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Kako J, Kajiwara K, Kobayashi M, Kanno Y, Morikawa M, Nakano K, Matsuda Y, Shimizu Y, Niino M, Suzuki M, Shimazu T. Applicability of Nursing Support for Patients With Terminal Cancer and Their Families: A Delphi Study. Am J Hosp Palliat Care 2024:10499091241245266. [PMID: 38580325 DOI: 10.1177/10499091241245266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND This report investigates the applicability of nursing support for patients with cancer with a prognosis of months and weeks, and their families. OBJECTIVES To evaluate the applicability of nursing support for five symptoms (dyspnea, pain, nausea/vomiting, constipation, and delirium) in patients with cancer during the last weeks of life, and the caregiver burden on their families. DESIGN SETTING A Delphi study was used to determine the applicability of nursing support for patients with terminal cancer and their families. Eight experts in symptom palliation in Japan who have direct care or research experience with these populations were included. The Delphi method was used to assess nursing support types for prognoses of months and weeks. Consensus was defined as ≥70% agreement for either "high applicability" or "low applicability" of each support type. RESULTS A total of 50 nursing support types for 5 symptoms were evaluated as highly applicable for 92% (n = 46) of patients with cancer with a prognosis of months. For patients with cancer with a prognosis of weeks, 78% (n = 39) of the nursing support was rated as highly applicable. For both prognosis groups, all nursing support (n = 6) for caregiver burden was highly applicable. CONCLUSION Applicability ratings of nursing support may be influenced by a high degree of invasiveness, accessibility of knowledge and information, and high expectations of effectiveness. Future studies are needed to verify the effectiveness of nursing support evaluated as highly applicable to patients with cancer during the last few months and weeks of life.
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Affiliation(s)
- Jun Kako
- Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kohei Kajiwara
- Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Masamitsu Kobayashi
- Graduate of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yusuke Kanno
- Nursing Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kimiko Nakano
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, NHO Kinki Chuo Chest Medical Center, Sakai, Japan
| | - Yoichi Shimizu
- School of Nursing, National College of Nursing, Kiyose, Japan
| | - Mariko Niino
- Center for Cancer Registries, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Miho Suzuki
- Faculty of Nursing and Medical Care, Keio University, Fujisawa, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
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Cygan HR, Dombrowski RD, Moore EWG, Tully J, Kin K, Hansen E. Development of a School Health Policy Implementation Survey: A Delphi Study. J Sch Nurs 2024; 40:135-143. [PMID: 34882017 DOI: 10.1177/10598405211057588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n = 378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n = 64) of questions. The remaining 15.8% (n = 12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.
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Affiliation(s)
- Heide R Cygan
- Community, Systems and Mental Health Nursing, Rush University College of Nursing, Chicago, IL
| | - Rachael D Dombrowski
- Division of Kinesiology Health and Sport Studies, College of Education, Wayne State University, Detroit, MI
| | - E Whitney G Moore
- Kinesiology, Health & Sport Studies, Achievement Motivation Theory Specialist, College of Education, Wayne State University, Detroit, MI
| | - Jamie Tully
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL
| | - Kimberly Kin
- Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI
| | - Elizabeth Hansen
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL
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Farina N, Rajagopalan J, Alladi S, Ibnidris A, Ferri CP, Knapp M, Comas-Herrera A. Estimating the number of people living with dementia at different stages of the condition in India: A Delphi process. Dementia (London) 2024; 23:438-451. [PMID: 37272749 DOI: 10.1177/14713012231181627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Numerous studies have previously estimated the dementia prevalence in India. However, as these estimates use different methodologies and sampling strategies, generating definitive prevalence estimates can be difficult. METHODS A Delphi process involving eight clinical and academic experts provided prevalence estimates of dementia within India, split by sex and age. The experts were also asked to estimate the number of people potentially living at different stages of the condition. A priori criteria were used to ascertain the point in which consensus was achieved. RESULTS Our consensus estimates generated a dementia prevalence of 2.8% (95% CI = 1.9 to 3.6) for those aged 60 years and above in India. Consensus was achieved across age and sex prevalence estimates, with the exception of one (females aged 60-64). Our experts estimated that 42.9% of people living with dementia in India had a mild severity. CONCLUSIONS The findings indicate that there could be approximately 3.9 million people living with dementia in India, of which 1.7 million could be living with dementia of mild severity. Such estimates can better help researchers and policy makers to estimate the true cost and impact of dementia in India and can inform resource allocation decisions.
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Affiliation(s)
| | - Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Suvarna Alladi
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Aliaa Ibnidris
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Cleusa P Ferri
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
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Jackson T, Sow Y, Dinkins J, Aguh C, Omueti Ayoade K, Barbosa V, Burgess C, Callender V, Cotsarelis G, Grimes P, Harvey V, Kindred C, Lester J, Lo Sicco K, Mayo T, McMichael A, Oboite M, Ogunleye T, Olsen E, Osei-Tutu A, Piliang M, Senna M, Shapiro J, Tosti A, Frey C, Adotama P, Taylor SC. Treatment for central centrifugal cicatricial alopecia- Delphi consensus recommendations. J Am Acad Dermatol 2024:S0190-9622(24)00308-6. [PMID: 38341148 DOI: 10.1016/j.jaad.2023.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. OBJECTIVE To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. METHODS We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. RESULTS In round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in round 2. After the final round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. LIMITATIONS This study included only English-speaking, US-based dermatologists and did not consider nonpharmacological therapies. CONCLUSION Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA.
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Affiliation(s)
| | - Yacine Sow
- Morehouse School of Medicine, Atlanta, Georgia
| | | | - Crystal Aguh
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Katherine Omueti Ayoade
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria Barbosa
- Section of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Cheryl Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, District of Columbia
| | | | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pearl Grimes
- Grimes Center for Medical and Aesthetic Dermatology, Vitiligo and Pigmentation Institute of Southern California, Los Angeles, California
| | - Valerie Harvey
- Tidewater Physicians Multispecialty Group, Virginia Beach, Virginia; Hampton Roads Center for Dermatology, Newport News, Virginia
| | | | - Jenna Lester
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Tiffany Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michelle Oboite
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Temitayo Ogunleye
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise Olsen
- Department of Dermatology, Duke University, Durham, North Carolina
| | | | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Maryanne Senna
- Lahey Hair Loss Center of Excellence and Research Unit, Burlington, Massachusetts
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Antonella Tosti
- Department of Dermatology, University of Miami, Miami, Florida
| | - Cheri Frey
- Department of Dermatology, Howard University, Washington, District of Columbia
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Sun S, Rodriguez G, Zhao G, Sanchez JE, Guo W, Du D, Rodriguez Moncivais OJ, Hu D, Liu J, Kirken RA, Li L. A novel approach to study multi-domain motions in JAK1's activation mechanism based on energy landscape. Brief Bioinform 2024; 25:bbae079. [PMID: 38446738 PMCID: PMC10939344 DOI: 10.1093/bib/bbae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
The family of Janus Kinases (JAKs) associated with the JAK-signal transducers and activators of transcription signaling pathway plays a vital role in the regulation of various cellular processes. The conformational change of JAKs is the fundamental steps for activation, affecting multiple intracellular signaling pathways. However, the transitional process from inactive to active kinase is still a mystery. This study is aimed at investigating the electrostatic properties and transitional states of JAK1 to a fully activation to a catalytically active enzyme. To achieve this goal, structures of the inhibited/activated full-length JAK1 were modelled and the energies of JAK1 with Tyrosine Kinase (TK) domain at different positions were calculated, and Dijkstra's method was applied to find the energetically smoothest path. Through a comparison of the energetically smoothest paths of kinase inactivating P733L and S703I mutations, an evaluation of the reasons why these mutations lead to negative or positive regulation of JAK1 are provided. Our energy analysis suggests that activation of JAK1 is thermodynamically spontaneous, with the inhibition resulting from an energy barrier at the initial steps of activation, specifically the release of the TK domain from the inhibited Four-point-one, Ezrin, Radixin, Moesin-PK cavity. Overall, this work provides insights into the potential pathway for TK translocation and the activation mechanism of JAK1.
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Affiliation(s)
- Shengjie Sun
- Department of Biomedical Informatic, School of Life Sciences, Central South University, Changsha 410083, China
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
| | - Georgialina Rodriguez
- Department of Biological Sciences, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
- Border Biomedical Research Center, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Gaoshu Zhao
- Google LLC, 1600 Amphitheatre Parkway Mountain View, CA 94043, USA
| | - Jason E Sanchez
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
| | - Wenhan Guo
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
| | - Dan Du
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
| | - Omar J Rodriguez Moncivais
- Department of Biological Sciences, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
- Border Biomedical Research Center, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Dehua Hu
- Department of Biomedical Informatic, School of Life Sciences, Central South University, Changsha 410083, China
| | - Jing Liu
- Department of Hematology, The Second Xiangya Hospital of Central South University; Molecular Biology Research Center, Center for Medical Genetics, School of Life Sciences, Central South University, Changsha 410083, China
| | - Robert Arthur Kirken
- Department of Biological Sciences, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
- Border Biomedical Research Center, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Lin Li
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
- Google LLC, 1600 Amphitheatre Parkway Mountain View, CA 94043, USA
- Department of Physics, The University of Texas at El Paso, 500 W University Ave, TX 79968, USA
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Bhachech H, Nath K, Sidana R, Shah N, Nagpal R, Sathianathan R, Kakkad A, Korukonda K. Personalized Approach in the Management of Difficult-to-Treat and Treatment-Resistant Depression With Second-Generation Antipsychotics: A Delphi Statement. Cureus 2024; 16:e52878. [PMID: 38406088 PMCID: PMC10890970 DOI: 10.7759/cureus.52878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Major depressive disorder (MDD) has many facets including mixed or atypical depression that requires personalized care to improve treatment-related outcomes. Second-generation antipsychotics (SGAs) offer complementary mechanisms for clinical roles in difficult-to-treat depression and treatment-resistant depression cases. Aim/objective To further delineate a consensus on the clinical positioning of SGAs for MDD, mixed, or atypical depression, a Knowledge Attitude Perception (KAP)-mediated Delphi Statement was planned. Material/methods A literature review for the definition, diagnosis, and management of MDD, mixed, and atypical depression as treatment-resistant depression (TRD) or difficult-to-treat depression (DTD) was conducted by a steering committee of academic and clinical experts (n=6) while developing a validated KAP questionnaire. Scientific statements as clinical recommendations were evolved using the Delphi methodology before building a clinical expert consensus with an online survey (n=24). Results Twenty-four psychiatrists highlighted DTD to offer a multidimensional approach to assess treatment strategies involving selective serotonin reuptake inhibitors (SSRIs) or SGAs, while ensuring symptom, functional, and quality of life (QoL) domain improvement for improved outcomes and remission rates. MDD cases with anxiety, anhedonia, comorbidities, and risk traits require personalized care with early induction of SGAs for severe cases or symptom persisters with functional impairment. Early augmentation with SGAs including aripiprazole or cariprazine can provide a favorable risk-benefit profile for clinical cases of MDD with or without the antecedent of mixed depression or personality disorder. Conclusion The literature review and KAP responses emphasize the importance of early identification for personalized care strategies with SGAs for DTD. Large-scale real-world evidence needs to evolve with due recognition of different phenotypes as TRD or DTD with partial or functional impairment to understand the impact of appropriate treatment pathways with SGAs.
