA SOURCES

Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.

METHODS

Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.

RESULTS

The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.

CONCLUSIONS

Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.

IMPACT

These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.

REPORTING METHOD

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution.

TRIAL REGISTRATION

CRD42023413817.

A Delphi Exploration of Toileting Activity Performance in Individuals With Cerebral Palsy Within the ICF-CY Framework: Unveiling Influential Factors

Introduction: Cerebral palsy (CP) is a common motor and postural developmental disability impacting daily activities like toileting. Despite its importance, toileting has often been undervalued in healthcare. This study is aimed at identifying and assessing the level of influence of various factors affecting toileting in individuals with CP using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework. Methods: The Delphi method was employed to reach a consensus on factors influencing toileting in individuals with CP. One hundred fifty-eight professionals from 17 countries, each with at least 3 years' experience in CP and/or toileting, participated in this two-round study. Ethical approval (IR.IUMS.REC.1400.1111) and informed consent were obtained. The questionnaire, available in Farsi and English, used a Likert scale (5 = very high impact to 1 = no impact). Factors with 75% agreement and a mean above 3.75 were included in the final list, while those with 50%-75% agreement or a mean between 2.5 and 3.75 proceeded to the second round. Factors were initially identified through a literature review and research team consultation and categorized according to the ICF-CY framework using the ICF 10 RULES. Validation and refinement were done through focus groups with caregivers and experienced professionals to ensure alignment with the framework and methodological rigor. Results: The study highlighted significant factors influencing toileting activities in individuals with CP. Within the ICF-CY framework, "neuromusculoskeletal and movement-related functions" scored highest at 94.5% in "body functions and structures." "Toilet environment" scored 90.5% in "environmental factors." Support and relationship factors scored 82.3%. Attitudes toward "menstruation" ranked highest at 92.9%. Associated deficits with CP ranked top in personal factors at 93.7%. Conclusion: The study identifies key factors influencing toileting activity performance in individuals with CP. "Main caregiver" emerges as a pivotal factor, followed by neuromusculoskeletal functions, personal factors, attitudes toward menstruation, the toilet environment, and support and relationships.

Chinese version of the Physical Resilience Scale (PRS): reliability and validity test based on Rasch analysis

BACKGROUND

Physical resilience is known to minimize the adverse outcomes of health stressors for older people. However, validated instruments that assess physical resilience in older adults are rare. Therefore, the purpose of this study was to translate the Physical Resilience Scale (PRS) into Chinese and to validate its psychometric properties in a population of community-dwelling older adults following SARS-CoV-2 infection.

METHODS

This study used a cross-sectional design and translated the Physical Resilience Scale into Chinese. A total of 426 older adults who had recovered from SARS-CoV-2 infection were chosen for assessment through convenience sampling. The measurement data were analyzed using the Rasch analysis.

RESULTS

Rasch analysis indicates that the Physical Resilience Scale demonstrates excellent reliability, validity, and unidimensionality. The Infit MNSQ and Outfit MNSQ of each entry were 0.77 ~ 1.19, and the degree of fit of each entry to the scale was good. Person and item separation reliability support the internal consistency of the studied samples and PRS items.

CONCLUSIONS

The Physical Resilience Scale has good reliability and is suitable for the assessment of physical resilience tests in older people. However, the overall difficulty of the scale is not suitable for older adults of all ability ranges, and it is possible to add higher and lower difficulty items and adjust the difficulty spacing between items in a later study.

Delphi Technique on Nursing Competence Studies: A Scoping Review

This scoping review was conducted under the Joanna Briggs Institute (JBI) framework. It included primary studies published until 30 April 2023, obtained through a systematic search across PubMed, Web of Science, CINAHL, and MEDLINE databases. The review focused on primary studies that used the Delphi technique in nursing competence research, especially those related to defining core competency frameworks and developing instruments to assess professional competence. The goal was to analyze the different methodological approaches used by authors, synthesize them, and propose recommendations to enhance methodological rigor, reliability, and validity in the application of the Delphi technique. For this purpose, the following review question was established: "What is the available evidence on the use of the Delphi technique in the study of professional competence in nursing?". The extracted textual elements underwent a content analysis, resulting in dimensions established through an inductive approach. Twenty studies were included, yielding insights into diverse methodological options for conducting Delphi studies, organised around a set of dimensions: (1) preparatory procedures; (2) procedures for accessing and selecting experts; (3) acquisition of expert input; (4) data analysis and consensus; and (5) ethical and legal procedures and guarantees. The study's limitations include the inability to include certain studies due to a lack of response to requests for clarification from corresponding authors. Additionally, the primary studies' methodological quality was not assessed, which is another relevant aspect. The study's results offer valuable insights for researchers intending to utilise the Delphi technique within the context of the research referenced in the included studies. This information encompasses important methodological choices, highlighting their potential benefits and associated risks. The review was prospectively registered on the Open Science Framework (Registration No: osf.io/kp2vw).

Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method

BACKGROUND

 Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey.

OBJECTIVE

 To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants.

METHODS

 Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items.

RESULTS

 The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth.

CONCLUSIONS

 Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.

Pictures versus words: can we use a pictorial scale to measure child health-related quality of life?

Measuring health-related quality of life (HRQoL) is important because it can serve as an indicator or a predictor of subsequent mortality or morbidity. HRQoL has been shown to be directly related to child growth and development and indirectly related to the healthcare costs of young children. Existing measures of HRQoL in children have heavily relied on traditional questionnaires that use age-suited versions or parent proxy questionnaires. However, both of these methods may present with different types of biases and may misrepresent underlying HRQoL. The current mini reivew will first illustrate these methodological limitations and highlight the potential use of pictorial scales in addition to discussing their suitability for specifically measuring HRQoL as an alternative. We will also synthesize existing recommendations on the development of pictorial scales to provide a protocol as a recommendation to researchers who are aiming to develop an overall HRQoL pictorial scale that is suited for children.

