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Kovacs Burns K, Bhatia Z, Gill B, van der Nest D, Knox J, Mouneimne M, Buck T, Charbonneau R, Aiello K, Loyola Sanchez A, Kamran R, Olayinka O, Ho C. Measures for Persons with Spinal Cord Injury to Monitor Their Transitions in Care, Health, Function, and Quality of Life Experiences and Needs: A Protocol for Co-Developing a Self-Evaluation Tool. Healthcare (Basel) 2024; 12:527. [PMID: 38470643 PMCID: PMC10930772 DOI: 10.3390/healthcare12050527] [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: 12/21/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert stakeholders initially exploring and selecting existing measures or tools through a modified Delphi process, followed by choosing one of two options. The options were to either support the use of the 10 selected tools from the Delphi method or to co-develop one unique condensed tool with relevant measures to evaluate all four domains. The stakeholders chose to co-develop one tool to be used by persons with SCI to monitor their transition experiences across settings and care providers. This includes any issues with care or support they needed to address at the time of discharge from acute care or rehabilitation and in the community at 3, 6, and 12 months or longer post-discharge. Once developed, the tool was made available online for the final stage of the protocol, which proposes that the tool be reliability tested prior to its launch, followed by validation testing by PwSCI.
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Affiliation(s)
- Katharina Kovacs Burns
- Clinical Quality Metrics/Primary Data Support, Data & Analytics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Zahra Bhatia
- Spinal Cord Injury Alberta, Calgary, AB T2H 1H7, Canada
| | - Benveet Gill
- ReYu Paralysis Recovery Centre, Edmonton, AB T5S 1G8, Canada
| | - Dalique van der Nest
- Slave Lake Healthcare Centre (North Zone), Alberta Health Services, Slave Lake, AB T0G 2A2, Canada
| | - Jason Knox
- Tertiary Neurorehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Magda Mouneimne
- Tertiary Neurorehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Taryn Buck
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Rebecca Charbonneau
- Physical Medicine and Rehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Kasey Aiello
- Patient Liaison to Neurosciences, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Adalberto Loyola Sanchez
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
- Department of Clinical Neurosciences, Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Rija Kamran
- Rehabilitation Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T2N 1N4, Canada
| | - Olaleye Olayinka
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Chester Ho
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
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Li X, Wang Y, Zou D, Zhang W, Li X, He P, Zhou H, Yang T, Zhu J, Hong B, Zhang Y, Xiao Y. Technical guideline for intra-prepontine cisternal drug delivery via spinal puncture through subarachnoid catheterization. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2024; 49:1-10. [PMID: 38615160 PMCID: PMC11017027 DOI: 10.11817/j.issn.1672-7347.2024.230597] [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] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 04/15/2024]
Abstract
OBJECTIVES The distribution characteristics of intrathecal drugs and the limitation of current catheterization techniques make traditional intrathecal analgesic treatment nearly useless for refractory craniofacial pain, such as trigemina neuralgia. This technical guideline aims to promote the widespread and standardize the application of intra-prepontine cisternal drug delivery via spinal puncture and catheterization. METHODS A modified Delphi approach was used to work for this guideline. On the issues related to the intra-prepontine cisternal targeted drug delivery technique, the working group consulted 10 experts from the field with 3 rounds of email feedback and 3 rounds of conference discussion. RESULTS For the efficacy and safety of the intra-prepontine cisternal targeted drug delivery technique, a consensus was formed on 7 topics (with an agreement rate of more than 80%), including the principles of the technique, indications and contraindications, patient preparation, surgical specifications for intra-prepontine cisternal catheter placement, analgesic dosage coordination, analgesic management, and prevention and treatment of complications. CONCLUSIONS Utilizing the intra-prepontine cisternal drug infusion system to manage refractory craniofacial pain could provide advantages in terms of minimally invasive, secure, and effective treatment. This application can not only alleviate the suffering of individuals experiencing the prolonged pain but also support the maintenance of quality of life and dignity in their final moments, justifiing its widespread dissemination and standardized adoption in domestic and international professional fields.
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Affiliation(s)
- Xinning Li
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011.
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011.
| | - Yaping Wang
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011
| | - Dingquan Zou
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011
| | - Wei Zhang
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011
| | - Xin Li
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011.
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011.
| | - Peiyao He
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011
| | - Haocheng Zhou
- Department of Pain Management, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Tongbiao Yang
- Department of Pain Management, Yongzhou Central Hospital, Yongzhou Hunan 425002
| | - Jun Zhu
- Department of Pain Management, Huaihua First People's Hospital, Huaihua Hunan 418099
| | - Bo Hong
- Department of Pain Management, Yueyang Traditional Chinese Medicine Hospital, Yueyang Hunan 414021
| | - Yu Zhang
- Department of Pain Management, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Yanying Xiao
- Department of Pain Management, Second Xiangya Hospital, Central South University, Changsha 410011.
- Hunan Provincial Pain Clinical Medical Research Center, Changsha 410011.
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Martin RL, Takla A, Disantis A, Kohlrieser D, Enseki K, Lifshitz L, Grant L, Bizzini M, Voight M, Ryan M, McGovern R, Tyler T, Steinfeld-Mass Y, Campbell A, Zhang Y. Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement. Int J Sports Phys Ther 2023; 18:1346-1355. [PMID: 38050542 PMCID: PMC10693491 DOI: 10.26603/001c.89269] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
Background Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. Purpose This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. Study Design A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. Results The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. Conclusion This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.