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Affiliation(s)
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, IND
| | - Roop Sidana
- Department of Psychiatry, Tekchand Sidana Memorial Psychiatric Hospital and Deaddiction Centre, Sriganganagar, IND
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Medical College, Sion, Mumbai, IND
| | - Rajesh Nagpal
- Department of Psychiatry, Manobal Clinic, New Delhi, IND
| | - R Sathianathan
- Department of Psychiatry, Madras Memory Clinic, Chennai, IND
| | - Ashutosh Kakkad
- Medical Services, Torrent Pharmaceuticals Limited, Ahmedabad, IND
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Montgomery AJ, Litell J, Dang J, Flurin L, Gajic O, Lal A. Gaining consensus on expert rule statements for acute respiratory failure digital twin patient model in intensive care unit using a Delphi method. Biomol Biomed 2023; 23:1108-1117. [PMID: 37431943 PMCID: PMC10655890 DOI: 10.17305/bb.2023.9344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Digital twin technology is a virtual depiction of a physical product and has been utilized in many fields. Digital twin patient model in healthcare is a virtual patient that provides opportunities to test the outcomes of various interventions virtually without subjecting an actual patient to possible harm. This can serve as a decision aid in the complex environment of the intensive care unit (ICU). Our objective is to develop consensus among a multidisciplinary expert panel on statements regarding respiratory pathophysiology contributing to respiratory failure in the medical ICU. We convened a panel of 34 international critical care experts. Our group modeled elements of respiratory failure pathophysiology using directed acyclic graphs (DAGs) and derived expert statements describing associated ICU clinical practices. The experts participated in three rounds of modified Delphi to gauge agreement on 78 final questions (13 statements with 6 substatements for each) using a Likert scale. A modified Delphi process achieved agreement for 62 of the final expert rule statements. Statements with the highest degree of agreement included the physiology, and management of airway obstruction decreasing alveolar ventilation and ventilation-perfusion matching. The lowest agreement statements involved the relationship between shock and hypoxemic respiratory failure due to heightened oxygen consumption and dead space. Our study proves the utility of a modified Delphi method to generate consensus to create expert rule statements for further development of a digital twin-patient model with acute respiratory failure. A substantial majority of expert rule statements used in the digital twin design align with expert knowledge of respiratory failure in critically ill patients.
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Affiliation(s)
| | - John Litell
- Department of Emergency Critical Care, Abbott Northwestern, Minneapolis, USA
| | - Johnny Dang
- Department of Neurology, Cleveland Clinic, Cleveland, USA
| | - Laure Flurin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Ognjen Gajic
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Amos Lal
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
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Studart-Pereira LM, Bianchini EMG, Assis M, Bussi MT, Corrêa CDC, Cunha TCA, Drager LF, Ieto V, Lorenzi-Filho G, de Luccas GR, Brasil EL, Sovinski SRP, Zancanella E, Pires GN. Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association. Sleep Sci 2023; 16:489-506. [PMID: 38370880 PMCID: PMC10869236 DOI: 10.1055/s-0043-1776109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either "agree" or "disagree"). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.
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Affiliation(s)
- Luciana Moraes Studart-Pereira
- Brazilian Sleep Association, São Paulo Brazil.
- Department of Speech-Language-Hearing Science, Federal University of Pernambuco, Recife Brazil.
| | | | - Márcia Assis
- Brazilian Sleep Association, São Paulo Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitibá, Brazil.
| | - Marieli Timpani Bussi
- Institute of Otorhinolaryngology & Head and Neck Surgery at UNICAMP, IOU, São Paulo Brazil.
| | | | - Thays Crosara Abrahão Cunha
- Brazilian Association of Sleep Dentistry, São Paulo Brazil.
- Núcleo de Ensino, Odontologia do Sono, São Paulo, Brazil.
| | - Luciano Ferreira Drager
- Brazilian Sleep Association, São Paulo Brazil.
- Hypertension Units, Institute of the Heart (InCor), and Course on Nephrology, University of São Paulo, São Paulo Brazil.
| | - Vanessa Ieto
- Speech-Language-Hearing Council, Brazilian Sleep Association, São Paulo Brazil.
| | | | - Gabriele Ramos de Luccas
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru Brazil.
| | - Evelyn Lucien Brasil
- Brazilian Sleep Association, São Paulo Brazil.
- Department of Critical Care Medicina, Hospital Israelita Albert Einstein, São Paulo Brazil.
| | | | - Edilson Zancanella
- Brazilian Association of Sleep Medicine, São Paulo Brazil.
- State University of Campinas, Campinas, São Paulo Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo – São Paulo Brazil.
- Sleep Institute, São Paulo Brazil.
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Zhang X, Yang M, Zhang J, Ye P, Wong RMY, Cheung WH, Armstrong E, Johansen A, Ivers R, Wu X, Tian M. Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry. Osteoporos Int 2023; 34:1763-1770. [PMID: 37341729 DOI: 10.1007/s00198-023-06832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.
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Affiliation(s)
- X Zhang
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - M Yang
- National Centre of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China.
| | - J Zhang
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - P Ye
- National Centre for Non-communicable Diseases Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - R M Y Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - W-H Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - E Armstrong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia
| | - A Johansen
- University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK
| | - R Ivers
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - X Wu
- National Centre of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China
| | - M Tian
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China.
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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Hira S, Dahl EJ, Maharjan K, Geisler JH. Further assessment of the clinical relevance of anatomical structures through PubMed and other measures. Clin Anat 2023; 36:1027-1039. [PMID: 37477195 DOI: 10.1002/ca.24095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
A previous paper has demonstrated a statistically significant moderate correlation between the number of citations obtained from PubMed and a Delphi study for 251 anatomical structures of the Head and Neck region, suggesting that clinical significance is a major driver of research involving anatomical structures. This raises the possibility that these ranks could be an objective measure of clinical relevance of individual anatomical structures. In the present study, we revisited the rankings of the PubMed results from the previous paper and compared it with a Delphi study for 450 musculoskeletal structures. PubMed ranks were derived using different search parameters; a PubMed search with quotations yielded a moderate, statistically significant correlation coefficient of 0.639 with the musculoskeletal dataset. Additionally, we developed a Python tool, PDF Term Search, to calculate the frequency of anatomical terms in four authoritative textbooks, and these frequencies exhibited moderate significant correlations ranging (0.549-0.646) with our PubMed-derived ranks. We further explored strategies to improve the accuracy of our PubMed results by addressing limitations identified in the previous paper. We refined the syntax of search queries for 500 anatomical structures, resulting in marked improvement in the correlation coefficients with the musculoskeletal dataset, demonstrating clear avenues for future iterations of PubMed-derived ranks. We also created a spreadsheet of 2181 anatomical structures ranked using PubMed, published Delphi studies, and authoritative texts, providing a resource for anatomical educators who are adjusting their curricula to better train future healthcare practitioners.
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Affiliation(s)
- Sarika Hira
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Eric J Dahl
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Kasmika Maharjan
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Jonathan H Geisler
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
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11
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Alayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL, Perl J, McCall N, Paul T, Ingabire JA, Shimelash N, Mutabazi E, Kimto EO, Danladi GM, Tubasiime R, Rickard J, Karekezi C, Makiriro G, Bigirimana SP, Harelimana JG, ElSayed A, Ndibanje AJ, Mpirimbanyi C, Masimbi O, Ndayishimiye M, Ntabana F, Haonga BT, Anderson GA, Byringyiro JC, Ntirenganya F, Riviello RR, Bekele A. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus 2023; 15:e43625. [PMID: 37600431 PMCID: PMC10433784 DOI: 10.7759/cureus.43625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
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Affiliation(s)
- Barnabas T Alayande
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Callum W Forbes
- Anesthesiology, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Jules Iradakunda
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Jean Paul Majyambere
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Butaro District Hospital, Kigali, RWA
| | - Matthew T Hey
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Brittany L Powell
- Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Juliana Perl
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Natalie McCall
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Tomlin Paul
- Educational Development and Quality Center, University of Global Health Equity, Kigali, RWA
| | - Jc Allen Ingabire
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Natnael Shimelash
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Emmanuel Mutabazi
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | | | - Claire Karekezi
- Surgery, Neurosurgery Unit, Rwanda Military Hospital, Kigali, RWA
| | - Gabriel Makiriro
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Simon Pierre Bigirimana
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - James G Harelimana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | - Ornella Masimbi
- Simulation, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | | | - Frederick Ntabana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Billy Thomson Haonga
- Orthopaedic Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Geoffrey A Anderson
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Jean Claude Byringyiro
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Orthopedics, University Teaching Hospital of Kigali, Kigali, RWA
| | - Faustin Ntirenganya
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Surgery, University Teaching Hospital of Kigali, Kigali, RWA
- NIHR Research Hub on Global Surgery, University of Rwanda, Kigali, RWA
| | - Robert R Riviello
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Kigali, RWA
| | - Abebe Bekele
- Cardiothoracic Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
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12
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Gouldthorpe C, Ancoli-Israel S, Cash E, Innominato P, Jakobsen G, Lévi F, Miaskowski C, Parganiha A, Pati AK, Pereira D, Revell V, Zeitzer JM, Davies A. International e- Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm Disorders (CARDs) in Patients with Cancer. Cancers (Basel) 2023; 15:3784. [PMID: 37568600 PMCID: PMC10416864 DOI: 10.3390/cancers15153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. METHODS An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. RESULTS Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. CONCLUSIONS The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head & Neck Surgery & Communicative Disorders, UofL Healthcare-Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Pasquale Innominato
- Oncology Department, Alaw, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Francis Lévi
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
- Gastro-Intestinal and General Oncology Service, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143, USA
| | - Arti Parganiha
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
| | - Atanu Kumar Pati
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
- Odisha State Higher Education Council, Government of Odisha, Bhubaneswar 751001, India
- Kalinga Institute of Social Sciences, Bhubaneswar 751024, India
| | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL 32610, USA
| | - Victoria Revell
- Surrey Sleep Research Centre, University of Surrey, Surrey GU2 7XH, UK
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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13
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Rosen CB, Roberts SE, Syvyk S, Finn C, Tong J, Wirtalla C, Spinks H, Kelz RR. A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial. JMIR Form Res 2023; 7:e42970. [PMID: 37440310 PMCID: PMC10375392 DOI: 10.2196/42970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with an increased risk of poor surgical outcomes among older adults; however, identifying multimorbidity in the clinical setting can be a challenge. OBJECTIVE We created the Multimorbid Patient Identifier App (MMApp) to easily identify patients with multimorbidity identified by the presence of a Qualifying Comorbidity Set and tested its feasibility for use in future clinical research, validation, and eventually to guide clinical decision-making. METHODS We adapted the Qualifying Comorbidity Sets' claims-based definition of multimorbidity for clinical use through a modified Delphi approach and developed MMApp. A total of 10 residents input 5 hypothetical emergency general surgery patient scenarios, common among older adults, into the MMApp and examined MMApp test characteristics for a total of 50 trials. For MMApp, comorbidities selected for each scenario were recorded, along with the number of comorbidities correctly chosen, incorrectly chosen, and missed for each scenario. The sensitivity and specificity of identifying a patient as multimorbid using MMApp were calculated using composite data from all scenarios. To assess model feasibility, we compared the mean task completion by scenario to that of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS-NSQIP-SRC) using paired t tests. Usability and satisfaction with MMApp were assessed using an 18-item questionnaire administered immediately after completing all 5 scenarios. RESULTS There was no significant difference in the task completion time between the MMApp and the ACS-NSQIP-SRC for scenarios A (86.3 seconds vs 74.3 seconds, P=.85) or C (58.4 seconds vs 68.9 seconds,P=.064), MMapp took less time for scenarios B (76.1 seconds vs 87.4 seconds, P=.03) and E (20.7 seconds vs 73 seconds, P<.001), and more time for scenario D (78.8 seconds vs 58.5 seconds, P=.02). The MMApp identified multimorbidity with 96.7% (29/30) sensitivity and 95% (19/20) specificity. User feedback was positive regarding MMApp's usability, efficiency, and usefulness. CONCLUSIONS The MMApp identified multimorbidity with high sensitivity and specificity and did not require significantly more time to complete than a commonly used web-based risk-stratification tool for most scenarios. Mean user times were well under 2 minutes. Feedback was overall positive from residents regarding the usability and usefulness of this app, even in the emergency general surgery setting. It would be feasible to use MMApp to identify patients with multimorbidity in the emergency general surgery setting for validation, research, and eventual clinical use. This type of mobile app could serve as a template for other research teams to create a tool to easily screen participants for potential enrollment.