Unveiling CPR training challenges in nursing education: Pedagogical strategies for success

AIM

This study explored the challenges nursing students face while learning CPR and identified experiential learning strategies to address these challenges.

BACKGROUND

Nursing students often experience challenges and anxiety during clinical learning, including CPR training. Given the experimental nature of CPR training, experiential learning models like mARC can significantly enhance the learning experience by addressing these prevalent challenges.

DESIGN

This study adopts an interpretivist approach within a qualitative methodology and uses a phenomenological design.

METHOD

Semi-structured interviews and the Delphi method were used to gather firsthand experiences from 37 educational supervisors, nursing professors and nursing students undergoing CPR clinical training at five public medical universities.

RESULTS

Four main challenges and eighteen sub-challenges of CPR training were identified, elaborated and modeled. Additionally, thirteen experiential learning strategies, based on the mARC experiential learning model (more Authentic, Reflective, Collaborative), were mapped to address these challenges.

CONCLUSIONS

Among the four main challenges of CPR training identified by this study, the lack of pedagogy appears to be the underlying cause of the other three. This underscores the significance of integrating effective pedagogical approaches into nurse education strategies and initiatives.

Assessment of Potentially Inappropriate Prescribing for People With Type 2 Diabetes Mellitus Using IMPACT2DM, a New Explicit Tool

Background: People with type 2 diabetes mellitus (T2DM) are at greater risk of potentially inappropriate prescribing (PIP) due to multiple comorbidities and polypharmacy. IMPACT2DM (Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus) is a tool designed to identify PIP for adults with T2DM. Objectives: To assess PIP for adults with T2DM in Ethiopia using the IMPACT2DM and to test the face validity and clinical validity of the tool. Methods: A cross-sectional study was undertaken using data extracted retrospectively from the medical records of adults being managed for T2DM at Debretabore Hospital. PIP was assessed using IMPACT2DM. Some items/item components of IMPACT2DM were modified to increase the tool's applicability for the outpatient setting, to clarify content or to use the terms most common in this particular setting. Multivariant logistic regression analyses were conducted to identify factors associated with PIP. Results: More than 90% of medical records had at least 1 PIP. Prescribing omission (80.9%) was the most commonly identified type of PIP. Adults with prescribing omissions are more likely to be ≥40 years old or to be prescribed with <5 medications. Adults with dosing problems were more likely ≥50 years old, or have had a fasting blood sugar (FBS) level out of the target range (80-130 mg/dL). Conclusions: IMPACT2DM is a clinically valid PIP identification tool for application in an Ethiopian outpatient setting. Health professionals should be alert to check for potential prescribing omissions for adults ≥40 years old and dosing problems for adults with an FBS level out of the target range or >50 years.

[Strengthening leadership for educational management in the Americas: an action research strategyFortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação]

The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives.The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas.A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations.The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course.The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

Understanding the post-diagnostic support priorities of autistic adults in the United Kingdom: A co-produced modified Delphi study

LAY ABSTRACT

Autistic adults in the United Kingdom report that support for themselves and their peers is not suitable for their needs. There has been an increase in adults receiving an autism diagnosis, which many have reported as having a positive impact on their lives. However, the lack of support and understanding after diagnosis, combined with long wait times for an assessment to obtain a diagnosis and to access follow-on support, is having a negative impact on people's lives. This study took place to find out what support autistic people need and want after receiving their diagnosis. It was co-designed with a group of 10 autistic adults which means that the researchers and group members collaboratively designed the research. For the study, 43 autistic adults, diagnosed aged 18 or older, completed three questionnaires. A fourth questionnaire followed that was completed by 139 autistic people who received their diagnosis in adulthood. These questionnaires aimed to help people identify their own priorities when it came to the support they would have liked to receive after being given their autism diagnosis. Participants ranked access to support where they live, training of professionals, support to process the impact of a late diagnosis, use of their preferred mode of contact and a personalised support plan as their top priorities. This demonstrates that local support is highly valued by autistic adults, as are well-trained professionals who offer a range of contact options, support to process a late-in-life autism diagnosis and help to develop and implement support plans.

A comprehensive value-based method for new nuclear medical service pricing: with case study of radium [223Ra] bone metastases treatment

IMPORTANCE

Innovative nuclear medicine services offer substantial clinical value to patients. However, these advancements often come with high costs. Traditional payment strategies do not incentivize medical institutes to provide new services nor determine the fair price for payers. A shift towards a value-based pricing strategy is imperative to address these challenges. Such a strategy would reconcile the cost of innovation with incentives, foster transparent allocation of healthcare resources, and expedite the accessibility of essential medical services.

OBJECTIVE

This study aims to develop and present a comprehensive, value-based pricing model for new nuclear medicine services, illustrated explicitly through a case study of the radium [223Ra] treatment for bone metastases. In constructing the pricing model, we have considered three primary value determinants: the cost of the new service, associated service risk, and the difficulty of the service provision. Our research can help healthcare leaders design an evidence-based Fee-For-Service (FFS) payment reference pricing with nuclear medicine services and price adjustments.