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Affiliation(s)
| | - Amir Takla
- Swinburne University of Technology
- Australian Sports Physiotherapy
- Hip Arthroscopy Australia
| | | | | | | | | | | | | | - Mike Voight
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Mark Ryan
- The Steadman Clinic Steadman Philippon Research Institute
| | | | | | | | - Ashley Campbell
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Yongni Zhang
- Duquesne University
- Duquesne - China Health Institute
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4
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Rocha JC, Ahring KK, Bausell H, Bilder DA, Harding CO, Inwood A, Longo N, Muntau AC, Pessoa ALS, Rohr F, Sivri S, Hermida Á. Expert Consensus on the Long-Term Effectiveness of Medical Nutrition Therapy and Its Impact on the Outcomes of Adults with Phenylketonuria. Nutrients 2023; 15:3940. [PMID: 37764724 PMCID: PMC10536918 DOI: 10.3390/nu15183940] [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: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Many adults with phenylketonuria (PKU) rely on medical nutrition therapy (MNT; low phenylalanine (Phe) diet with protein substitutes/medical foods) to maintain blood Phe concentrations within recommended ranges and prevent PKU-associated comorbidities. Despite disease detection through newborn screening and introduction of MNT as early as birth, adherence to MNT often deteriorates from childhood onwards, complicating the assessment of its effectiveness in the long term. Via a modified Delphi process, consensus (≥70% agreement) was sought on 19 statements among an international, multidisciplinary 13-member expert panel. After three iterative voting rounds, the panel achieved consensus on 17 statements related to the limitations of the long-term effectiveness of MNT (7), the burden of long-term reliance on MNT (4), and its potential long-term detrimental health effects (6). According to the expert panel, the effectiveness of MNT is limited in the long term, is associated with a high treatment burden, and demonstrates that adults with PKU are often unable to achieve metabolic control through dietary management alone, creating an unmet need in the adult PKU population.
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Affiliation(s)
- Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Kirsten K. Ahring
- Departments of Paediatrics and Clinical Genetics, PKU Clinic, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Heather Bausell
- Division of Genetics, Genomics, and Metabolism, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Deborah A. Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Utah Huntsman Mental Health Institute, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR 97239, USA
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Queensland Children’s Hospital, 501 Stanley St., South Brisbane, QLD 4101, Australia
- School of Nursing and Social Work, The University of Queensland, Chamberlain Building, St. Lucia, QLD 4072, Australia
| | - Nicola Longo
- Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ania C. Muntau
- Department of Pediatrics, University Children’s Hospital, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - André L. Santos Pessoa
- Albert Sabin Children’s Hospital, R. Tertuliano Sales, 544—Vila União, Fortaleza 60410-794, CE, Brazil
- Av. Dr. Silas Munguba, 1700—Itaperi, State University of Ceará (UECE), Fortaleza 60714-903, CE, Brazil
| | | | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Gevher Nesibe Cd., 06230 Ankara, Turkey
| | - Álvaro Hermida
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Faculty of Medicine, Clinical University Hospital of Santiago de Compostela, University of Santiago de Compostela, CIBERER, MetabERN, Institute of Clinical Research of Santiago de Compostela (IDIS), Rúa de San Francisco s/n, 15706 Santiago de Compostela, Spain
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Mundis GM, Ito K, Lakomkin N, Shahidi B, Malone H, Iannacone T, Akbarnia B, Uribe J, Eastlack R. Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion. Medicina (Kaunas) 2023; 59:1149. [PMID: 37374353 DOI: 10.3390/medicina59061149] [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: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF). Materials and Methods: A search algorithm was employed to identify all the articles that described complications following LLIF. A modified Delphi technique was then used to perform three rounds of consensus among twenty-six anonymized experts across seven countries. Published complications were classified as major, minor, or non-complications using a 60% agreement threshold for consensus. Results: A total of 23 articles were extracted, describing 52 individual complications associated with LLIF. In Round 1, forty-one of the fifty-two events were identified as a complication, while seven were considered to be approach-related occurrences. In Round 2, 36 of the 41 events with complication consensus were classified as major or minor. In Round 3, forty-nine of the fifty-two events were ultimately classified into major or minor complications with consensus, while three events remained without agreement. Vascular injuries, long-term neurologic deficits, and return to the operating room for various etiologies were identified as important consensus complications following LLIF. Non-union did not reach significance and was not classified as a complication. Conclusions: These data provide the first, systematic classification scheme of complications following LLIF. These findings may improve the consistency in the future reporting and analysis of surgical outcomes following LLIF.
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Affiliation(s)
| | - Kenyu Ito
- Aichi Spine Hospital, Aichi, Inuyama 484-0066, Japan
| | - Nikita Lakomkin
- Mayo Clinic College of Medicine and Science, Rochester, NY 55905, USA
| | - Bahar Shahidi
- San Diego Department of Orthopaedic Surgery, University of California, La Jolla, CA 92093, USA
| | - Hani Malone
- Scripps Clinic Medical Group, San Diego, CA 92037, USA
| | | | - Behrooz Akbarnia
- San Diego Department of Orthopaedic Surgery, University of California, La Jolla, CA 92093, USA
- San Diego Spine Foundation, San Diego, CA 92121, USA
| | - Juan Uribe
- Barrow Neurological Institute, Phoenix, AZ 85013, USA
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Calamai I, Greco M, Savi M, Vitiello G, Garbero E, Spina R, Pisani L, Mongodi S, Finazzi S. Thoracic UltrasONOgraphy Reporting: The TUONO Consensus. Diagnostics (Basel) 2023; 13:diagnostics13091535. [PMID: 37174927 PMCID: PMC10177560 DOI: 10.3390/diagnostics13091535] [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: 03/28/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
The widespread use of the lung ultrasound (LUS) has not been followed by the development of a comprehensive standardized tool for its reporting in the intensive care unit (ICU) which could be useful to promote consistency and reproducibility during clinical examination. This work aims to define the essential features to be included in a standardized reporting tool and provides a structured model form to fully express the diagnostic potential of LUS and facilitate intensivists in the use of a LUS in everyday clinical ICU examination. We conducted a modified Delphi process to build consensus on the items to be integrated in a standardized report form and on its structure. A committee of 19 critical care physicians from 19 participating ICUs in Italy was formed, including intensivists experienced in ultrasound from both teaching hospitals and referral hospitals, and internationally renowned experts on the LUS. The consensus for 31 statements out of 33 was reached at the third Delphi round. A structured model form was developed based on the approved statements. The development of a standardized model as a backbone to report a LUS may facilitate the guidelines' application in clinical practice and increase inter-operator agreement. Further studies are needed to evaluate the effects of standardized reports in critically ill patients.