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Affiliation(s)
| | | | - Solomiya Syvyk
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Caitlin Finn
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jason Tong
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Hunter Spinks
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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14
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Longo C, Navarrete-Dechent C, Tschandl P, Apalla Z, Argenziano G, Braun RP, Bataille V, Cabo H, Hoffmann-Wellhenhof R, Forsea AM, Garbe C, Guitera P, Raimond K, Marghoob AA, Malvehy J, del Marmol V, Moreno D, Nehal KS, Nagore E, Paoli J, Pellacani G, Peris K, Puig S, Soyer HP, Swetter S, Stratigos A, Stolz W, Thomas L, Tiodorovic D, Zalaudek I, Kittler H, Lallas A. Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna. Dermatol Pract Concept 2023; 13:dpc.1303a244. [PMID: 37403983 PMCID: PMC10412039 DOI: 10.5826/dpc.1303a244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Melanoma of the lentigo maligna (LM) type is challenging. There is lack of consensus on the optimal diagnosis, treatment, and follow-up. OBJECTIVES To obtain general consensus on the diagnosis, treatment, and follow-up for LM. METHODS A modified Delphi method was used. The invited participants were either members of the International Dermoscopy Society, academic experts, or authors of published articles relating to skin cancer and melanoma. Participants were required to respond across three rounds using a 4-point Likert scale). Consensus was defined as >75% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing. RESULTS Of the 31 experts invited to participate in this Delphi study, 29 participants completed Round 1 (89.9% response rate), 25/31 completed Round 2 (77.5% response rate), and 25/31 completed Round 3 (77.5% response rate). Experts agreed that LM diagnosis should be based on a clinical and dermatoscopic approach (92%) followed by a biopsy. The most appropriate primary treatment of LM was deemed to be margin-controlled surgery (83.3%), although non-surgical modalities, especially imiquimod, were commonly used either as alternative off-label primary treatment in selected patients or as adjuvant therapy following surgery; 62% participants responded life-long clinical follow-up was needed for LM. CONCLUSIONS Clinical and histological diagnosis of LM is challenging and should be based on macroscopic, dermatoscopic, and RCM examination followed by a biopsy. Different treatment modalities and follow-up should be carefully discussed with the patient.
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Affiliation(s)
- Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Zoe Apalla
- Second Dermatology Department, Aristotle University of Thessaloniki, Greece
| | | | - Ralph P. Braun
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Horacio Cabo
- Dermatology Department “Instituto de Investigaciones Médicas A. Lanari”, University of Buenos Aires, Argentina
| | - Rainer Hoffmann-Wellhenhof
- Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Ana Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Ashfaq A. Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Veronique del Marmol
- Department of Dermatology, CUB Hôpital Erasme - Brussels University Clinics, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno
- Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Kishwer S. Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Susana Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Susan Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Alexander Stratigos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, ‘A. Sygros’ Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Wilhelm Stolz
- Department of Dermatology, Allergology, and Environmental Medicine Clinic Thalkirchen, Hospital Munich, Munich, Germany
| | - Luc Thomas
- Department of Dermatology, Lyon-1 University, and Cancer research center Lyon, Lyon, France
| | | | - Iris Zalaudek
- Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
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15
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Rawal KB, Mateti UV, Shetty V, Shastry CS, Unnikrishnan MK, Shetty S, Rajesh A. Development of evidence-based indicators for the detection of drug-related problems among ovarian cancer patients. Front Pharmacol 2023; 14:1203648. [PMID: 37456735 PMCID: PMC10348894 DOI: 10.3389/fphar.2023.1203648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
Background: Antineoplastic drugs produce serious drug-related problems and their management is challenging. DRPs are critical, for saving on therapeutic costs, particularly in resource poor settings within low-middle-income countries such as India. Indicators are clues that helps to detect DRPs within the healthcare organization and minimize overall harm from medications. Indicators enable healthcare professionals to determine the future therapeutic course. And enable healthcare professionals to take a proactive stand, and stay informed and empowered to both prevent and manage DRPs. This study aims to develop evidence-based indicators for detecting potential drug-related problems in ovarian cancer patients. Patients and Methods: A retrospective study was conducted in the Department of Oncology of a tertiary care teaching hospital in South India. Based on literature search, we developed a list of indicators, which were validated by a Delphi panel of multidisciplinary healthcare professionals (16 members). Based on 2 years of ovarian cancer data, we performed a feasibility test retrospectively and classified the DRPs according to the Pharmaceutical Care Network Europe classification of DRPs version-9.1. Results: The feasibility test identified 130 out of 200 indicators. A total of 803 pDRPs were identified under four main categories: drug selection problem, drug use problem, adverse drug reaction and drug-drug interaction The most frequently observed were ADR 381 (47.45%), DDIs 354 (44.08%), and drug selection problems 62 (7.72%). Conclusion: Indicators developed by us effectively identified pDRPs in ovarian cancer patients, which can potentially help healthcare professionals in the early detection, timely management, and attenuating severity of DRPs. Identifying the pDDIs can potentially improve interdisciplinary involvement and task sharing, including enhanced pharmacists' participation within the healthcare team.
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Affiliation(s)
- Kala Bahadur Rawal
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Uday Venkat Mateti
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Vijith Shetty
- Department of Medical Oncology, KS Hegde Medical Academy (KSHEMA), Justice KS Hegde Charitable Hospital, Mangaluru, Karnataka, India
| | - Chakrakodi Shashidhara Shastry
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | | | - Shraddha Shetty
- Department of Biostatistics, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Aparna Rajesh
- Department of Obstetrics and Gynecology, KS Hegde Medical Academy (KSHEMA), Justice KS Hegde Charitable Hospital, Nitte (Deemed to be University), Mangaluru, Karnataka, India
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16
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Gressler LE, Cowley T, Velezis M, Aryal S, Clare D, Kusiak JW, Cowley AW, Sedrakyan A, Marinac-Dabic D, Reardon M, Schmidt L, Feldman JG, DiFabio V, Bergman S, Simonyan V, Yesha Y, Vasiliu-Feltes I, Durham J, Steen AI, Woods P, Kapos FP, Loyo-Berrios N. Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders. Front Digit Health 2023; 5:1132446. [PMID: 37255961 PMCID: PMC10226081 DOI: 10.3389/fdgth.2023.1132446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Background Conflicting reports from varying stakeholders related to prognosis and outcomes following placement of temporomandibular joint (TMJ) implants gave rise to the development of the TMJ Patient-Led RoundTable initiative. Following an assessment of the current availability of data, the RoundTable concluded that a strategically Coordinated Registry Network (CRN) is needed to collect and generate accessible data on temporomandibular disorder (TMD) and its care. The aim of this study was therefore to advance the clinical understanding, usage, and adoption of a core minimum dataset for TMD patients as the first foundational step toward building the CRN. Methods Candidate data elements were extracted from existing data sources and included in a Delphi survey administered to 92 participants. Data elements receiving less than 75% consensus were dropped. A purposive multi-stakeholder sub-group triangulated the items across patient and clinician-based experience to remove redundancies or duplicate items and reduce the response burden for both patients and clinicians. To reliably collect the identified data elements, the identified core minimum data elements were defined in the context of technical implementation within High-performance Integrated Virtual Environment (HIVE) web-application framework. HIVE was integrated with CHIOS™, an innovative permissioned blockchain platform, to strengthen the provenance of data captured in the registry and drive metadata to record all registry transaction and create a robust consent network. Results A total of 59 multi-stakeholder participants responded to the Delphi survey. The completion of the Delphi surveys followed by the application of the required group consensus threshold resulted in the selection of 397 data elements (254 for patient-generated data elements and 143 for clinician generated data elements). The infrastructure development and integration of HIVE and CHIOS™ was completed showing the maintenance of all data transaction information in blockchain, flexible recording of patient consent, data cataloging, and consent validation through smart contracts. Conclusion The identified data elements and development of the technological platform establishes a data infrastructure that facilitates the standardization and harmonization of data as well as perform high performance analytics needed to fully leverage the captured patient-generated data, clinical evidence, and other healthcare ecosystem data within the TMJ/TMD-CRN.
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Affiliation(s)
- Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Marti Velezis
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Allen W. Cowley
- Department of Physiology, Medical College of Wisconsin, Madison, WI, United States
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | | | | | | | - Vincent DiFabio
- Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore, MD, United States
| | - Suzie Bergman
- Dentistry on Officers Row, Vancouver, WA, United States
| | | | - Yelena Yesha
- Department of Computer Science, University of Miami, Miami, FL, United States
| | | | - Justin Durham
- School of Dental Sciences, NewcastleUnited Kingdom
- Newcastle-Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle, United Kingdom
| | - Andrew I. Steen
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Phillip Woods
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Flavia P. Kapos
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
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17
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Maga G, Arrigoni C, Brigante L, Cappadona R, Caruso R, Daniele MAS, Del Bo E, Ogliari C, Magon A. Developmental Strategy and Validation of the Midwifery Interventions Classification (MIC): A Delphi Study Protocol and Results from the Developmental Phase. Healthcare (Basel) 2023; 11:healthcare11060919. [PMID: 36981576 PMCID: PMC10048446 DOI: 10.3390/healthcare11060919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
This study protocol aims to describe the rationale and developmental strategy of the first study in the Italian context which aimed to define a Midwifery Interventions Classification, an evidence-based, standardized taxonomy and classification of midwifery interventions. Midwifery interventions require a specific definition, developed through a consensus-building process by stakeholders to develop the Italian taxonomy of the Midwifery Interventions Classification with the potential for international transferability, implementation, and scaling up. A multi-round Delphi study was designed between June and September 2022, and data collection is planned between February 2023 and February 2024. The developmental phase of the study is based on a literature review to select meaningful midwifery interventions from the international literature, aiming to identify an evidence-based list of midwifery interventions. This phase led to including 16 articles derived from a systematic search performed on PubMed, CINAHL, and Scopus; 164 midwifery interventions were selected from the data extraction performed on the 16 included articles. Healthcare professionals, researchers, and service users will be eligible panelists for the Delphi surveys. The protocol designed a dynamic number of consultation rounds based on the ratings and interim analysis. A nine-point Likert scoring system is designed to evaluate midwifery interventions. Attrition and attrition bias will be evaluated. The results from the study designed in this protocol will inform the development of the Italian taxonomy of the Midwifery Interventions Classification. A shared classification of midwifery interventions will support audit and quality improvement, education, and comparable data collections for research, sustaining public recognition of midwifery interventions to promote optimal maternal and newborn health.