DESIGN, SETTING AND PARTICIPANTS

This multi-center study was conducted from March 2021 to February 2022 (including consultation meetings) and employed both qualitative and quantitative methodologies. We organized focus group consultations with physicians from nuclear medicine departments in Beijing, Chongqing, Guangzhou, and Shanghai to standardize the treatment process for radium [223Ra] bone metastases. We used a specially designed 'Radium Nuclide [223Ra] Bone Metastasis Data Collection Form' to gather nationwide resource consumption data to extract information from local databases. Four interviews with groups of experts were conducted to determine the add-up ratio, based on service risk and difficulty. The study organized consultation meeting with key stakeholders, including policymakers, service providers, clinical researchers, and health economists, to finalize the pricing equation and the pricing result of radium [223Ra] bone metastases service.

MAIN OUTCOMES AND MEASURES

We developed and detailed a pricing equation tailored for innovative services in the nuclear medicine department, illustrating its application through a step-by-step guide. A standardized service process was established to ensure consistency and accuracy. Adhering to best practice guidelines for health cost data analysis, we emphasized the importance of cross-validation of data, where validated data demonstrated less variation. However, it required a more advanced health information system to manage and analyze the data inputs effectively.

RESULTS

The standardized service of radium [223Ra] bone metastases includes: pre-injection assessment, treatment plan, administration, post-administration monitoring, waste disposal and monitoring. The average duration for each stage is 104 min, 39 min, 25 min, 72 min and 56 min. A standardized monetary value for medical consumables is 54.94 yuan ($7.6), and the standardised monetary value (medical consumables cost plus human input) is 763.68 yuan ($109.9). Applying an agreed value add-up ratio of 1.065, the standardized value is 810.19 yuan ($116.9). Feedback from a consultation meeting with policymakers and health economics researchers indicates a consensus that the pricing equation developed was reasonable and well-grounded.

CONCLUSION

This research is the first study in the field of nuclear medicine department pricing methodology. We introduce a comprehensive value-based nuclear medical service pricing method and use radium[223Ra] bone metastases treatment pricing in China as a case study. This study establishes a novel pricing framework and provides practical instructions on its implementation in a real-world healthcare setting.

Problematic situations related to social media use and competencies to prevent them: results of a Delphi study

A three-round Delphi method was used to study the problematic situations that adolescents may encounter when using the social media, and the competencies needed to address these situations. A panel of Finnish experts (N = 22) provided an open-ended list of problematic situations and competencies in 2020-2021. These were then evaluated and ranked according to their significance. The experts provided an information-rich list of both problematic situations and competencies. Finally, 16 problematic situations and 19 competencies were ranked in order of importance by the experts. The most important problematic situations were direct and indirect cyberbullying and sexual harassment. The most important competencies were the ability to act responsibly, knowing what kinds of activity are prohibited, and knowing whom to contact on exposure to cyberbullying or harassment. The findings can be used in developing policies, recommendations, and solutions aimed at counteracting the harmful effects of social media on wellbeing during adolescence.

European value-based healthcare benchmarking: moving from theory to practice

BACKGROUND

Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems.

METHODS

In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics.

RESULTS

Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers.

CONCLUSIONS

To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.

Assessment of adherence to pre-vaccination precautions and AEFI reporting practices during BCG vaccination in 4 hospitals in Ghana

The BCG vaccine, like all other vaccines, is associated with adverse events following immunization (AEFI). Reducing the incidence of AEFI is crucial in reposing confidence in BCG vaccination and reducing hesitancy associated with the vaccine. This requires safety precautions before and during vaccinations, as well as reporting AEFIs after vaccination. This study assessed the adherence of health-care professionals to pre-vaccination precautions and adverse events following immunization (AEFI) reporting practices during BCG vaccination in four hospitals in Ghana. It is hoped that the findings of the study will serve as a baseline to identify gaps for further studies to generate a stronger evidence for policy formulation aimed at improving BCG vaccine safety in Ghana and other tuberculosis endemic countries. A cross-sectional study design was employed, and Statistical Package for Social Sciences, IBM® SPSS version 25 (SPSS Inc. USA) software was used for analysis. Chi-square and binary logistic regression tests were used to test the association between categorical variables and predictors of adherence to pre-BCG vaccination precautions, respectively, and a p-value of <.05 was considered statistically significant. The AEFIs commonly reported by mothers included abscess, injection site pain, injection site redness, fever, rash, muscle weakness, diarrhea, vomiting, coughing and rhinitis. Ninety-three participants (73.2%) were adherent to pre-BCG vaccination precautions. Ninety-two participants (72.4%) informed mothers to report all AEFIs encountered. Adherence to pre-BCG vaccination precautions and AEFI reporting were generally good; however, there is still room for improvement.

Teleconsultations for mental health: Recommendations from a Delphi panel

Introduction

The use of teleconsultations for mental health has drastically increased since 2020 due to the Covid19 pandemic. In the present paper, we aimed to analyze the advantages and disadvantages of teleconsultations for mental health compared to face-to-face consultations, and to provide recommendations in this domain.

Methods

The recommendations were gathered using a Delphi methodology. The expert panel (N = 21) included professionals from the health and ICT domains. They answered questions via two rounds of web surveys, and then discussed the results in a plenary meeting. Some of the questions were also shared with non-experts (N = 104).

Results

Both the experts and the non-experts with teleconsultation experience reported a general satisfaction concerning teleconsultations. A SWOT analysis revealed several strengths and opportunities of teleconsultations for mental health, but also several weaknesses and threats. The experts provided a set of practical recommendations for the preparation and organization of teleconsultations for mental health.