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Affiliation(s)
- Italo Calamai
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marzia Savi
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Gaia Vitiello
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
| | - Elena Garbero
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
| | - Rosario Spina
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Luigi Pisani
- Intensive Care Unit, Ospedale Generale Regionale Miulli, 70021 Acquaviva delle Fonti, Italy
- Mahidol Oxford Tropical Research Unit, Bangkok 10400, Thailand
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, San Matteo Hospital, 94403 Pavia, Italy
| | - Stefano Finazzi
- Laboratory of Clinical Epidemiology, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
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7
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Yilmaz Y, Chan MK, Richardson D, Atkinson A, Bassilious E, Snell L, Chan TM. Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education. Med Teach 2023; 45:395-403. [PMID: 36471921 DOI: 10.1080/0142159x.2022.2136517] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. METHOD A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. RESULTS Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. CONCLUSIONS The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner.
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Affiliation(s)
- Yusuf Yilmaz
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Denyse Richardson
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adelle Atkinson
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Ereny Bassilious
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Linda Snell
- Medicine and Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Teresa M Chan
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Divisions of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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8
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MacKay C, Lee L, Best K, Campbell J, Cimino SR, Cowley H, Delvin M, Dilkas S, Landry M, Marzolini S, Mayo A, Oh P, Payne M, Viana R, Totosy de Zepetnek J, Domingo A, King S, Miller WC, Robert M, Tang A, Zidarov D, Zucker-Levin A, Hitzig SL. Developing a research agenda on exercise and physical activity for people with limb loss in Canada. Disabil Rehabil 2022; 44:8130-8138. [PMID: 34843420 DOI: 10.1080/09638288.2021.2003877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/18/2023]
Abstract
PURPOSE There is a lack of high-quality evidence about the effects of exercise or physical activity interventions for adults with lower limb amputations (LLAs). A planning meeting involving stakeholders (i.e., people with LLA, community advocates, health care providers, researchers) was organized to identify key research priorities related to exercise and physical activity for people with LLAs. METHODS We used a collaborative prioritized planning process with a pre-meeting survey and 2-day virtual meeting that included: identification and prioritization of challenges or gaps; identification and consolidation of solutions; and action planning. This process integrated a modified Delphi approach, including anonymous feedback in two surveys. RESULTS Thirty-five stakeholders participated. Six challenges related to exercise and physical activity for people with LLA were prioritized. One solution was prioritized for each challenge. After consolidation of solutions, participants developed five research action plans for research including: developing an on-line interface; developing and evaluating peer-support programs to support physical activity; examining integration of people with LLA into cardiac rehabilitation; development and evaluation of health provider education; and determining priority outcomes related to physical activity and exercise. CONCLUSIONS This collaborative process resulted in an action plan for amputation research and fostered collaborations to move identified priorities into action.IMPLICATIONS FOR REHABILITATIONLower limb amputations impact mobility leading to lower levels of physical activity.There are research gaps in our understanding of the effects of exercise or physical activity interventions for adults with lower limb amputations.Through a collaborative planning process, participants prioritized research directions on physical activity and exercise for people with LLA to advance research in the field.Action plans for research focused on developing online resources, peer support, cardiac rehabilitation for people with LLA, health provider education and determining priority outcomes related to physical activity and exercise.
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Affiliation(s)
- Crystal MacKay
- West Park Healthcare Centre, Toronto, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Leanna Lee
- West Park Healthcare Centre, Toronto, Canada
| | - Krista Best
- Faculté de médecine, Universite Laval, Quebec City, Canada
| | | | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Steven Dilkas
- West Park Healthcare Centre, Toronto, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mireille Landry
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital, Toronto, Canada
| | - Susan Marzolini
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Amanda Mayo
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Michael Payne
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Parkwood Institute, St. Joseph's Health Care, London, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Parkwood Institute, St. Joseph's Health Care, London, Canada
| | | | | | | | - William C Miller
- GF Strong Rehab Centre, Vancouver, Canada.,Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Maxime Robert
- Faculté de médecine, Universite Laval, Quebec City, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Diana Zidarov
- Faculté de Médecine, École de réadaptation, Université de Montréal, Montréal, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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9
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Natalia Jaworska, Kira Makuk, Karla D. Krewulak, Daniel J. Niven, Zahinoor Ismail, Lisa D. Burry, Sangeeta Mehta, Kirsten M. Fiest. A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness. Crit Care Explor 2022; 4:e0806. [PMID: 36506828 DOI: 10.1097/CCE.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Antipsychotic medications are frequently prescribed to critically ill patients leading to their continuation at transitions of care thereafter. The aim of this study was to generate evidence-informed consensus statements with key stakeholders on antipsychotic minimization and deprescribing for ICU patients. DESIGN We completed three rounds of surveys in a National modified Delphi consensus process. During rounds 1 and 2, participants used a 9-point Likert scale (1-strongly disagree, 9-strongly agree) to rate perceptions related to antipsychotic prescribing (i.e., experiences regarding delivery of patient care), knowledge and frequency of antipsychotic use, knowledge surrounding antipsychotic guideline recommendations, and strategies (i.e., interventions addressing current antipsychotic prescribing practices) for antipsychotic minimization and deprescribing. Consensus was defined as a median score of 1-3 or 7-9. During round 3, participants ranked statements on antipsychotic minimization and deprescribing strategies that achieved consensus (median score 7-9) using a weighted ranking scale (0-100 points) to determine priority. SETTING Online surveys distributed across Canada. SUBJECTS Fifty-seven stakeholders (physicians, nurses, pharmacists) who work with ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Participants prioritized six consensus statements on strategies for consideration when developing and implementing interventions to guide antipsychotic minimization and deprescribing. Statements focused on limiting antipsychotic prescribing to patients: 1) with hyperactive delirium, 2) at risk to themselves, their family, and/or staff due to agitation, and 3) whose care and treatment are being impacted due to agitation or delirium, and prioritizing 4) communication among staff about antipsychotic effectiveness, 5) direct and efficient communication tools on antipsychotic deprescribing at transitions of care, and 6) medication reconciliation at transitions of care. CONCLUSIONS We engaged diverse stakeholders to generate evidence-informed consensus statements regarding antipsychotic prescribing perceptions and practices that can be used to implement interventions to promote antipsychotic minimization and deprescribing strategies for ICU patients with and following critical illness.