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Affiliation(s)
- Giulia Maga
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Lia Brigante
- Department of Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Marina Alice Sylvia Daniele
- Department of Midwifery and Radiography, School of Health and Psychological Sciences, University of London, London EC1V 0HB, UK
| | - Elsa Del Bo
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Ogliari
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy
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Abstract
The use of the Delphi technique is prevalent across health sciences research, and it is used to identify priorities, reach consensus on issues of importance and establish clinical guidelines. Thus, as a form of expert opinion research, it can address fundamental questions present in healthcare. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Advantages of the use of Delphi include anonymity, controlled feedback, flexibility for the choice of statistical analysis, and the ability to gather participants from geographically diverse areas. Areas of methodological uncertainty worthy of further discussion broadly include experts and data management. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. For data management, there are issues with data collection, defining consensus and methods of data analysis, such as percent agreement, central tendency, measures of dispersion, and inferential statistics. Overall, the use of Delphi addresses important issues present in health sciences research, but methodological issues remain. It is likely that the aggregation of future Delphi studies will eventually pave the way for more comprehensive reporting guidelines and subsequent methodological clarity.
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Affiliation(s)
- Zhida Shang
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- * Correspondence: Zhida Shang, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada (e-mail: )
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19
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Halkett GKB, Breen LJ, Berg M, Sampson R, Sim HW, Gan HK, Kong BY, Nowak AK, Day BW, Harrup R, James M, Saran F, Mcfarlane B, Tse C, Koh ES. Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers. Curr Oncol 2022; 29:9928-55. [PMID: 36547195 DOI: 10.3390/curroncol29120781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.
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20
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Mousa M, Teede HJ, Garth B, Winship IM, Prado L, Boyle JA. Using a Modified Delphi Approach and Nominal Group Technique for Organisational Priority Setting of Evidence-Based Interventions That Advance Women in Healthcare Leadership. Int J Environ Res Public Health 2022; 19:15202. [PMID: 36429927 PMCID: PMC9690121 DOI: 10.3390/ijerph192215202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few studies address how to prioritise organisational interventions that advance women in leadership. We report on the relevance, feasibility and importance of evidence-based interventions for a large healthcare organisation. This study supports the first stage of implementation in a large National Health and Medical Research Council funded initiative seeking to advance women in healthcare leadership. METHODS An expert multi-disciplinary panel comprised of health professionals and leaders from a large healthcare network in Australia participated. The initial Delphi survey was administered online and results were presented in a Nominal Group Technique workshop. Here, the group made sense of the survey results, then evaluated findings against a framework on implementation criteria. Two further consensus surveys were conducted during the workshop. RESULTS Five priority areas were identified. These included: 1. A committed and supportive leadership team; 2. Improved governance structures; 3. Mentoring opportunities; 4. Leadership training and development; and 5. Flexibility in working. We describe the overall priority setting process in the context of our findings. CONCLUSIONS With evidence and expert input, we established priorities for advancing women in healthcare leadership with a partnering healthcare organisation. This approach can be adapted in other settings, seeking to advance women in leadership.
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Affiliation(s)
- Mariam Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- Epworth Healthcare, Richmond, VIC 3121, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- Monash Partners Academic Health Science Centre, Melbourne, VIC 3168, Australia
| | - Belinda Garth
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3168, Australia
| | | | - Luis Prado
- Epworth Healthcare, Richmond, VIC 3121, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- Epworth Healthcare, Richmond, VIC 3121, Australia
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Melbourne, VIC 3168, Australia
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21
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Sebastiani GD, Mosca M, Ravasio R, Brambilla P, Raimondo P, Doria A. La gestione del trattamento del paziente con diagnosi di Lupus Eritematoso Sistemico: un’analisi di consenso Delphi. Glob Reg Health Technol Assess 2022; 9:123-32. [PMID: 36628305 DOI: 10.33393/grhta.2022.2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Systemic lupus erythematosus (SLE) is associated with clinical burden for the patient and organ damage. The development of therapies for SLE has been constrained by clinical and biologic heterogeneity. These represent challenges in clinical trial design and endpoint selection. Objective: To identify the most relevant descriptors for efficacy, endpoints, disease activity, organ damage, quality of life (QoL), and Patient Reported Outcome Measures (PROMs) in the treatment of SLE. Methods: A Delphi study was conducted using a national expert panel of clinicians in the treatment of SLE. A steering committee composed of 3 opinion leaders with deep expertise in SLE treatment was defined. The steering committee analyzed and appraised the evidence, designed the Delphi study, defined the statements, and analyzed the expert panel responses. A 2-round Delphi survey was conducted. Participants were asked to rate the statements using a five-point Likert scale. Results: Nine experts participated in the Delphi survey. After the two rounds, the consensus was reached on 18 of the 23 statements: 2 statements were included in the “efficacy” domain, 2 in the “glucocorticoid-sparing” domain, 2 in the “endpoint evaluation” domain, 4 in the “score” domain, 1 in the “disease activity” domain, 1 in the “organ damage” domain, 1 in the “QoL” domain, 2 in the “PROMs” domain, 1 in the “AIFA monitoring” domain and 2 in the “extra” domain. No statements reached consensus within the “onset” domain. Conclusion: In this Delphi study, 18 statements across 11 domains were agreed upon for the treatment of SLE.
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22
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Affiliation(s)
- Sarah Badran
- Division of Pediatric and Congenital Cardiology, Helen Devos Children's Hospital at Spectrum Health, Grand Rapids, Michigan, USA; Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, Michigan, USA.
| | - Sangjin Lee
- Section of Advanced Heart Failure and Heart Transplantation, Spectrum Health, Grand Rapids, Michigan, USA
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23
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Jobson D, Roffey B, Arnold C, Azzi A, Button-Sloan A, Dawson T, Fernandez-Penas P, Fishburn P, Gyorki DE, Hiscutt EL, Jakrot V, Lilleyman A, Lochhead A, Long GV, Mailer S, Mann G, McCormack CJ, Muir J, Pratt GF, Scolyer RA, Shackelton M, Shumack S, Soyer HP, Tan CG, Webb A, Zalcberg J, Morton R, Mar V. Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study. Australas J Dermatol 2022; 63:344-351. [PMID: 35486539 DOI: 10.1111/ajd.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty-six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. METHODS Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two-round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. RESULTS Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. CONCLUSION This study provides a multi-stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).
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Affiliation(s)
- Dale Jobson
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Roffey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Arnold
- Hodgson Associates, Melbourne, Victoria, Australia.,Biogrid Australia, Parkville, Victoria, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, New South Wales, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Skin Cancer Institute, Singapore City, Singapore.,Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | | | - Tamara Dawson
- Melanoma and Skin Cancer Advocacy Network, Carlton, Victoria, Australia
| | - Pablo Fernandez-Penas
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Paul Fishburn
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Norwest Skin Cancer Centre, New South Wales, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma L Hiscutt
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | - Alister Lilleyman
- Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | - Alistair Lochhead
- Southern IML Pathology, Wollongong, New South Wales, Australia.,Department of Anatomical Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Mater Hospital, Sydney, New South Wales, Australia
| | - Sonia Mailer
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Melanoma Research Victoria, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher J McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jim Muir
- University of Queensland, Brisbane, Queensland, Australia.,Mater Hospital, Brisbane, Queensland, Australia
| | - George F Pratt
- Plastic and Reconstructive Unit, Monash Health, Dandenong, Victoria, Australia.,Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackelton
- Central Clinical School and School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Department of Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Stephen Shumack
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Skin Health Institute, Carlton, Victoria, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Rachael Morton
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sun S, Karki C, Aguilera J, Hernandez AEL, Sun J, Li L. Computational Study on the Function of Palmitoylation on the Envelope Protein in SARS-CoV-2. J Chem Theory Comput 2021; 17:6483-6490. [PMID: 34516136 PMCID: PMC8457325 DOI: 10.1021/acs.jctc.1c00359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 01/02/2023]
Abstract
SARS-CoV-2 that caused COVID-19 has spread since the end of 2019. Its major effects resulted in over four million deaths around the whole world by August 2021. Therefore, understanding virulence mechanisms is important to prevent future outbreaks and for COVID-19 drug development. The envelope (E) protein is an important structural protein, affecting virus assembly and budding. The E protein pentamer is a viroporin, serving as an ion transferring channel in cells. In this work, we applied molecular dynamic simulations and topological and electrostatic analyses to study the effects of palmitoylation on the E protein pentamer. The results indicate that the cation transferring direction is more from the lumen to the cytosol. The structure of the palmitoylated E protein pentamer is more stable while the loss of palmitoylation caused the pore radius to reduce and even collapse. The electrostatic forces on the two sides of the palmitoylated E protein pentamer are more beneficial to attract cations in the lumen and to release cations into the cytosol. The results indicate the importance of palmitoylation, which can help the drug design for the treatment of COVID-19.
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Affiliation(s)
- Shengjie Sun
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Chitra Karki
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Javier Aguilera
- Department of Biological Sciences and Border Biomedical Research Center, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Alan E Lopez Hernandez
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Jianjun Sun
- Department of Biological Sciences and Border Biomedical Research Center, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
| | - Lin Li
- Computational Science Program, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
- Department of Physics, The University of Texas at El Paso, 500 W University Ave, TX, 79968, USA
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Moroney C, O’Leary F, Flood VM. The Med-NKQ: A Reliable Mediterranean Diet Nutrition Knowledge Questionnaire for Cardiovascular Disease. Nutrients 2021; 13:nu13092949. [PMID: 34578825 PMCID: PMC8471340 DOI: 10.3390/nu13092949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
The Mediterranean diet (MD) has significant benefits for cardiovascular disease (CVD), yet clinicians lack reliable tools to measure patient knowledge. This study aimed to develop a short tool to test knowledge of MD related to cardiac health. Themes included foods to reduce CVD risk factors, quantification of servings, and common MD dietary patterns; a maximum score of 42 was determined for correct responses. Content validity was assessed through expert consensus in a Delphi survey. A 70% level of agreement was set for each domain tested. Repeatability was assessed via a test-retest protocol in a sample with self-reported CVD, advertised through social media and administered online. Ten and six of twenty-five invited experts responded to round one and two of the Delphi survey respectively. All items achieved greater than 70% consensus. Twenty people completed the repeatability study. A paired t-test found no significant difference in mean scores between the two test periods (Test one, 28 (standard deviation (SD) 5.4). Test two 29.5, (SD 5.5), p = 0.174) and a Bland-Altman Plot indicated no bias between the two surveys. The Med-NKQ demonstrated good content validity and reliability in people with CVD, and is short and easy to administer, making it practical in clinical and research settings.