Discussion

Teleconsultations for mental health have the potential to allow access to care for patients in remote and isolated areas. Thus, their use will unlikely be discontinued after the end of the pandemic. In this context, we suggest that the collaboration among clinicians, researchers, and interface designers is crucial to improve usability and user experience for both clinicians and patients. The importance of teaching teleconsultation skills and informing the public on the features of teleconsultations (e.g., data privacy/security) is also highlighted.

Transforming the landscape of obesity education - The Canadian obesity education competencies

Background

With ongoing gaps in obesity education delivery for health professions in Canada and around the world, a transformative shift is needed to address and mitigate weight bias and stigma, and foster evidence-based approaches to obesity assessment and care in the clinical setting. Obesity Canada has created evidence-based obesity competencies for medical education that can guide curriculum development, assessment and evaluation and be applied to health professionals' education programs in Canada and across the world.

Methods

The Obesity Canada Education Action Team has seventeen members in health professions education and research along with students and patient experts. Through an iterative group consensus process using four guiding principles, key and enabling obesity competencies were created using the 2015 CanMEDS competency framework as its foundation. These principles included the representation of all CanMEDS Roles throughout the competencies, minimizing duplication with the original CanMEDS competencies, ensuring obesity focused content was informed by the 2020 Adult Obesity Clinical Practice Guidelines and the 2019 US Obesity Medication Education Collaborative Competencies, and emphasizing patient-focused language throughout.

Results

A total of thirteen key competencies and thirty-seven enabling competencies make up the Canadian Obesity Education Competencies (COECs).

Conclusion

The COECs embed evidence-based approaches to obesity care into one of the most widely used competency-based frameworks in the world, CanMEDS. Crucially, these competencies outline how to address and mitigate the damaging effects of weight bias and stigma in educational and clinical settings. Next steps include the creation of milestones and nested Entrustable Professional Activities, a national report card on obesity education for undergraduate medical education in Canada, and Free Open Access Medication Education content, including podcasts and infographics, for easier adoption into curriculum around the world and across the health professions spectrum.

Medication risk checklist for older adults (LOTTA) - development and validation of a self-assessment tool

BACKGROUND

Patient safety strategies highlight patients' own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years.

MATERIALS AND METHODS

The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis.

RESULTS

The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min.

CONCLUSIONS

A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.

A Delphi study to obtain consensus on medical emergency team (MET) stand-down decision making

AIM

A medical emergency team (MET) stand-down decision is the decision to end a MET response and hand responsibility for the patient back to ward staff for ongoing management. Little research has explored this decision. This study aimed to obtain expert consensus on the essential elements required to make optimal MET call stand-down decisions and the communication required before MET departure.

DESIGN

A Delphi design was utilised.

METHODS

An expert panel of 10 members were recruited based on their expert knowledge and recent clinical MET responder experience in acute hospital settings. Participants were emailed a consent form and an electronic interactive PDF for each survey. Two rounds were conducted with no attrition between rounds. The CREDES guidance on conducting and reporting Delphi studies was used to report this study.

RESULTS

Consensus by an expert panel of 10 MET responders generated essential elements of MET stand-down decisions. Essential elements comprised of two steps: (1) the stand-down decision that was influenced by both the patient situation and the ward/organisational context; and (2) the communication required before actioning stand-down. Communication after the decision required both verbal discussions and written documentation to hand over patient responsibility. Specific patient information, a management plan and an escalation plan were considered essential.

CONCLUSION

The Delphi surveys reached consensus on the actions and communication required to stand down a MET call. Passing responsibility back to ward staff after a MET call requires both patient and ward safety assessments, and a clearly articulated patient plan for ward staff. Observation of MET call stand-down decision-making is required to validate the essential elements.

IMPLICATION FOR THE PROFESSION AND PATIENT/OR PATIENT CARE

In specifying the essential elements, this study offers clinical and MET staff a process to support the handing over of clinical responsibility from the MET to the ward staff, and clarification of management plans in order to reduce repeat MET calls and improve patient outcomes.

IMPACT

Minimal research has been focussed on the decision to hand responsibility back to ward staff so the MET may leave the ward with safety plan in place. This study provided expert consensus to optimise MET stand-down decision-making and the ultimate decision to end a MET call. Communication of agreed patient treatment and escalation plans is recommended before leaving the ward. This study can be used as a checklist for MET responder staff making these decisions and ward staff responsible for post-MET call care. The aim being to reduce the likelihood of potentially preventable repeat deterioration in the MET patient population.

REPORTING METHOD

The CREDES guidance on conducting and reporting Delphi studies.

PATIENT OR PUBLIC CONTRIBUTION

None.

Eye donation from palliative and hospice care contexts: the EDiPPPP mixed-methods study

Background

Over 2 million people in the United Kingdom are living with sight loss with costs to the United Kingdom economy reported as £4.34 billion annually. Conditions that lead to sight loss and impaired vision can be treated if eye tissue is available for corneal transplantation, reconstructive surgery and research into eye diseases. Supply of eye tissue (only available via eye donation) is currently insufficient to meet demand; therefore, new routes are needed. Hospice and hospital-based Palliative Care Services have been reported as potential donation sources of this tissue.

Objectives

To: (1) scope the size and clinical characteristics of the potential eye donation population from research sites; (2) map the donation climate of each research site; (3) identify factors that enable or challenge service providers to consider the option of eye donation from a local and national perspective; (4) identify service users' views regarding the option of eye donation and the propriety of discussing eye donation; and (5) develop and pilot an empirically based intervention designed to change behaviours in relation to eye donation.

Design

A 36-month mixed-methods, multicentre study undertaking three work packages.

Settings

Three hospice care and three hospital-based palliative care services situated in the North, Midlands and the South of England (one service of each type per region).