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10
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Rutz E, Novacheck TF, Dreher T, Davids JR, McCarthy J, Kay RM, Shore BJ, Shrader MW, Veerkamp M, Chambers H, Narayanan U, Pierz K, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Graham K. Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review. J Child Orthop 2022; 16:442-453. [PMID: 36483640 PMCID: PMC9723875 DOI: 10.1177/18632521221137391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In children with cerebral palsy, flexion deformities of the knee can be treated with a distal femoral extension osteotomy combined with either patellar tendon advancement or patellar tendon shortening. The purpose of this study was to establish a consensus through expert orthopedic opinion, using a modified Delphi process to describe the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. A literature review was also conducted to summarize the recent literature on distal femoral extension osteotomy and patellar tendon shortening/patellar tendon advancement. METHOD A group of 16 pediatric orthopedic surgeons, with more than 10 years of experience in the surgical management of children with cerebral palsy, was established. The group used a 5-level Likert-type scale to record agreement or disagreement with statements regarding distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. Consensus for the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening was achieved through a modified Delphi process. The literature review, summarized studies of clinical outcomes of distal femoral extension osteotomy/patellar tendon shortening/patellar tendon advancement, published between 2008 and 2022. RESULTS There was a high level of agreement with consensus for 31 out of 44 (70%) statements on distal femoral extension osteotomy. Agreement was lower for patellar tendon advancement/patellar tendon shortening with consensus reached for 8 of 21 (38%) of statements. The literature review included 25 studies which revealed variation in operative technique for distal femoral extension osteotomy, patellar tendon advancement, and patellar tendon shortening. Distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening were generally effective in correcting knee flexion deformities and extensor lag, but there was marked variation in outcomes and complication rates. CONCLUSION The results from this study will provide guidelines for surgeons who care for children with cerebral palsy and point to unresolved questions for further research. LEVEL OF EVIDENCE level V.
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Affiliation(s)
- Erich Rutz
- Department of Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia,Erich Rutz, Department of Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Bob Dickens Chair Paediatric Orthopaedic Surgery, Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Tom F Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | | | - Jon R Davids
- Shriners Hospitals for Children-Northern California, Sacramento, CA, USA
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Robert M Kay
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - M Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | - Kerr Graham
- Department of Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
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11
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Claeys KC, Trautner BW, Leekha S, Coffey KC, Crnich CJ, Diekema D, Fakih MG, Goetz MB, Gupta K, Jones MM, Leykum L, Liang SY, Pineles L, Pleiss A, Spivak ES, Suda KJ, Taylor J, Rhee C, Morgan DJ. Optimal Urine Culture Diagnostic Stewardship Practice- Results from an Expert Modified-Delphi Procedure. Clin Infect Dis 2021; 75:382-389. [PMID: 34849637 DOI: 10.1093/cid/ciab987] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urine cultures are nonspecific for infection and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. This study aimed to develop expert guidance on best practices for urine culture diagnostic stewardship. METHODS A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped in three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed in a virtual meeting, and a then second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed. RESULTS 165 questions were reviewed with the panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional reflex urine cultures and urine white blood cell as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions. CONCLUSIONS These 18 guidance statements can optimize use of the imperfect urine culture for better patient outcomes.
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Affiliation(s)
- Kimberly C Claeys
- Infectious Diseases, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - K C Coffey
- Associate Hospital Epidemiologist, VA Maryland Healthcare System, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher J Crnich
- Chief of Medicine, Hospital Epidemiologist, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Dan Diekema
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - Mohamad G Fakih
- Chief Quality Officer, Quality Department, Clinical & Network Services, Ascension Healthcare, Grosse Pointe Woods and Wayne State University School of Medicine, Detroit, MI, USA
| | - Matthew Bidwell Goetz
- Infectious Diseases Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalpana Gupta
- Associate Chief of Staff and Chief, Section of Infectious Diseases, VA Boston Healthcare System, of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Makoto M Jones
- Salt Lake City Veterans Affairs Healthcare System, Internal Medicine - Associate Professor, Division of Epidemiology, The University of Utah, Salt Lake City, UT, USA
| | - Luci Leykum
- Department of Internal Medicine, University of Texas at Austin Dell School of Medicine, Austin, TX, USA
| | - Stephen Y Liang
- Medicine, Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashley Pleiss
- Lead Clinical Nurse, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Emily S Spivak
- Co-Director of the Antimicrobial Stewardship, University of Utah Health and the Salt Lake City Veterans Affairs Healthcare System, Salt Lake City, UT, USA
| | - Katie J Suda
- VA Pittsburgh Healthcare System, Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh and the, Pittsburgh, PA, USA
| | | | - Chanu Rhee
- Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Associate Hospital Epidemiologist, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel J Morgan
- Chief Hospital, VA Maryland Healthcare System, Epidemiologist Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Teo YH, Peh TY, Abdurrahman ABHM, Lee ASI, Chiam M, Fong W, Wijaya L, Krishna LKR. A modified Delphi approach to enhance nurturing of professionalism in postgraduate medical education in Singapore. Singapore Med J 2021. [PMID: 34823327 DOI: 10.11622/smedj.2021224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/18/2022]
Abstract
INTRODUCTION Nurturing professional identities instils behavioural standards of physicians, in turn facilitating consistent professional attitudes, practice, and patient care. Identities are socioculturally constructed efforts, thus we must account for the social, cultural, and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aims to forward a program to nurture professionalism amongst physicians in Singapore. METHODS A 3-phased-evidenced-based-approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created drawing from the SS's findings. Third, a modified Delphi involving local experts identifying socioculturally appropriate elements to nurture professionalism was conducted. RESULTS The 124 included articles in the SSR revealed definitions, knowledge, skills, and approaches to nurturing professionalism. The modified Delphi identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. CONCLUSION Results formed the basis to a holistic and longitudinal program focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. Findings will be of interest to medical communities in the region and beyond.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Assisi Hospice, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, United Kingdom
- Centre of Biomedical Ethics, National University of Singapore, Singapore
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13