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Affiliation(s)
- Carissa Moroney
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Fiona O’Leary
- Sydney School of Nursing, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Victoria M. Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Western Sydney Local Health District, Research and Education Network, Westmead Hospital, Westmead, NSW 2145, Australia
- Correspondence: ; Tel.: +61-2-9351-9001
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Kim JH, Goo B, Seo BK. Establishing a critical pathway for Korean medical management of lumbar disc herniation: A modified Delphi consensus process. Medicine (Baltimore) 2021; 100:e26991. [PMID: 34414980 PMCID: PMC8376369 DOI: 10.1097/md.0000000000026991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
A modified Delphi method was used to establish a consensus. Stakeholders and experts were invited to participate in the expert panel. Best practice statements and decision-making questionnaires were distributed to the panel. Panel members were asked to mark "Strongly disagree" to "Strongly agree" after a series of statements over several rounds until either a consensus was reached or the decision-making method was deemed unsuitable for reaching a consensus.The most common cause of lumbar pain is intervertebral degeneration, which leads to degenerative disc disease and lumbar disc herniation. There is a lack of unanimity regarding appropriate patient protocols and rehabilitation expectations for Korean medical care. The long-term viability of Korean medical treatment, further adoption in the institutional setting, and specific patient outcomes are contingent on the existence of appropriate Korean medical programs.A Korean medical expert panel of 17 practitioners employed a modified Delphi method to achieve consensus on Korean medical care for lumbar disc herniation. The panel first reviewed the literature and guidelines relevant to Korean medical treatment for lumbar disc herniation. The panel members considered questionnaires intended to determine "standardized" Korean medical care recommendations for patients with a wide range of symptoms of lumbar disc herniation. Each panel member participated in a round of voting, which was followed by an opinion-collecting session online. Consensus was defined as a ≥75% agreement among the respondents.In the first round, 144 questionnaires across 5 domains were administered to the expert panels. After reviewing the responses and open-ended comments collected in the first round, the authors modified the questionnaires to 53 items and proceeded. In round 2, consensus was achieved in all 53 survey questions. The final treatment pathway comprised a standardized and comprehensive care approach for lumbar disc herniations in 4 types of medical institutions.This study identified a core set of evidence- and consensus-based principles that are essential to a comprehensive model of care, incorporating identification, referral, and management of patients with lumbar disc herniation.
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Affiliation(s)
- Jung-hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Byung-kwan Seo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
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Asbun HJ, Abu Hilal M, Kunzler F, Asbun D, Bonjer J, Conlon K, Demartines N, Feldman LS, Morales-Conde S, Pietrabissa A, Pryor AD, Schlachta CM, Sylla P, Targarona EM, Agra Y, Besselink MG, Callery M, Cleary SP, De La Cruz L, Eckert P, Evans C, Han HS, Jones DB, Gan TJ, Koch D, Lillemoe KD, Lomanto D, Marks J, Matthews B, Mellinger J, Melvin WS, Moreno-Paquentin E, Navarrete C, Pawlik TM, Pessaux P, Ricciardi W, Schwaitzberg S, Shah P, Szokol J, Talamini M, Torres R, Triboldi A, Udomsawaengsup S, Valsecchi F, Vauthey JN, Wallace M, Wexner SD, Zinner M, Francis N. International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative. Ann Surg 2021; 274:50-56. [PMID: 33630471 PMCID: PMC8189258 DOI: 10.1097/sla.0000000000004674] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. BACKGROUND The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. METHODS Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. RESULTS One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. CONCLUSIONS The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.
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Affiliation(s)
- Horacio J Asbun
- Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida
| | - Mohammad Abu Hilal
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
- Department of Surgery, Southampton University Hospital, Southampton, England
| | - Filipe Kunzler
- Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida
| | - Domenech Asbun
- Department of Surgery, University of California San Francisco Fresno, Fresno, California
| | - Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kevin Conlon
- Department of Surgery, Trinity College Dublin, and St. Vincent's University Hospital, Dublin, Ireland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Liane S Feldman
- Department of Surgery McGill University Surgeon-in-chief, McGill University Health Centre Montreal, Quebec, Canada
| | | | - Andrea Pietrabissa
- Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università Degli Studi Di Pavia; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aurora D Pryor
- Stony Brook University Department of Surgery, Stony Brook, New York
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Patricia Sylla
- Icahn School Medicine at Mount Sinai, New York, New York
| | - Eduardo M Targarona
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marc G Besselink
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mark Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sean P Cleary
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Luis De La Cruz
- Department of Anesthesia at Baptist Hospital of Miami; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Philippe Eckert
- General Management, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tong Joo Gan
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Daniel Koch
- Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Davide Lomanto
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeffrey Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brent Matthews
- Divisions of General and Gastrointestinal Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - John Mellinger
- Southern Illinois University School of Medicine, Departments of Surgery and Medical Education, Springfield, Illinois
| | - William Scott Melvin
- Division of General Surgery, Department of Surgery, Montefiore Medical Center, New York, New York
| | | | - Claudio Navarrete
- Servicio de Cirugía Endoscópica Hospital San Borja Arriarán de Santiago. Departamento de Cirugía, Clinica Santa Maria, Santiago, Chile
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Patrick Pessaux
- Department of Digestive Surgery, Nouvel Hôpital Civil, Université de Strasbourg, IHU Institute of Image-Guided Surgery of Strasbourg and U1110 Inserm, Institute of Viral and Liver Disease, Strasbourg, France
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore; Department of Woman and Child Health and Public Health - Public Health Area Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Paresh Shah
- Department of Surgery, NYU Langone Health, New York, New York
| | - Joseph Szokol
- Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Mark Talamini
- Departments of Surgery, State University of New York, Stony Brook, New York
| | - Ricardo Torres
- Departamento of Surgery, Hospital Escuela "José de San Martín," Corrientes, Argentina
| | | | - Suthep Udomsawaengsup
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Michael Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | | | - Nader Francis
- Department of General Surgery, Yeovil District Hospital National Health Service Foundation Trust, Yeovil, England; Division of Surgery and Interventional Science, University College London, London, England; The Griffin Institute at Northwick Park Institute for Medical Research, Norwich Park London, London, England; Enhanced-Recovery After Surgery - UK (ERAS-UK), Yeovil, UK
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Allart E, Mazevet D, Idée S, Constant Boyer F, Bonan I. Adjunct therapies after botulinum toxin injections in spastic adults: systematic review and SOFMER recommendations. Ann Phys Rehabil Med 2021; 65:101544. [PMID: 34091058 DOI: 10.1016/j.rehab.2021.101544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjunct therapies (ATs) may further improve outcomes after botulinum toxin injections in spastic patients, but evidence was unclear in previous systematic reviews. OBJECTIVE To assess the efficacy of non-pharmacological ATs in spastic adults according to the International Classification of Functioning, Disability and Health and build an expert consensus based on a Delphi process. METHODS Four electronic databases were searched up to May 2020 for reports of comparative trials of non-pharmacologic ATs after botulinum toxin injections in spastic adults. Then 25 French experts participated in a two-round Delphi process to build recommendations on the use of ATs. RESULTS We included 32 studies (1202 participants, median 32/study) evaluating the effects of physical agents (n=9), joint posture procedures (JPPs, n=11), and active ATs (n=14), mainly after stroke. The average quality of articles was good for randomised controlled trials (median [interquartile range] PEDro score = 7 [6-8]) but moderate (n=2) or poor (n=2) for non-randomised controlled trials (Downs & Black checklist). Meta-analysis was precluded owing to the heterogeneity of ATs, control groups and outcome measures. There is evidence for the use of JPPs except low-dose manual stretching and soft posture techniques. Continuous postures (by taping or casting) are recommended; discontinuous postures (by orthosis) may be preferred in patients with active function. Device-free or device-assisted active ATs may be beneficial in the mid-term (> 3 months after botulinum toxin injections), particularly when performed at a high intensity (>3 hr/week) as in constraint-induced movement therapy. Self-rehabilitation remains understudied after a focal treatment, but its interest is highlighted by the experts. The use of physical agents is not recommended. CONCLUSIONS JPPs and active ATs (device-assisted or device-free) may further improve impairments and activities after botulinum toxin injections. Further studies are needed to better define the best strategies for ATs as a function of the individual treatment goals, participation and quality of life. Review Registration. PROSPERO (CRD42018105856).
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Affiliation(s)
- Etienne Allart
- CHU Lille, Neurorehabilitation Unit, 59000 Lille, France; Université Lille, INSERM UMR-S-1172, Lille Neuroscience and Cognition, 59000 Lille, France.
| | | | - Stéphane Idée
- CHU Strasbourg, PRM Department, 67000 Strasbourg, France
| | | | - Isabelle Bonan
- CHU Rennes, PRM Department, University of Rennes 1 & 2, 35000 Rennes, France; Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, 35042 Rennes cedex, France
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Ahmad R, AlLehaibi LH, AlSuwaidan HN, Alghiryafi AF, Almubarak LS, AlKhalifah KN, AlMubarak HJ, Alkhathami MA. Evaluation of clinical trials for natural products used in diabetes: An evidence-based systemic literature review. Medicine (Baltimore) 2021; 100:e25641. [PMID: 33879744 PMCID: PMC8078398 DOI: 10.1097/md.0000000000025641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND RELEVANCE A plethora of literature is available regarding the clinical trials for natural products however; no information is available for critical assessments of the quality of these clinical trials. AIM OF STUDY This is a first time report to critically evaluate the efficacy, safety and large scale applications of up-to-date clinical trials for diabetes, based on the three scales of Jadad, Delphi, and Cochrane. METHODOLOGY An in-depth and extensive literature review was performed using various databases, journals, and books. The keywords searched included, "clinical trials," "clinical trial in diabetes," "diabetes," "natural products in diabetes," "ethnopharmacological relevance of natural products in diabetes," etc. RESULTS Based on eligibility criteria, 16 plants with 74 clinical trials were found and evaluated. Major drawbacks observed were; "non-randomization and blindness of the studies," "non-blindness of patients/healthcare/outcome assessors," "lack of patient compliance and co-intervention reports," "missing information regarding drop-out/withdrawal procedures," and "inappropriate baseline characteristics." Principal component analysis and Pearson correlation revealed four components with %variability; PC1: 23.12, PC2: 15.83, PC3: 13.11, and PC4: 11.38 (P ≤ .000). According to descriptive statistics, "non-blinding of outcome assessors" was the major drawback (82%) whereas, "not mentioning the timing of outcome assessment" was observed lowest (6.8%). An in-house quality grading (scale 0-24) classified these clinical trials as; poor (67.6%), acceptable (19.9%), and good quality trials (13.5%). CONCLUSION Proper measures in terms of more strict regulations with pharmacovigilance of plants are utmost needed in order to achieve quality compliance of clinical trials.