Participants

Work package 1 - 105 service providers. Work package 2 - 62 service users, and 156 service providers in the national survey. Work package 3 - 21 expert consultees (patient and public involvement, cross discipline).

Data sources

Scoping review, retrospective note review, qualitative interviews/focus groups, participant observation, secondary analysis of primary data, national survey, transparent expert consultation.

Results

Potential: The retrospective notes review demonstrated that of 1199 deceased patients' notes, 553 (46%) patients met the criteria for eye donation (56%, n = 337 in hospice care service settings and 36%, n = 216 in hospital palliative care service). Practice: Less than 4% of all cases agreed as eligible for donation had been approached or referred for eye donation. Eye donation is not currently an embedded practice at local and national levels. Perceptions: Service providers were motivated to discuss eye donation but lacked opportunity and capability. Service users were willing and able to hold conversations about eye donation but were not aware of the option and had not had the option discussed with them. Preferences: Service users wanted to be offered the option of eye donation, and service providers wanted bespoke education and training related to eye donation. Evaluation of the developed intervention STEPS - Support Toolkit for Eye donation in Palliative care Settings will follow implementation of the full intervention (expected to begin in October 2022).

Limitations

Due to the significant impact of the COVID-19 pandemic on clinical sites, partner organisations and national service providers, only two elements of the developed intervention have been pilot tested for proof of concept and the response rate to the national survey was low (8%).

Conclusions

Significant potential exists for eye donation from hospice care and hospital palliative care services; however, individual and organisational behaviour as well as information system-based changes are needed to maximise this potential.

Future work

Evaluation of the STEPS - Support Toolkit for Eye donation in Palliative care Settings; Research exploring the wider public knowledge and views regarding eye donation; research exploring the use of language by National Health Service Blood and Transplant-Tissue and Eye Services in their public-facing infographics, communications and campaigns (specifically the use of the term eye donation).

Trial registration

This trial is registered as ISRCTN14243635: Eye donation from palliative care and hospice care settings.

Funding details

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (17/49/42) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 20. See the NIHR Journals Library website for further project information.

Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study

OBJECTIVE

To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.

DESIGN

A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.

SETTING

High-income countries.

PARTICIPANTS

Household food security experts in academia, government and non-government organisations who had published in the last 5 years.

RESULTS

Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.

CONCLUSIONS

This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Comparison of methods to engage diverse stakeholder populations in prioritizing PrEP implementation strategies for testing in resource-limited settings: a cross-sectional study

BACKGROUND

There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting.

METHODS

We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) "past experience surveys" with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) "pre- and post-small-group ranking" surveys before and after group discussion (N = 44 and 40); (4) "go-zone" quadrant plots of perceived effectiveness vs feasibility. Kendall's correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.

RESULTS

The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.

CONCLUSIONS

Both experienced and inexperienced stakeholder participants' strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.

Consensus on Feedback Statements That Create Responsibility Among People With Parkinson's Disease: A Delphi Study

IMPORTANCE

Sense of agency is associated with a sense of responsibility, which is essential to performing goal-directed occupations.

OBJECTIVE

To reach consensus on a set of extrinsic feedback statements that have the potential to create a sense of responsibility among patients with neurological disorders in the course of performing daily or social occupations.

DESIGN

Anonymous Delphi study with two rounds with international experts and one round with Irani patients with Parkinson's disease (PD).

SETTING

Electronic survey.

PARTICIPANTS

One hundred experts and 73 patients with idiopathic PD.

OUTCOMES AND MEASURES

Experts and patients anonymously rated (5 = strongly agree/very effective, 4 = agree/effective, 3 = neither agree nor disagree/uncertain, 2 = disagree/ineffective, 1 = strongly disagree/very ineffective) their level of agreement with each survey statement and the effectiveness of each statement in creating a sense of responsibility in the course of performing daily or social occupations. Consensus was set as an interquartile range of ≤1 and ≥70% agreement in two adjacent categories of a Likert scale.

RESULTS

In the experts' first round, consensus was reached on the level of agreement and effectiveness of 18 statements. In the second round, final consensus was achieved on all statements. In the one patient round, patients reached consensus on all statements. Finally, 34 statements were rated as 4 or 5 in terms of agreement and effectiveness, based on the opinions of experts and patients.

CONCLUSIONS AND RELEVANCE

This study has produced a collection of feedback statements that might be useful in occupation-based interventions. What This Article Adds: Extrinsic responsibility feedback delivered while administering occupation-based interventions may increase volition, motivation, and engagement.

Towards criteria and symptoms of constipation in people with severe or profound intellectual and multiple disabilities: A Delphi study

Background

Chronic constipation is common in people with intellectual disabilities, and seems to be highly prevalent in people with severe or profound intellectual and multiple disabilities (SPIMD). However, there is no current widely accepted definition for the constipation experienced by these individuals.

Aim

This Delphi study aims to compile a list of operationalized criteria and symptoms of constipation in people with SPIMD based on practical experiences of and consensus between experts supporting them.

Methods

A two-round Delphi study with an intermediate evaluation and analyses was conducted. Parents and relatives of persons with SPIMD and support professionals were included. The panel answered statements and open questions about symptoms and criteria of constipation. They were also requested to provide their opinion about classifying criteria and symptoms into domains. Answers to statements were analysed separately after both rounds with regard to consensus rate and displayed qualitatively; answers to open questions were analysed deductively.