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Johnston EE, Martinez I, Wolfe J, Asch SM. Quality measures for end-of-life care for children with cancer: A modified Delphi approach. Cancer 2021; 127:2571-2578. [PMID: 33784408 DOI: 10.1002/cncr.33546] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/02/2020] [Revised: 12/15/2020] [Accepted: 01/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quality of adult end-of-life (EOL) cancer care has benefited from quality measures, but corresponding pediatric measures are lacking. Therefore, the authors used a validated expert panel method to recommend EOL quality measures for pediatric oncology. METHODS The authors used the modified Delphi method to assess potential quality measures. Panelists were selected on the basis of professional organization nominations and expert qualifications. Pediatric and adult oncology, pediatric palliative care, social work, nursing, and hospice were represented. The authors provided the panel with a literature review on 20 proposed measures derived from adult measures and bereaved family interviews. The panel first scored the importance of each measure on a 9-point scale and then discussed the measures via a conference call. The panel then rescored the measures. According to a priori standards, measures with median scores ≥ 7 with at least 7 of 9 experts ranking it as ≥4 were endorsed. RESULTS The 16 endorsed measures included measures related to avoidance of medically intense care (eg, intensive care unit death and intubation in the last 14 days of life), death location (eg, death in the preferred location), hospital policies/programs (eg, the removal of visitor restrictions at EOL and the presence of a bereavement program), and supportive care services (eg, pediatric palliative care involvement and sibling needs assessment). Unendorsed measures included avoidance of chemotherapy at EOL and home death. CONCLUSIONS Expert panel-endorsed quality measures have been developed for EOL care in pediatric oncology. The measures need validation with bereaved families and further refinement before they are ready for real-world application as a tool for standardizing EOL care in pediatric oncology. LAY SUMMARY Quality measures for end-of-life care for children with cancer lag behind adult quality measures. Therefore, the authors have conducted an expert panel to develop an endorsed list of quality measures for end-of-life care for children with cancer. The 16 endorsed measures include measures related to avoidance of medically intense care (eg, intensive care unit death and intubation in the last 14 days of life), location of death (eg, death in the preferred location), hospital policies/programs (eg, the removal of visitor restrictions at the end of life and the presence of a bereavement program), and supportive care services (eg, pediatric palliative care involvement and sibling needs assessment).
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Affiliation(s)
- Emily E Johnston
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isaac Martinez
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Steven M Asch
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.,VA Center for Innovation to Implementation, Palo Alto, California
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14
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Duncan A, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Prioritizing a Research Agenda of Transitional Care Interventions for Childhood-Onset Disabilities. Front Pediatr 2021; 9:682078. [PMID: 34589448 PMCID: PMC8475648 DOI: 10.3389/fped.2021.682078] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/20/2023] Open
Abstract
Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systematic review, on importance, impact, and feasibility. Seven of the 16 interventions categories received a mean score rating of ≥7 (out of 10) on all three rating categories. Participants then rank ordered the reduced list of seven interventions in order of priority and the top four ranked interventions advanced for further discussion at a consensus meeting. Using the Template for Intervention Description and Replication (TIDieR) checklist as a guide, the participants identified that a study of a peer system navigator was worthy of future evaluation. This study highlighted that transitional care interventions are complex and multifaceted. However, the presence of a peer to support system navigation, advocacy and individual and family education was considered the most ideal intervention addressing the current gap in care. Future research, which aims to engage patients and families in a co-design approach, is recommended to further develop this intervention.
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Affiliation(s)
- Andrea Duncan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Mark T Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada.,Division of Physical Medicine, University of Toronto, Toronto, ON, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brian Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - C J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Laura Hartman
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Lennox Huang
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Shauna Kingsnorth
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Alene Toulany
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Joanne Zee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Sarah E P Munce
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
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15
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Hrabok M, Engbers JDT, Wiebe S, Sajobi TT, Subota A, Almohawes A, Federico P, Hanson A, Klein KM, Peedicail J, Pillay N, Singh S, Josephson CB. Primary care electronic medical records can be used to predict risk and identify potentially modifiable factors for early and late death in adult onset epilepsy. Epilepsia 2020; 62:51-60. [PMID: 33316095 DOI: 10.1111/epi.16738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/23/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To use clinically informed machine learning to derive prediction models for early and late premature death in epilepsy. METHODS This was a population-based primary care observational cohort study. All patients meeting a case definition for incident epilepsy in the Health Improvement Network database for inclusive years 2000-2012 were included. A modified Delphi process identified 30 potential risk factors. Outcome was early (within 4 years of epilepsy diagnosis) and late (4 years or more from diagnosis) mortality. We used regularized logistic regression, support vector machines, Gaussian naive Bayes, and random forest classifiers to predict outcomes. We assessed model calibration, discrimination, and generalizability using the Brier score, mean area under the receiver operating characteristic curve (AUC) derived from stratified fivefold cross-validation, plotted calibration curves, and extracted measures of association where possible. RESULTS We identified 10 499 presumed incident cases from 11 194 182 patients. All models performed comparably well following stratified fivefold cross-validation, with AUCs ranging from 0.73 to 0.81 and from 0.71 to 0.79 for early and late death, respectively. In addition to comorbid disease, social habits (alcoholism odds ratio [OR] for early death = 1.54, 95% confidence interval [CI] = 1.12-2.11 and OR for late death = 2.62, 95% CI = 1.66-4.16) and treatment patterns (OR for early death when no antiseizure medication [ASM] was prescribed at baseline = 1.33, 95% CI = 1.07-1.64 and OR for late death after receipt of enzyme-inducing ASM at baseline = 1.32, 95% CI = 1.04-1.66) were significantly associated with increased risk of premature death. Baseline ASM polytherapy (OR = 0.55, 95% CI = 0.36-0.85) was associated with reduced risk of early death. SIGNIFICANCE Clinically informed models using routine electronic medical records can be used to predict early and late mortality in epilepsy, with moderate to high accuracy and evidence of generalizability. Medical, social, and treatment-related risk factors, such as delayed ASM prescription and baseline prescription of enzyme-inducing ASMs, were important predictors.