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Affiliation(s)
- Rizwan Ahmad
- Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam Abdul Rahman Bin Faisal University, Kingdom of Saudi Arabia
| | | | - Hind Nasser AlSuwaidan
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ali Fuad Alghiryafi
- College of Clinical Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lyla Shafiq Almubarak
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Khawlah Nezar AlKhalifah
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hawra Jassim AlMubarak
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Majed Ali Alkhathami
- First Health Cluster in Eastern Province, Dammam Medical Complex, Dammam, Saudi Arabia
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Kolesnyk P, Bayen S, Shushman I, Kolesnyk A, Kuodza G, Klemenc-Ketiš Z, Frese T. Identification and Ranking of Core Values in Family Medicine: A Mixed Methods Study From Ukraine. Front Med (Lausanne) 2021; 8:646276. [PMID: 33829026 PMCID: PMC8019795 DOI: 10.3389/fmed.2021.646276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction/Context: The term core value (CV) can be defined as fundamental beliefs or principles, guiding one's behavior in a social context. Though core competencies of family medicine (FM) have been clearly defined by WONCA, there has been an ongoing debate on what the CVs are for family doctors (FDs). Ukraine is a developing country in the middle of Europe with a population of 43 million inhabitants, gained independence from the Soviet Union in 1991. Ukraine is a low-income country, developing a modern European healthcare system, especially regarding FM. To implement WONCA standards, it is mandatory to assess the ongoing understanding of CVs in clinical daily practice among active FDs, working in different countries of Europe including Ukraine. Research questions: How do Ukrainian FDs (Delphi group experts) define the CVs of FM in Ukraine and how important are these CVs to a wider population of Ukrainian FDs in their everyday practice? Methods: A mixed method study was conducted in two steps during August and September 2020 in Ukraine. The first part was a qualitative Delphi round (three rounds) design among 20 Ukrainian FDs who were familiar with teaching and terms like CV. A consensus list of six CVs has emerged from the Delphi round study. The second part was a quantitative survey among Ukrainian FDs, who were not specially used to discussing CVs. The consensus list of those six CVs was then submitted to 2000 FDs (randomly selected) who were not involved in the Delphi team, to rank those values from one to nine, according to the importance from their personal point of view. Demographic characteristics have been assessed for all the participants of the Delphi round and quantitative survey. Results: Twenty FDs were involved as experts in the first Delphi round, whereas only five experts continued their participation in the second and the third rounds of the survey. The following six CVs emerged from the Delphi round: comprehensive approach, care coordination, first recourse, continuity of care, integrated approach, and patient and family centered care. The final sample consisted of 375 FDs (19% response rate). There were 323 (88.7%) female and 34 (9.3%) male FDs in the sample. The mean age of the participants was 44.6±13.5 years. Discussion/Conclusion: Defining CVs for FM by Ukrainian FDs in a given socio-economical and historical-cultural setting is crucial to optimize primary medical care and to guarantee an appropriate and successful implementation of WONCA standards as well as CVs in different countries including those where reformation of the health system is ongoing.
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Affiliation(s)
- Pavlo Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | - Ivanna Shushman
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Andrew Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - George Kuodza
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Zalika Klemenc-Ketiš
- Community Health Centre Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Frese
- Department of General Practice & Family Medicine, Medical Faculty, Martin-Luther University Halle, Halle, Germany
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Small RN, Fleet L, Whalen D, Renouf TS. SPIRALS: An Approach to Non-Linear Thinking for Medical Students in the Emergency Department. Cureus 2020; 12:e9727. [PMID: 32944446 PMCID: PMC7489793 DOI: 10.7759/cureus.9727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context We lack guidelines to inform the necessary components of an emergency medicine undergraduate rotation. Traditionally, clinical reasoning has been taught using linear thought processes likely not ideal for diagnostic and management decisions made in the emergency department. Methods We used the Delphi method to obtain consensus on a set of competencies for undergraduate emergency medicine that illustrate the non-linear concepts we believe are necessary for learners. Competencies were informed by a naturalistic observational study of emergency physicians. A survey outlining these competencies was subsequently circulated to emergency physicians who rated their relative importance. Results Eleven competencies were included in Round 1, all rated within the “for consideration” for inclusion range. This was reduced to 10 competencies in Round 2, which was only marginally more definitive with respondents rating one competency in the “definite inclusion range” and the remaining in the “for consideration” range. Conclusions This study was conducted to address a gap in the current undergraduate emergency medicine curriculum. Consensus on the relative importance of each competency was not achieved, though we believe that the competencies that arose from this study will help medical students develop the non-linear thinking processes necessary to succeed in emergency medicine.
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Affiliation(s)
- Rebecca N Small
- Internal Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Lisa Fleet
- Office of Professional Development, Memorial University of Newfoundland, St. John's, CAN
| | - Desmond Whalen
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Tia S Renouf
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
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Chakravorty A, Pandey S, Pahari S, Zhao S, Alexov E. Capturing the Effects of Explicit Waters in Implicit Electrostatics Modeling: Qualitative Justification of Gaussian-Based Dielectric Models in DelPhi. J Chem Inf Model 2020; 60:2229-2246. [PMID: 32155062 PMCID: PMC9883665 DOI: 10.1021/acs.jcim.0c00151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Our group has implemented a smooth Gaussian-based dielectric function in DelPhi (J. Chem. Theory Comput. 2013, 9 (4), 2126-2136) which models the solute as an object with inhomogeneous dielectric permittivity and provides a smooth transition of dielectric permittivity from surface-bound water to bulk solvent. Although it is well-understood that the protein hydrophobic core is less polarizable than the hydrophilic protein surface, less attention is paid to the polarizability of water molecules inside the solute and on its surface. Here, we apply explicit water simulations to study the behavior of water molecules buried inside a protein and on the surface of that protein and contrast it with the behavior of the bulk water. We selected a protein that is experimentally shown to have five cavities, most of which are occupied by water molecules. We demonstrate through molecular dynamics (MD) simulations that the behavior of water in the cavity is drastically different from that in the bulk. These observations were made by comparing the mean residence times, dipole orientation relaxation times, and average dipole moment fluctuations. We also show that the bulk region has a nonuniform distribution of these tempo-spatial properties. From the perspective of continuum electrostatics, we argue that the dielectric "constant" in water-filled cavities of proteins and the space close to the molecular surface should differ from that assigned to the bulk water. This provides support for the Gaussian-based smooth dielectric model for solving electrostatics in the Poisson-Boltzmann equation framework. Furthermore, we demonstrate that using a well-parametrized Gaussian-based model with a single energy-minimized configuration of a protein can also reproduce its ensemble-averaged polar solvation energy. Thus, we argue that the Gaussian-based smooth dielectric model not only captures accurate physics but also provides an efficient way of computing ensemble-averaged quantities.
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Affiliation(s)
- Arghya Chakravorty
- Computational Biophysics and Bioinformatics, Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, United States,Corresponding Authors:,
| | - Shailesh Pandey
- Computational Biophysics and Bioinformatics, Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, United States
| | - Swagata Pahari
- Computational Biophysics and Bioinformatics, Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, United States
| | - Shan Zhao
- Department of Mathematics, University of Alabama, Tuscaloosa, Alabama 35487, Unites States
| | - Emil Alexov
- Computational Biophysics and Bioinformatics, Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, United States,Corresponding Authors:,
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Murray MJ, Ruffle A, Lowis S, Howell L, Shanmugavadivel D, Dommett R, Gamble A, Shenton G, Nicholson J. Delphi method to identify expert opinion to support children's cancer referral guidelines. Arch Dis Child 2020; 105:241-246. [PMID: 31420330 DOI: 10.1136/archdischild-2019-317235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/16/2019] [Accepted: 08/02/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) guidance for referral of children with suspected cancer was first published in 2005 and updated in 2015. The updated version relied on sparse primary care evidence and published without input from key stakeholders, for example, acute general paediatricians and paediatric haematologists/oncologists. This led to a document that fell short as a practical guide for referring physicians managing children with potentially life-threatening conditions. Following discussions between the Children's Cancer and Leukaemia Group (CCLG, the UK multidisciplinary professional body for healthcare professionals caring for children with cancer) and NICE, it was agreed that a practical supplement should be produced for the 2015 guidance. A prerequisite was evidence gathering from tertiary care to balance the existing primary care evidence, and a Delphi consensus method was therefore convened. METHODS A CCLG NICE Guidance Committee formulated 25 draft statements for review. The CCLG emailed its paediatric haematologist/oncologist membership (n=179) and 88 responded (49%). To achieve consensus, statements required ≥70% agreement from ≥60% of actual respondents, from the denominator (n=88). RESULTS Fifteen of 25 original statements were accepted at the first round of voting. Three of 25 statements where >50% did not support were rejected outright. One statement could not be revised without replicating a previously accepted statement. The six remaining statements were revised and a second round of voting undertaken; all six revised statements were accepted. Overall, 21 of 25 statements (84%) met consensus criteria. CONCLUSIONS This expert opinion should help streamline suspected cancer referral in children and help optimise subsequent outcomes.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy Ruffle
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stephen Lowis
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Lisa Howell
- Department of Paediatric Haematology and Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, Liverpool, UK
| | | | - Rachel Dommett
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group, Leicester, UK
| | - Geoff Shenton
- Paediatric Haematology, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - James Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Olsen AA, Minshew LM, Morbitzer KA, Brock TP, McLaughlin JE. Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula. J Med Educ Curric Dev 2020; 7:2382120520943597. [PMID: 32775693 PMCID: PMC7391422 DOI: 10.1177/2382120520943597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/12/2020] [Indexed: 05/12/2023]
Abstract
To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students' abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.
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Affiliation(s)
- Amanda A Olsen
- College of Education, The University of Texas at Arlington, Arlington, TX, USA
| | - Lana M Minshew
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn A Morbitzer
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tina P Brock
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Monash Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Jacqueline E McLaughlin
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Monash Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
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Abstract
OBJECTIVES Visual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors. DESIGN A list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders. PARTICIPANTS Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. SETTING University. OUTCOME MEASURES COS. RESULTS Following the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires. CONCLUSIONS COS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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Goodyear-Smith F, Bazemore A, Coffman M, Fortier R, Howe A, Kidd M, Phillips R, Rouleau K, van Weel C. Primary care financing: a systematic assessment of research priorities in low- and middle-income countries. BMJ Glob Health 2019; 4:e001483. [PMID: 31478025 PMCID: PMC6703294 DOI: 10.1136/bmjgh-2019-001483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Financing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC. METHODS Three-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance. RESULTS A diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions. CONCLUSIONS This novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Bazemore
- Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA
| | - Megan Coffman
- Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA
| | - Richard Fortier
- Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amanda Howe
- Department of Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| | - Michael Kidd
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Robert Phillips
- Research and Policy Department, the American Board of Family Medicine, Lexington, Kentucky, USA
| | - Katherine Rouleau
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris van Weel
- Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
- Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
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Goodyear-Smith F, Bazemore A, Coffman M, Fortier RDW, Howe A, Kidd M, Phillips R, Rouleau K, van Weel C. Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach. BMJ Glob Health 2019; 4:e001482. [PMID: 31497316 PMCID: PMC6703507 DOI: 10.1136/bmjgh-2019-001482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes—particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation. Methods Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated. Results Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs. Conclusion In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Andrew Bazemore
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA
| | - Megan Coffman
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA
| | - Richard D W Fortier
- Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.,McGill University, Montreal, Quebec, Canada
| | - Amanda Howe
- Primary Care, University of East Anglia Norwich Medical School, Norwich, UK
| | - Michael Kidd
- Department of Family and Community Medicine, University of Toronto and Southgate Institute for Health, Toronto, Ontario, Canada.,Flinders University, Adelaide, South Australia, Australia
| | - Robert Phillips
- Research and Policy of the American Board of Family Medicine, Lexington, Kentucky, USA
| | - Katherine Rouleau
- Department of Family and Community Medicine, University of Toronto and Southgate Institute for Health, Toronto, Ontario, Canada
| | - Chris van Weel
- Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
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Knaapen M, Hall NJ, van der Lee JH, Butcher NJ, Offringa M, Van Heurn EWE, Bakx R, Gorter RR. Establishing a core outcome set for treatment of uncomplicated appendicitis in children: study protocol for an international Delphi survey. BMJ Open 2019; 9:e028861. [PMID: 31123006 PMCID: PMC6538019 DOI: 10.1136/bmjopen-2018-028861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Appendicitis is a global disease affecting roughly 1 in every 12 people in the world, with the highest incidence between ages 10 and 19 years. To date, a wide variety of health outcomes have been reported in randomised controlled trials and meta-analyses evaluating treatments for appendicitis. This is especially the case in studies comparing non-operative treatment with operative treatment. A set of standard outcomes, to be reported in all future trials, is needed to allow for adequate comparison and interpretation of clinical trial results and to make data pooling possible. This protocol describes the development of such a global core outcome set (COS) to allow unified reporting of treatment interventions in children with acute uncomplicated appendicitis. METHODS AND ANALYSIS We use current international standard methodology for the development and reporting of this COS. Its development consists of three phases: (1) an update of the most recent systematic review on outcomes reported in uncomplicated paediatric appendicitis research to identify additional outcomes, (2) a three-step global Delphi study to identify a set of core outcomes for which there is consensus between parents and (paediatric) surgeons and (3) an expert meeting to finalise the COS and its definitions. Children and young people will be involved through their parents during phase 2 and will be engaged directly using a customised face-to-face approach. ETHICS AND DISSEMINATION The medical research ethics committee of the Academic Medical Center Amsterdam has approved the study. Each participating country/research group will ascertain ethics board approval. Electronic informed consent will be obtained from all participants. Results will be presented in peer-reviewed academic journals and at (international) conferences. TRIAL REGISTRATION NUMBER COMET registration: 1119.