Results

In the first Delphi round (n = 47), consensus was achieved on criteria within the domains 'Defecation' and 'Physical features', that were assigned to broader categories. Symptoms retrieved within the domain 'Behavioural/Emotional' were brought back to the panel as statements. After the second Delphi round (n = 38), consensus was reached on questions about domains, and for eight criteria (domain 'Defecation' n = 5; domain 'Physical features n = 3). Within the domain 'Behavioural/Emotional', consensus was achieved for five symptoms. Criteria and symptoms with consensus >70% were considered 'generic' and <70% as 'personal'. Symptoms mentioned in the text boxes were used to operationalize categories.

Discussion and conclusion

It was possible to compile a list of generic criteria related to the domains 'Defecation' (n = 5) and 'Physical features' (n = 3) supplemented with generic symptoms related to the domain 'Behavioural/Emotional' (n = 5). We propose using both generic as well as personal criteria and symptoms resulting in a personal profile for an individual with SPIMD. Based on the current results, we recommend follow-up research to develop a screening tool to be used by relatives and professional caregivers, and a definition of constipation. This may support reciprocal collaboration and lead to timely identification of constipation in people with SPIMD.

The heart of the matter: Right heart imaging indicators for treatment escalation in pulmonary arterial hypertension

Right heart (RH) structure and function are major determinants of symptoms and prognosis in pulmonary arterial hypertension (PAH). RH imaging provides detailed information, but evidence and guidelines on the use of RH imaging in treatment decisions are limited. We conducted a Delphi study to gather expert opinion on the role of RH imaging in decision-making for treatment escalation in PAH. A panel of 17 physicians with expertise in PAH and RH imaging used three surveys in a modified Delphi process to reach consensus on the role of RH imaging in PAH. Survey 1 used open-ended questions to gather information. Survey 2 contained Likert scale and other questions intended to identify consensus on topics identified in Survey 1. Survey 3 contained Likert scale questions derived from Survey 2 and summary information on the results of Survey 2. The Delphi panel reached consensus that RH imaging is likely to improve the current risk stratification algorithms and help differentiate risk levels in patients at intermediate risk. Tricuspid annular plane systolic excursion, right ventricular fractional area change, right atrial area, tricuspid regurgitation, inferior venae cavae diameter, and pericardial effusion should be part of routine echocardiography in PAH. Cardiac magnetic resonance imaging is valuable but limited by cost and access. A pattern of abnormal RH imaging results should prompt consideration of hemodynamic evaluation and possible treatment escalation. RH imaging is an important tool for decisions about treatment escalation in PAH, but systematically collected evidence is needed to clarify its role.

Enhancing Veteran Community Reintegration Research (ENCORE): Protocol for a Mixed Methods and Stakeholder Engagement Project

BACKGROUND

Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service.

OBJECTIVE

Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration's Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT.

METHODS

ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals.

RESULTS

As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR-related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination.

CONCLUSIONS

The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42029.

Numerical and experimental methods used to evaluate active drag in swimming: A systematic narrative review

Introduction: In swimming, it is necessary to understand and identify the main factors that are important to reduce active drag and, consequently, improve the performance of swimmers. However, there is no up-to-date review in the literature clarifying this topic. Thus, a systematic narrative review was performed to update the body of knowledge on active drag in swimming through numerical and experimental methods.

Methods: To determine and identify the most relevant studies for this review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used.

Results: 75 studies related to active drag in swimming and the methodologies applied to study them were analyzed and kept for synthesis. The included studies showed a high-quality score by the Delphi scale (mean score was 5.85 ± 0.38). Active drag was included in seven studies through numerical methods and 68 through experimental methods. In both methods used by the authors to determine the drag, it can be concluded that the frontal surface area plays a fundamental role. Additionally, the technique seems to be a determining factor in reducing the drag force and increasing the propulsive force. Drag tends to increase with speed and frontal surface area, being greater in adults than in children due to body density factors and high levels of speed. However, the coefficient of drag decreases as the technical efficiency of swimming increases (i.e., the best swimmers (the fastest or most efficient) are those with the best drag and swimming hydrodynamics efficiency).

Conclusion: Active drag was studied through numerical and experimental methods. There are significantly fewer numerical studies than experimental ones. This is because active drag, as a dynamical phenomenon, is too complex to be studied numerically. Drag is greater in adults than in children and greater in men than in women across all age groups. The study of drag is increasingly essential to collaborate with coaches in the process of understanding the fundamental patterns of movement biomechanics to achieve the best performance in swimming. Although most agree with these findings, there is disagreement in some studies, especially when it is difficult to define competitive level and age. The disagreement concerns three main aspects: 1) period of the studies and improvement of methodologies; 2) discrimination of methodologies between factors observed in numerical vs. experimental methods; 3) evidence that drag tends to be non-linear and depends on personal, technical, and stylistic factors. Based on the complexity of active drag, the study of this phenomenon must continue to improve swimming performance.

Media competencies for nurses: A Delphi study

BACKGROUND

Media raises awareness of important health issues, provides guidance to promote health, and shapes health policies. However, nurses are poorly represented in media.

PURPOSE

To propose competencies that can be used to advance nurses' knowledge and skills in using media to advance health.

METHODS

A Delphi study design of three successive surveys was employed. The Round 1 survey was sent to 70 nurse media leaders, and 28 (40%) responded. Seventeen respondents (61%) participated in Round 2. The Round 3 survey was not needed.

DISCUSSION

These competencies provide direction for academia, healthcare organizations, nursing associations and others who seek to develop the leadership and population health skills of nurses. Ways the competencies can be used are outlined.

CONCLUSION

There is an urgent need to improve population health outcomes by reducing disparities and promoting equity in health and health care. Media engagmeent is an importnat strategy for promoting population health. Additionally, promotion of better media representation of nurses and improved media engagement by nurses and nursing organizations all speak to the importance of advancing media competence.