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Affiliation(s)
- Marianne Hrabok
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ann Subota
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Amal Almohawes
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alexandra Hanson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Joseph Peedicail
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shaily Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
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16
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Dekhtyar M, Colford C, Whisenant E, Huber J, Johnson E, Thomas P, Kirley K, Mazzurco L, Dingle AD, Terry V, Rajasekaran S, Barkowski L, Kulkarni-Date M, Henderson D, Wilkerson L. Development of Learning Objectives to Guide Enhancement of Chronic Disease Prevention and Management Curricula in Undergraduate Medical Education. Teach Learn Med 2020; 32:241-249. [PMID: 32090644 DOI: 10.1080/10401334.2020.1724791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner's Chronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic disease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees identified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective.
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Affiliation(s)
- Michael Dekhtyar
- Medical Education Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Cristin Colford
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ebony Whisenant
- Department of Humanities, Health & Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Jill Huber
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Eric Johnson
- Department of Family and Community Medicine and Department of Education Resources, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Patricia Thomas
- Departments of Medicine and Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kate Kirley
- Improving Health Outcomes, Chronic Disease Prevention, American Medical Association, Chicago, Illinois, USA
| | - Lauren Mazzurco
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Arden D Dingle
- Department of Psychiatry and Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Valerie Terry
- Department of Psychiatry and Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Senthil Rajasekaran
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Laken Barkowski
- Improving Health Outcomes, Chronic Disease Prevention, American Medical Association, Chicago, Illinois, USA
| | - Mrinalini Kulkarni-Date
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
- Department of Medical Education, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - David Henderson
- Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - LuAnn Wilkerson
- Department of Medical Education, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
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Abstract
Objectives: To develop a screening scale for community-dwelling older adults with multiple care needs.Methods: A modified Delphi was employed; 10 experts were invited to evaluate the relevancy, clarity, and suitability of the scale. A descriptive evaluation survey was tested on the screening scale users who were community volunteers to evaluate the clarity, relevance, and usefulness of the scale using a 10-point rating system. Confirmatory factor analysis was applied to determine the suitability of the factorial structure of the HCOASS. The internal consistency was examined using Kuder-Richardson Formula 20. A suitable cutoff point was developed using receiver operating characteristic analysis.Results: In the first round of the modified Delphi, the item-level content validity index (I-CVI) on the content relevance, item clarity, and suitability of the scale were all higher than .90, .80, and .80, respectively. In the second round, the scores for content relevancy, item clarity, and suitability were all 1.0. Community volunteers rated highly on the scale. The result of the confirmatory factor analysis indicated a good fit. The internal consistency reliability was satisfactory. The area under curve (AUC), sensitivity, and specificity for cutoff score of 6/7 were .91, 88%, and 81%, respectively.Conclusions: The screening scale demonstrated adequate reliability, content validity, and discriminant validity.Clinical Implications: The screening scale would serve as a reference for community volunteers in the identification of community-dwelling older adults with multiple care needs.
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Affiliation(s)
- Meng-Chin Chen
- Department of Nursing, Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jing-Jy Wang
- Institute of Allied Health Science, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Fen Hsu
- Center of Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Ambasta A, Pancic S, Wong BM, Lee T, McCaughey D, Ma IWY. Expert Recommendations on Frequency of Utilization of Common Laboratory Tests in Medical Inpatients: a Canadian Consensus Study. J Gen Intern Med 2019; 34:2786-2795. [PMID: 31385217 PMCID: PMC6854150 DOI: 10.1007/s11606-019-05196-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Repetitive inpatient laboratory testing in the face of clinical stability is a marker of low-value care. However, for commonly encountered clinical scenarios on medical units, there are no guidelines defining appropriate use criteria for laboratory tests. OBJECTIVE This study seeks to establish consensus-based recommendations for the utilization of common laboratory tests in medical inpatients. DESIGN This study uses a modified Delphi method. Participants completed two rounds of an online survey to determine appropriate testing frequencies for selected laboratory tests in commonly encountered clinical scenarios. Consensus was defined as agreement by at least 80% of participants. PARTICIPANTS Participants were 36 experts in internal medicine across Canada defined as internists in independent practice for ≥ 5 years with experience in medical education, quality improvement, or both. Experts represented 8 of the 10 Canadian provinces and 13 of 17 academic institutions. MAIN MEASURES Laboratory tests and clinical scenarios included were those that were considered common on medical units. The final survey contained a total of 45 clinical scenarios looking at the utilization of six laboratory tests (complete blood count, electrolytes, creatinine, urea, international normalized ratio, and partial thromboplastin time). The possible frequency choices were every 2-4 h, 6-8 h, twice a day, daily, every 2-3 days, weekly, or none unless there was specific diagnostic suspicion. These scenarios were reviewed by two internists with training in quality improvement and survey methods. KEY RESULTS Of the 45 initial clinical scenarios included, we reached consensus on 17 scenarios. We reached weak consensus on an additional 19 scenarios by combining two adjacent frequency categories. CONCLUSIONS A Canadian expert panel of internists has provided frequency recommendations on the utilization of six common laboratory tests in medical inpatients. These recommendations need validation in prospective studies to assess whether restrictive versus liberal laboratory test ordering impacts patient outcomes.