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Affiliation(s)
- Max Knaapen
- Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Nigel J Hall
- University Surgery Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Johanna H van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nancy J Butcher
- Child Health Evaluative Sciences, Sick Kids, Toronto, Ontario, Canada
| | - Martin Offringa
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ernst W E Van Heurn
- Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Roel Bakx
- Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Kayser L, Karnoe A, Duminski E, Somekh D, Vera-Muñoz C. A new understanding of health related empowerment in the context of an active and healthy ageing. BMC Health Serv Res 2019; 19:242. [PMID: 31014350 PMCID: PMC6480610 DOI: 10.1186/s12913-019-4082-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, several initiatives have focused on how to create true person-centred health services. This calls for a new understanding of health-related empowerment in relation to people living with one or more chronic conditions. We report on a Delphi investigation among participants in the European Innovation Partnership on Active and Healthy Ageing that has led to a new understanding of health-related empowerment. METHODS The Delphi process was conducted in three sequential rounds. In the first round, we presented a suggested first version for a definition of "health-related empowerment" divided into nine statements. One hundred and twenty-two experts were then asked if they agreed or not with each individual statement, and in the case they disagreed, to state the reasons for their disagreement. After revisions, the experts who had replied to the first version were asked again, if they agreed or not with each individual statement of the second version and to elaborate on disagreements. Finally, in the third round the experts were asked to provide comments to the final proposed definition in general and not by each statement. RESULTS A total of 33 experts responded to the first version. The following revision included a merging of two statements, and the addition of health literacy as part of the understanding. The second version was sent out to the 33 experts and a total of 19 experts commented with moderate consensus. Changes included removal of "self-esteem" and change of "self-confidence" to confidence. Third version was sent out to all 122 experts with 16 respondents. Strong consensus was obtained for this third version, and is with one minor change presented as the final version. CONCLUSION We propose a new understanding of the concept health-related empowerment, by focusing on the individual as a co-manager with freedom to choose and focus on their own well-being.
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Affiliation(s)
- Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Astrid Karnoe
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emily Duminski
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Somekh
- European Health Futures Forum, Dromahair, Ireland
| | - Cecilia Vera-Muñoz
- Life Supporting Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
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Mackenzie RM, Ells LJ, Simpson SA, Logue J. Development of a core outcome set for behavioural weight management programmes for adults with overweight and obesity: protocol for obtaining expert consensus using Delphi methodology. BMJ Open 2019; 9:e025193. [PMID: 30826797 PMCID: PMC6398651 DOI: 10.1136/bmjopen-2018-025193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Weight management interventions in research studies and in clinical practice differ in length, advice, frequency of meetings, staff and cost. Very few real-world programmes have published patient-related outcomes, and those that have published used different ways of reporting the information, making it impossible to compare interventions and further develop the evidence base. Developing a core outcome set for behavioural weight management programmes (BWMPs) for adults with overweight and obesity will allow different BWMPs to be compared and reveal which interventions work best for which members of the population. METHODS AND ANALYSIS An expert group, comprised of 40 people who work in, refer to, or attend BWMPs for adults with overweight and obesity, will be asked to decide which outcomes services should report. An online Delphi process will be employed to help the group reach consensus as to which outcomes should be measured and reported, and which definitions/instruments should be used in order to do so. The first stage of the Delphi process (three rounds of questionnaires) will focus on outcomes while the second stage (three additional rounds of questionnaires) will focus on definition/instrument selection. ETHICS AND DISSEMINATION Ethical approval for this study has been received from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee. With regard to disseminating results, a report will be submitted to our funding body, the Chief Scientist Office of the Scottish Government Health Department. In addition, early findings will be shared with Public Health England and Health Scotland, and results communicated via conference presentations, peer review publication and our institutions' social media platforms.
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Affiliation(s)
- Ruth M Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Louisa J Ells
- School of Health and Social Care, Teeside University, Middlesbrough, UK
| | | | - Jennifer Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Blaschke SM, Lambert SD, Livingston PM, Aranda S, Boltong A, Schofield P, Chambers SK, Krishnasamy M, Ugalde A. Identifying priorities for cancer caregiver interventions: protocol for a three-round modified Delphi study. BMJ Open 2019; 9:e024725. [PMID: 30765405 PMCID: PMC6398770 DOI: 10.1136/bmjopen-2018-024725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Cancer is often considered a chronic disease, and most people with cancer have a caregiver, often a family member or friend who provides a significant amount of care during the illness trajectory. Caregivers are frequently in need of support, and a range of interventions have been trialled to improve outcomes. Consensus for optimal ways to support caregivers is not known. The aim of this protocol paper is to describe procedures for a modified Delphi study to explore expert consensus about important factors when developing caregiver interventions. METHODS AND ANALYSIS Online modified Delphi methodology will be used to establish consensus for important caregiver intervention factors incorporating the Patient problem, Intervention, Comparison and Outcome framework. Round 1 will comprise a free-text questionnaire and invite the panel to contribute factors they deem important in the development and evaluation of caregiver interventions. Round 2 is designed to determine preliminary consensus of the importance of factors generated in round 1. The panel will be asked to rate each factor using a 4-point Likert-type scale. The option for panellists to state reasoning for their rating will be provided. Descriptive statistics (median scores and IQR) will be calculated to determine each item's relative importance. Levels of consensus will be assessed based on a predefined consensus rating matrix. In round 3, factors will be recirculated including aggregate group responses (statistics and comment summaries) and panellists' own round 2 scores. Panellists will be invited to reconsider their judgements and resubmit ratings using the same rating system as in round 2. This will result in priority lists based on the panel's total rating scores. ETHICS AND DISSEMINATION Ethics for this study has been gained from the Deakin University Human Ethics Advisory Group. It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums.
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Affiliation(s)
- Sarah-May Blaschke
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Patricia M Livingston
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Anna Boltong
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meinir Krishnasamy
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
- Centre for Cancer Research, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Abstract
OBJECTIVE This study aimed to establish the first global health bachelor curriculum in China. DESIGN The Delphi methodology was used to determine expert consensus on which courses should be included in the global health bachelor curriculum. A literature review and a workshop proceeding were performed to generate courses. Then a two-round Delphi process was conducted with 28 invited experts from universities, health administrative departments and non-governmental organisations to rate courses using a 5-point Likert scale. Additionally, the experts could alter, add or delete courses as appropriate. Consensus was predefined as a mean score of 4 or above and the percent agreement (proportion of panel members scoring 'very important' or 'important') no less than 75%. RESULTS The responses in the two-round Delphi process were 85.7% and 70.8%, respectively. In the first round, 12 courses did not meet the inclusion criteria and were removed. Based on the participants' comments, 32 courses were included in round 2. In the second round, the consensus was reached on 31 courses which were selected as the final curriculum. These courses were categorised into five modules, including General Knowledge, Methodology, Global Health Issues, Intercultural Communication, and Health Policy and Programme Management. CONCLUSION This study established the first global health bachelor curriculum in China. It will provide guidance for other educational institutions to develop similar programmes or curricula in the future.
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Affiliation(s)
- Li Guan
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Pan Gao
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - SuYang Liu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - YiSi Liu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - XiangYu Li
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - FeiFei Liu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - ZongFu Mao
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - YuanAn Lu
- Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
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Zanker J, Scott D, Reijnierse EM, Brennan-Olsen SL, Daly RM, Girgis CM, Grossmann M, Hayes A, Henwood T, Hirani V, Inderjeeth CA, Iuliano S, Keogh JWL, Lewis JR, Maier AB, Pasco JA, Phu S, Sanders KM, Sim M, Visvanathan R, Waters DL, Yu SCY, Duque G. Establishing an Operational Definition of Sarcopenia in Australia and New Zealand: Delphi Method Based Consensus Statement. J Nutr Health Aging 2019; 23:105-110. [PMID: 30569078 DOI: 10.1007/s12603-018-1113-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. OBJECTIVE The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. METHOD A four-Phase modified Delphi process was undertaken in which 24 individuals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. RESULTS In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. CONCLUSION With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.
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Affiliation(s)
- J Zanker
- Prof. Gustavo Duque, MD, PhD, FRACP, FGSA, Australian Institute for Musculoskeletal Science (AIMSS), 176 Furlong Road, St. Albans, VIC, Australia 3021, e-mail: , phone: +61 8395 8121
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González-Gutiérrez-Solana L, Guillén-Navarro E, del Toro M, Dalmau J, González-Meneses A, Couce ML. Diagnosis and follow-up of patients with Hunter syndrome in Spain: A Delphi consensus. Medicine (Baltimore) 2018; 97:e11246. [PMID: 30024503 PMCID: PMC6086518 DOI: 10.1097/md.0000000000011246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hunter syndrome or mucopolysaccharidosis type II (MPSII) is a progressive multisystem X-linked lysosomal storage disease caused by mutations in the IDS gene that shows a wide spectrum of clinical symptoms and severity. Idursulfase, a specific enzyme replacement therapy (ERT) for MPSII, has been available since 2007. ERT, along with symptomatic management of patients, is fundamental for improving patient prognosis and quality of life. The aims of this study were to investigate whether Spanish pediatricians who are experts in managing the disease agreed with current international guidelines regarding MPSII patient diagnosis and follow-up; and to reach a consensus regarding which items are essential for the diagnosis, follow-up, and treatment of these patients in Spain.An advisory panel of 5 experts from the Hunter Spanish Working Group reviewed key studies, developed a questionnaire based on a modified Delphi method, sent the questionnaire to selected experts, and reviewed the responses. The final questionnaire had 83 items in the following categories: diagnosis, ERT considerations after diagnosis, Periodic assessments, and ERT considerations during follow-up. A total of 85 experts were invited to participate; 28 (35%) responded and showed a strong consensus for most items. The advisory panel decided not to perform a second Delphi round. There was strong agreement (>3.1 median value; range, 1 to 4) for 43/56 items in Diagnosis, for 4/6 items in "ERT considerations after diagnosis," for 6/16 items in "Periodic assessments," and for 3/5 items in "ERT considerations during follow-up." Most responses were in agreement with international guidelines, and controversial items were discussed by the advisory panel. Based on the results, on the key studies, and on clinical experience and opinions, the panel developed and scheduled recommendations for the diagnosis and follow-up of patients with MPSII.An expert 5-person panel oversaw a Delphi survey of 28 pediatricians and reached a consensus on recommendations for the diagnosis and follow-up of MPSII patients. This document will help guide clinicians involved in the diagnosis, management, and treatment of MPSII.