Thinking globally to improve care locally: A Delphi study protocol to achieve international clinical consensus on best-practice end-of-life communication with adolescents and young adults with cancer

For the sizeable subset of adolescents and young adults whose cancer is incurable, developmentally appropriate end-of-life discussions are critical. Standards of care for adolescent and young adult end-of-life communication have been established, however, many health-professionals do not feel confident leading these conversations, leaving gaps in the implementation of best-practice end-of-life communication. We present a protocol for a Delphi study informing the development and implementation of clinician training to strengthen health-professionals' capacity in end-of-life conversations. Our approach will inform training to address barriers to end-of-life communication with adolescents and young adults across Westernized Adolescent and Young Adult Cancer Global Accord countries. The Adolescent and Young Adult Cancer Global Accord team involves 26 investigators from Australia, New Zealand, the United States, Canada and the United Kingdom. Twenty-four consumers, including adolescents and young adults with cancer history and carers, informed study design. We describe methodology for a modified Delphi questionnaire. The questionnaire aims to determine optimal timing for end-of-life communication with adolescents and young adults, practice-related content needed in clinician training for end-of-life communication with adolescents and young adults, and desireability of evidence-based training models. Round 1 involves an expert panel of investigators identifying appropriate questionnaire items. Rounds 2 and 3 involve questionnaires of international multidisciplinary health-professionals, followed by further input by adolescents and young adults. A second stage of research will design health-professional training to support best-practice end-of-life communication. The outcomes of this iterative and participatory research will directly inform the implementation of best-practice end-of-life communication across Adolescent and Young Adult Cancer Global Accord countries. Barriers and training preferences identified will directly contribute to developing clinician-training resources. Our results will provide a framework to support further investigating end-of-life communication with adolescents and young adults across diverse countries. Our experiences also highlight effective methodology in undertaking highly collaborative global research.

Screening Strategies for Pulmonary Hypertension in Patients With Interstitial Lung Disease: A Multidisciplinary Delphi Study

BACKGROUND

Pulmonary hypertension (PH) is a common complication of interstitial lung disease (ILD) and is associated with worse outcomes and increased mortality. Evaluation of PH is recommended in lung transplant candidates, but there are currently no standardized screening approaches. Trials have identified therapies that are effective in this setting, providing another rationale to routinely screen patients with ILD for PH.

RESEARCH QUESTION

What screening strategies for identifying PH in patients with ILD are supported by expert consensus?

STUDY DESIGN AND METHODS

The study convened a panel of 16 pulmonologists with expertise in PH and ILD, and used a modified Delphi consensus process with three surveys to identify PH screening strategies. Survey 1 consisted primarily of open-ended questions. Surveys 2 and 3 were developed from responses to survey 1 and contained statements about PH screening that panelists rated from -5 (strongly disagree) to 5 (strongly agree).

RESULTS

Panelists reached consensus on several triggers for suspicion of PH including the following: symptoms, clinical signs, findings on chest CT scan or other imaging, abnormalities in pulse oximetry, elevations in brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP), and unexplained worsening in pulmonary function tests or 6-min walk distance. Echocardiography and BNP/NT-proBNP were identified as screening tools for PH. Right heart catheterization was deemed essential for confirming PH.

INTERPRETATION

Many patients with ILD may benefit from early evaluation of PH now that an approved therapy is available. Protocols to evaluate patients with ILD often overlap with evaluations for pulmonary hypertension-interstitial lung disease and can be used to assess the risk of PH. Because standardized approaches are lacking, this consensus statement is intended to aid physicians in the identification of patients with ILD and possible PH, and provide guidance for timely right heart catheterization.

Core competencies for a biomedical laboratory scientist - a Delphi study

BACKGROUND

After completing university education, biomedical laboratory scientists work in clinical laboratories, in biomedical research laboratories, in biotech, and in pharmaceutical companies. Laboratory diagnostics have undergone rapid development over the recent years, with the pace showing no signs of abatement. This rapid development challenges the competence of the staff and will most certainly influence the education of future staff. This study aimed to examine what was considered the necessary competencies needed to pursue a career as a biomedical laboratory scientist.

METHODS

A modified Delphi technique was used, with the panel of experts expressing their views in a series of three questionnaire. Consensus was defined as the point which 75 % or more of the panel participants agreed that a particular competency was necessary.

RESULTS

The study highlights the perceived importance of mostly generic competencies that relate to quality, quality assurance, and accuracy, as well as different aspects of safety, respect, trustworthiness (towards patients/clients and colleagues), and communication skills. The results also stress the significance of self-awareness and professionality.

CONCLUSIONS

We identified important competencies for biomedical laboratory scientists. Together with complementary information from other sources, i.e., guidelines, laws, and scientific publications, the competencies identified can be used as learning outcomes in a competency-based education to provide students with all the competencies needed to work as professional biomedical laboratory scientists.

Understanding the implementation strategy of a secondary care tobacco addiction treatment pathway (the CURE project) in England: a strategic behavioural analysis

OBJECTIVES

The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project implemented an evidence-based intervention that offers a combination of pharmacotherapy and behavioural support to tobacco-dependent inpatients. Understanding key characteristics of CURE's implementation strategy, and identifying areas for improvement, is important to support the roll-out of nationwide tobacco dependence services. This study aimed to (1) specify key characteristics of CURE's exiting implementation strategy and (2) develop theoretical-informed and stakeholder-informed recommendations to optimise wider roll-out.