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Affiliation(s)
- Anshula Ambasta
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada. .,Ward of the 21st century, University of Calgary, Calgary, Alberta, Canada.
| | - Stefana Pancic
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Brian M Wong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Center for Quality Improvement and Patient Safety, Toronto, Ontario, Canada
| | - Todd Lee
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Deirdre McCaughey
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Irene W Y Ma
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.,Ward of the 21st century, University of Calgary, Calgary, Alberta, Canada
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Havers SM, Martin E, Wilson A, Hall L. Implementation of government-directed policy in the hospital setting: a modified Delphi study. Health Res Policy Syst 2019; 17:91. [PMID: 31775771 DOI: 10.1186/s12961-019-0500-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background In the last 20 years governments have sought to introduce policy that improves the quality of care provided in hospitals, yet little research has been done to understand how these policies are implemented, factors that affect the implementation process or what should be considered by decision-makers during policy development or implementation planning. Experts with real-life experience in the introduction and implementation of policy are best placed to provide valuable insight into practical issues that affect implementation and the associated outcomes of these policies. Methods A modified Delphi study of experts in hospital policy development and implementation was undertaken to investigate factors influencing the implementation of government-directed policy in the hospital setting. This study built on the findings of two previous studies — a qualitative study of clinician perspectives of policy implementation and a systematic review and meta-synthesis, in which common contextual factors and policy characteristics associated with policy implementation were ascertained. International experts with extensive experience in government-directed policy implementation at global, national, corporate, jurisdictional and organisational levels were asked to provide opinions on predetermined factors and the feasibility of considering these in policy development and implementation planning. Survey design and analysis was guided by the Consolidated Framework for Implementation Research. Results Eleven experts from four countries and with different health system perspectives participated in the study. Consensus was reached on the importance of all predetermined factors in the first survey round with additional factors for investigation highlighted by participants for examination in subsequent rounds. On study completion, expert consensus was reached on 24 factors of importance; only 20 of these factors reached consensus for feasibility. Conclusions Study findings indicated that, whilst there are multiple factors of importance in policy implementation across all Consolidated Framework for Implementation Research domains, some factors, such as establishment of roles and responsibilities for implementation and organisational lines of accountability, are feasible for consideration at a hospital level only. In addition, four factors did not reach consensus in terms of feasibility, indicating that it may not be practical to consider all factors of importance when implementing policy; this has important implications for implementation planning and resource allocation.
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20
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Woodhouse B, Pattison S, Segelov E, Singh S, Parker K, Kong G, Macdonald W, Wyld D, Meyer-Rochow G, Pavlakis N, Conroy S, Gordon V, Koea J, Kramer N, Michael M, Wakelin K, Asif T, Lo D, Price T, Lawrence B. Consensus-Derived Quality Performance Indicators for Neuroendocrine Tumour Care. J Clin Med 2019; 8:jcm8091455. [PMID: 31547431 PMCID: PMC6780732 DOI: 10.3390/jcm8091455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 12/16/2022] Open
Abstract
Quality performance indicators (QPIs) are used to monitor the delivery of cancer care. Neuroendocrine tumours (NETs) are a family of individually uncommon cancers that derive from neuroendocrine cells or their precursors, and can occur in most organs. There are currently no QPIs available for NETs and their heterogeneity makes QPI development difficult. CommNETs is a collaboration between NET clinicians, researchers and advocates in Canada, Australia and New Zealand. We created QPIs for NETs using a three-step consensus process. First, a multidisciplinary team used the nominal group technique to create candidates (n = 133) which were then curated into appropriateness statements (62 statements, 44 sub-statements). A two-stage modified RAND/UCLA Delphi consensus process was conducted: an online survey rated the statement appropriateness then the top-ranked statements (n = 20) were assessed in a face-to-face meeting. Finally, 10 QPIs met consensus criteria; documentation of primary site, proliferative index, differentiation, tumour board review, use of a structured pathology report, presence of distant metastasis, 5- and 10-year disease-free and overall survival. These NET QPIs will be trialed as a method to monitor and improve care for people with NETs and to facilitate international comparison.
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Affiliation(s)
- Braden Woodhouse
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
| | - Sharon Pattison
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand.
| | - Eva Segelov
- Department of Medical Oncology, Monash University and Monash Health, Melbourne 3800, Australia.
| | - Simron Singh
- Department of Medical Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Kate Parker
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
| | - Grace Kong
- Department of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.
| | - William Macdonald
- Department of Nuclear Medicine, Fiona Stanley Hospital, Perth 6150, Australia.
| | - David Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia.
- School of Medicine, University of Queensland, Brisbane 4072, Australia.
| | - Goswin Meyer-Rochow
- Department of General Surgery, Waikato Hospital, Hamilton 3204, New Zealand.
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia.
| | | | - Vallerie Gordon
- Department of Medical Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada.
| | - Jonathan Koea
- Department of General Surgery, North Shore Hospital, Auckland 0620, New Zealand.
| | - Nicole Kramer
- Department of Pathology, North Shore Hospital, Auckland 0620, New Zealand.
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.
| | | | - Tehmina Asif
- Department of Medical Oncology, Saskatchewan Cancer Agency, Saskatoon, SK S4W 0G3, Canada.
| | - Dorothy Lo
- Department of Medical Oncology, St Joseph's Health Care, Toronto, ON M6R 1B5, Canada.
| | - Timothy Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide 5011, Australia.
| | - Ben Lawrence
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
- Department of Medical Oncology, Auckland City Hospital, Auckland 1023, New Zealand.
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21
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Cachecho S, Elfassy C, Hamdy R, Rosenbaum P, Dahan-Oliel N. Arthrogryposis multiplex congenita definition: Update using an international consensus-based approach. Am J Med Genet C Semin Med Genet 2019; 181:280-287. [PMID: 31452331 DOI: 10.1002/ajmg.c.31739] [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] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) has been described and defined in thousands of articles, but the terminology used has been inconsistent. Some have described it as a diagnosis or syndrome, others as a term or clinical finding. This lack of common language can lead to confusion in clinical and research communities. The aim of this study was to develop a consensus-based definition for AMC using international expert opinion. A consensus-based definition will help harmonize research and clinical endeavors and will facilitate communication among families, clinicians, and researchers. This article describes the methodology used leading to a proposed definition of AMC. First, a literature review was conducted to identify AMC definitions used in included studies. The most commonly used words in the definitions were extracted. Second, a group of eight experts in AMC was selected to identify elements considered critically important to the definition of AMC. Third, based on these critical elements and the literature review, a definition was drafted by the research team. Fourth, a modified Delphi consensus process was conducted using electronic surveys with 25 experts in the field of AMC from eight countries. Survey results were analyzed quantitatively and qualitatively and drafts were modified accordingly. Three rounds of surveys were completed until consensus was reached on a definition of AMC. An annotation of this definition, developed by a panel of international experts, is provided in a separate manuscript in this special issue.