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Affiliation(s)
| | - Encarnación Guillén-Navarro
- Sección de Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia; Grupo Clínico vinculado al Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid
| | - Mireia del Toro
- Servicio de Neurología Pediátrica, Hospital Universitario Vall d’Hebrón, Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona
| | - Jaime Dalmau
- Unidad de Nutrición y Metabolopatías. Hospital Infantil La Fe. Valencia
| | | | - María L. Couce
- Metabolic Unit, Service of Neonatology. Department of Pediatrics. Hospital Clínico Universitario de Santiago, IDIS, CIBERER, ISCIII, Santiago de Compostela, Spain
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Fish R, Sanders C, Williamson PR, Renehan AG. Core outcome research measures in anal cancer (CORMAC): protocol for systematic review, qualitative interviews and Delphi survey to develop a core outcome set in anal cancer. BMJ Open 2017; 7:e018726. [PMID: 29170292 PMCID: PMC5719280 DOI: 10.1136/bmjopen-2017-018726] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The incidence of anal squamous cell carcinoma (ASCC) has increased threefold in the last 30 years. Initial treatment is chemoradiotherapy, associated with short-term and long-term side effects. Future therapy innovations aim to reduce morbidity in treatment of early tumours while maintaining treatment efficacy, and to escalate treatment intensity in locally advanced tumours with acceptable quality of life (QoL). However, all phase III randomised controlled trials to-date have utilised different primary outcomes, which hinders evidence synthesis and presents challenges to the selection of optimal outcomes in future trials. No trial comprehensively assessed long-term side effects and QoL, suggesting outcomes reflecting issues important to patients are under-represented. This project aims to determine the priority outcomes for all stakeholders and reach agreement on a standardised core set of outcomes to be measured and reported on in all future ASCC trials. METHODS AND ANALYSIS A systematic review will identify all outcomes reported in trials and observational studies of chemoradiotherapy as primary treatment for ASCC. Outcomes of importance to patients will be identified through patient interviews. The long list of outcomes generated from the systematic review and interviews will be used to create a two-round Delphi process, including key stakeholders (patients and healthcare professionals). The results of the Delphi will be discussed at a face-to-face consensus meeting. Discussion will focus on outcomes that did not achieve consensus through the Delphi process and conclude with anonymous voting to ratify the final core outcome set (COS). ETHICS AND DISSEMINATION The final COS will feed directly into the PersonaLising Anal cancer radioTherapy dOse (PLATO) national anal cancer trials and the Association of coloproctologists of Great Britain and Ireland (ACPGBI) supported national anal cancer database. Utilisation of the COS will increase the relevance of research output to all stakeholders and increase the capacity for data synthesis between trials. This study has ethical approval and is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative. TRIAL REGISTRATION NUMBER PROSPERO registration ID: CRD42016036540.
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Affiliation(s)
- Rebecca Fish
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Paula R Williamson
- Department of Biostatistics, University of Liverpool, Liverpool, UK
- Medical Research Council North West Hub for Trials Methodology Research, Liverpool, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
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Abstract
INTRODUCTION 'Core outcome sets' are an agreed, standardised set of outcomes based on what key stakeholders (clinicians, patients, their partners, researchers, service developers, funding organisations and so on) consider the important outcomes in the management or prevention of a condition. This paper describes the rationale and design for the development of Core Outcome Sets for Miscarriage Trials. METHODS AND ANALYSIS Systematic reviews, interviews and focus groups with patients and their partners will be conducted to identify potential core outcomes that will be introduced into a modified Delphi survey. To ensure all key stakeholders are included, patients, partners, clinicians, charities and researchers will be invited to take part in the modified Delphi survey. There will be three rounds of scoring and rescoring during the Delphi survey to reach consensus regarding outcomes to be included in the core set, which will be subsequently refined through face-to-face consensus discussions. ETHICS AND DISSEMINATION The use of core outcome sets allows results from different studies to be compared and combined, thereby reducing inconsistency and aiding interpretation of study findings. It also means research is more likely to report relevant outcomes and so can reduce reporting bias. Understanding which outcomes are important to patients has the potential to act as a driver to improve both the quality and cost-effectiveness of miscarriage services.
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Affiliation(s)
- Paul Smith
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Natalie Cooper
- Women’s Health Research Unit, Barts and The London School of Medicine, Queen Mary University of London, London and Barts Health NHS Trust, London, UK
| | - Rima Dhillon-Smith
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Emily O’Toole
- Women’s Voices Involvement Panel, Royal College of Obstetricians and Gynaecologists, London, UK
| | - T Justin Clark
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Arri Coomarasamy
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
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Brett J, Staniszewska S, Simera I, Seers K, Mockford C, Goodlad S, Altman D, Moher D, Barber R, Denegri S, Entwistle AR, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines. BMJ Open 2017; 7:e016948. [PMID: 29061613 PMCID: PMC5665282 DOI: 10.1136/bmjopen-2017-016948] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)). METHODS There were three key stages in the development of GRIPP2: identification of key items for the guideline from systematic review evidence of the impact of PPI on health research and health services, a three-phase online Delphi survey with a diverse sample of experts in PPI to gain consensus on included items and a face-to-face consensus meeting to finalise and reach definitive agreement on GRIPP2. Challenges and lessons learnt during the development of the reporting guidelines are reported. DISCUSSION The process of reaching consensus is vital within the development of guidelines and policy directions, although debate around how best to reach consensus is still needed. This paper discusses the critical stages of consensus development as applied to the development of consensus for GRIPP2 and discusses the benefits and challenges of consensus development.
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Affiliation(s)
- Jo Brett
- Department of Midwifery, Community and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK
| | - Sophie Staniszewska
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iveta Simera
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Kate Seers
- Division of Health and Social Care Research, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carole Mockford
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susan Goodlad
- Centre for Research in Psychology, Behaviour and Acheivement, University of Coventry, Coventry, UK
| | - Doug Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford, UK
| | - David Moher
- Ottawa Hospital Research Institute, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosemary Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Denegri
- INVOLVE, National Institute of Health Research (NIHR), University of Southampton, Southampton, UK
| | | | | | - Christopher Morris
- Peninsula Cerebra Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | | | - Victoria Thomas
- Patient and Public Involvement Unit, Public Involvement Programme, National Institute for Health and Clinical Excellence, London, UK
| | - Colin Tysall
- UNTRAP, University of Warwick, Coventry, Warwicks, UK
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Baines RL, Regan de Bere S. Optimizing patient and public involvement (PPI): Identifying its "essential" and "desirable" principles using a systematic review and modified Delphi methodology. Health Expect 2017; 21:327-335. [PMID: 28929554 PMCID: PMC5750770 DOI: 10.1111/hex.12618] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background There is international interest in the active involvement of patients and the public. However, consensus on how best to optimize its application is currently unavailable. Objective To identify and assess the underlying principles of patient and public involvement (PPI) in health and social care services, research, education and regulation across medicine, dentistry and nursing. Design A four‐phase methodology: (i) an extensive systematic review of published and grey literature; (ii) inductive thematic analysis of review findings; (iii) development of best practice principles; and (iv) consensus testing of identified principles using a modified Delphi methodology. Setting and participants Twelve systematic reviews and 88 grey literature publications were reviewed leading to the unique identification of 13 principles later assessed by 18 PPI experts. Results Essential consensus (>75% agreement) was obtained for nine principles reviewed. Working in equal partnership and sharing information achieved the highest consensus rates: 16/17 essential 94.1%; 1/17 desirable 5.8%. The four remaining principles that failed to reach essential consensus were categorized as desirable by expert respondents. No principles were considered irrelevant. No alternatives were suggested. Discussion Expert respondents suggest essential principles must be achieved to optimize PPI best practice. To advance PPI practice, desirable principles should also be aspired to wherever possible. Conclusions This study's innovative approach advances existing knowledge by providing previously unavailable consensus about PPI best practice. Research findings hold important theoretical and practical implications for educators, regulators, researchers and practitioners looking to effectively work together.
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Affiliation(s)
- Rebecca L Baines
- Collaboration for the Advancement of Medical Education Research & Assessment, University of Plymouth, Plymouth, UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research & Assessment, University of Plymouth, Plymouth, UK
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Coster JE, Irving AD, Turner JK, Phung VH, Siriwardena AN. Prioritizing novel and existing ambulance performance measures through expert and lay consensus: A three-stage multimethod consensus study. Health Expect 2017; 21:249-260. [PMID: 28841252 PMCID: PMC5750751 DOI: 10.1111/hex.12610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/30/2022] Open
Abstract
Background Current ambulance quality and performance measures, such as response times, do not reflect the wider scope of care that services now provide. Using a three‐stage consensus process, we aimed to identify new ways of measuring ambulance service quality and performance that represent service provider and public perspectives. Design A multistakeholder consensus event, modified Delphi study, and patient and public consensus workshop. Setting and participants Representatives from ambulance services, patient and public involvement (PPI) groups, emergency care clinical academics, commissioners and policymakers. Results Nine measures/principles were highly prioritized by >75% of consensus event participants, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to further refine and prioritize measures; 20 measures in three domains scored ≥8/9, indicating good consensus, including proportion of calls correctly prioritized, time to definitive care and measures related to pain. Eighteen patient/public representatives attended a consensus workshop, and six measures were identified as important. These include time to definitive care, response time, reduction in pain scores, calls correctly prioritized to appropriate levels of response and survival to hospital discharge for treatable emergency conditions. Conclusions Using consensus methods, we identified a shortlist of ambulance outcome and performance measures that are important to ambulance clinicians and service providers, service users, commissioners, and clinical academics, reflecting current pre‐hospital ambulance care and services. The measures can potentially be used to assess pre‐hospital quality or performance over time, with most calculated using routinely available data.
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Affiliation(s)
| | | | | | - Viet-Hai Phung
- Community and Health Research Unit, University Lincoln, Lincoln, UK
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50
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Sobota AE, Shah N, Mack JW. Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers. Pediatr Blood Cancer 2017; 64. [PMID: 27905689 DOI: 10.1002/pbc.26374] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/25/2016] [Accepted: 10/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. PROCEDURE We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. RESULTS The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. CONCLUSIONS By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients.
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Affiliation(s)
- Amy E Sobota
- Boston University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Nishita Shah
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer W Mack
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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