DESIGN AND METHODS

Data were collected via document review and secondary analysis of interviews with 10 healthcare professionals of a UK hospital. Intervention content was specified through behaviour change techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A logic model was developed to specify CURE's implementation strategy and its mechanisms of impact. We explored the extent to which BCTs and intervention functions addressed the key theoretical domains influencing implementation using prespecified matrices. The development of recommendations was conducted over a two-round Delphi exercise.

RESULTS

We identified six key theoretical domains of influences: 'environmental context and resources', 'goals', 'social professional role and identity', 'social influences', 'reinforcement' and 'skills'. The behavioural analysis identified 26 BCTs, 4 intervention functions and 4 policy categories present within the implementation strategy. The implementation strategy included half the relevant intervention functions and BCTs to target theoretical domains influencing CURE implementation, with many BCTs focusing on shaping knowledge. Recommendations to optimise content were developed following stakeholder engagement.

CONCLUSIONS

CURE offers a strong foundation from which a tobacco dependence treatment model can be developed in England. The exiting strategy could be strengthened via the inclusion of more theoretically congruent BCTs, particularly relating to 'environmental context and resources'. The recommendations provide routes to optimisation that are both theoretically grounded and stakeholder informed. Future research should assess the feasibility/acceptability of these recommendations in the wider secondary-care context.

Use of mucoactive agents in cystic fibrosis: A consensus survey of Italian specialists

Background

The goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients.

Method

A consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF.

Results

Full or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice.

Conclusions

The consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient.

Review: Preference elicitation methods for appropriate breeding objectives

Breeding objectives of livestock and other agricultural species are usually profit maximising. The selection emphasis placed on specific traits to achieve a breeding objective is often informed by the financial value of a trait to a farm system. However, there are alternative, and complementary approaches to defining both the breeding objective and the selection emphasis placed on traits that are included in associated selection tools. These are based on the preferences of stakeholders, which are often heterogeneous and include broader values and motivations than profit. In this regard, stated preference methods are useful when considering traits that have either no discernible market value or whose value is not fully transferred via the market. Such approaches can guide more appropriate breeding decisions that are amenable to changing societal values, for example with reduced negative environmental externalities. However, while stated preference methods offer promising conceptualisations of value in genetic improvement programmes, there is still a substantial knowledge gap in terms of the current state of research and a catalogue of publications to date. This paper reviews publications of stated preference approaches in the field of livestock breeding (and some relevant crop breeding examples), providing a knowledge base of published applications and promoting their continued development and implementation towards the formulation of appropriate breeding objectives and selection indices. A systematic review of 84 peer-reviewed publications and an aggregate ranking of traits for the most commonly studied subject (cattle) reveals uncertainty in preference estimates which may be driven by (i) a diverse set of non-standardised methodologies, (ii) common oversights in the selection, inclusion and description of traits, and (iii) inaccurate representations of the respondent population. We discuss key considerations to help overcome these limitations, including avoiding methodological confinement to a disciplinary silo and reducing complexity so that the values of broader respondent groups may be accounted for.

Analysis of Human Reliability in Fever Clinics during the Epidemic Based on the DEMATEL Method

Objective. To explore the method and process of human reliability analysis in epidemic prevention and control system in the complex environment of fever clinics. Methods. Based on the actual situation in the fever clinic of a level A tertiary hospital in Wenzhou, factors that affect clinical safety are sorted out. The Delphi method is used when evaluating the interrelationship among the contributing factors, and then, the DEMATEL method is used to further sort it out to build an impact model. Finally, the data of the experimental model are analyzed, and the impact of factors on human reliability is summarized. Results. Through the data analysis of 23 factors in the fever clinic of the hospital, the impact, prominence, and relation of each factor are confirmed. It is concluded that layout design, disinfection, and isolation setting and on-the-job training are the core factors impacting the operation of the fever clinic. Conclusion. Conducting a human factor reliability analysis with the help of the DEMATEL method can quantitatively describe the influence and interrelationship of human factors in epidemic prevention and control system and effectively promote the safety enhancement of fever clinics.

FIDEPOC: Consensus on Inspiratory Flow and Lung Deposition as Key Decision Factors in COPD Inhaled Therapy

Purpose

The pharmacological treatment of chronic obstructive pulmonary disease (COPD) is largely based on inhaled bronchodilators. Inspiratory flow and lung deposition are key parameters to be considered in inhaled therapy; however, the relationship between these two parameters, the patient specificities, and the suitability of the inhaler type for COPD management has not been fully addressed. The present study follows a Delphi Panel methodology to find expert consensus on the role of inspiratory flow and lung deposition as key decision factors in COPD inhaled therapy.

Methods

A two-round Delphi Panel, consisting of 38 statements (items) and completed by 57 Spanish pulmonologists, was carried out to measure the experts' consensus degree with each item.

Results

A high degree of consensus was reached on most of the items consulted, among these inspiratory flow or inspiratory capacity should be periodically considered when choosing an inhalation device and to ensure the suitability of the inhaler used; the outflow velocity and particle size of the different devices should be considered to ensure adequate lung deposition; an active device (pressurized metered-dose inhalers (pMDI) or soft mist inhalers (SMI)) should be used in patients with low inspiratory flow to achieve adequate lung deposition; and, the use of dry powder inhalers (DPI) should be re-evaluated in patients with severe obstruction and severe exacerbations.

Conclusion

This study shows the relevance of inspiratory flow and the degree of particle deposition in the lung in the choice of an inhalation device for COPD management, as well as the convenience of an SMI type device in cases of low inspiratory flow. Moreover, it highlights the scarcity of information on the specific features of inhalation devices in COPD guidelines.