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Affiliation(s)
- Sarah Cachecho
- Rehabilitation Department, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | - Caroline Elfassy
- Rehabilitation Department, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Division of Pediatric Orthopaedics, Department of Orthopaedics, McGill University, Montreal, Quebec, Canada
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Noémi Dahan-Oliel
- Clinical Research Department, Shriners Hospital for Children-Canada, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Courtenay M, Castro-Sánchez E, Deslandes R, Hodson K, Lim R, Morris G, Reeves S, Weiss M. Defining antimicrobial stewardship competencies for undergraduate health professional education in the United Kingdom: A study protocol. J Interprof Care 2018; 32:638-640. [PMID: 29658808 DOI: 10.1080/13561820.2018.1463200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/17/2022]
Abstract
Multi-drug resistant infections have been identified as one of the greatest threats to human health. Healthcare professionals are involved in an array of patient care activities for which an understanding of antimicrobial stewardship is important. Although antimicrobial prescribing and stewardship competencies have been developed for healthcare professionals who adopt the role of a prescriber, competencies do not exist for other medicine-related stewardship activities. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. A modified Delphi process will be used in which a panel of Experts, comprising members from across the United Kingdom, with expertise in prescribing and medicines management with regard to the education and practice of healthcare professionals, and antimicrobial prescribing and stewardship, will be invited to take part in two survey rounds. The competencies developed will be applicable to all undergraduate healthcare professional education programmes. They will help to standardise curricula content and enhance the impact of antimicrobial stewardship education.
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Affiliation(s)
- Molly Courtenay
- a School of Healthcare Sciences , Cardiff University , Cardiff , UK
| | - Enrique Castro-Sánchez
- b NIHR Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance , Imperial College London , UK
| | - Rhian Deslandes
- c Cardiff School of Pharmacy and Pharmaceutical Sciences , Cardiff University , Cardiff , UK
| | - Karen Hodson
- c Cardiff School of Pharmacy and Pharmaceutical Sciences , Cardiff University , Cardiff , UK
| | - Rosemary Lim
- d Reading School of Pharmacy, Whiteknights, Reading , Berkshire , UK
| | - Gary Morris
- a School of Healthcare Sciences , Cardiff University , Cardiff , UK.,e Hywel Dda University Health Board , Carmarthen , Wales
| | - Scott Reeves
- f Centre for Health and Social Care Research, Kingston and St George's , University of London , London , UK
| | - Marjorie Weiss
- c Cardiff School of Pharmacy and Pharmaceutical Sciences , Cardiff University , Cardiff , UK
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23
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Courtenay M, Franklin P, Griffiths M, Hall T, Macangus J, Myers J, Peniston-Bird F, Radley K. Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: A modified Delphi consensus study. J Adv Nurs 2018; 74:1863-1874. [PMID: 29633337 DOI: 10.1111/jan.13584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 12/01/2022]
Abstract
AIM To provide national consensus on the range of conditions community practitioner nurse prescribers manage and for which it is considered important that they can prescribe. BACKGROUND Around 35,000 community practitioner nurse prescribers in the United Kingdom are able to prescribe from a limited formulary. Although prescribing is a key role for these nurses, there has been a decline in the numbers of community practitioner nurse prescribers who prescribe. It is evident that changing patterns of client and service delivery, changes the role of community nurses and the conditions they manage, however, little is known about the conditions community practitioner nurse prescribers manage. DESIGN AND METHODS A modified Delphi approach comprising three on-line surveys delivered to a national Expert Panel of 89 qualified community practitioner prescribers. Data collection took place between January-March 2017. RESULTS Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions for which it is believed community practitioner nurse prescribers should be able to prescribe. Conditions identified by school nurses (N = 12) and health visitors (N = 7) were mainly acutely focused, whereas those identified by district nurses (N = 9) and community staff nurses (N = 6) included both long-term and acute conditions. CONCLUSION Given the high degree of consensus, this list of conditions should influence any decisions about the items community and public health nurses should be able to prescribe. The findings should also influence the education and training of these nurses.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Matt Griffiths
- Doctors Urgent Care, Accident & Emergency Department, Urgent Care Centre, The Royal United Hospital, Bath, UK
| | | | - Julie Macangus
- Bridgewater Community Healthcare NHS Foundation Trust, Warrington, UK
| | | | - Fiona Peniston-Bird
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham, UK
| | - Kathy Radley
- University of Hertfordshire and East and North Hertfordshire NHS Trust, Hatfield, UK
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24
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Kunz D, Pariyadath M, Wittler M, Askew K, Manthey D, Hartman N. Derivation of a Performance Checklist for Ultrasound-Guided Arthrocentesis Using the Modified Delphi Method. J Ultrasound Med 2017; 36:1147-1152. [PMID: 28319265 DOI: 10.7863/ultra.16.08004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Arthrocentesis is an important skill for physicians in multiple specialties. Recent studies indicate a superior safety and performance profile for this procedure using ultrasound guidance for needle placement, and improving quality of care requires a valid measurement of competency using this modality. METHODS We endeavored to create a validated tool to assess the performance of this procedure using the modified Delphi technique and experts in multiple disciplines across the United States. RESULTS We derived a 22-item checklist designed to assess competency for the completion of ultrasound-guided arthrocentesis, which demonstrated a Cronbach's alpha of 0.89, indicating an excellent degree of internal consistency. CONCLUSIONS Although we were able to demonstrate content validity for this tool, further validity evidence should be acquired after the tool is used and studied in clinical and simulated contexts.
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Affiliation(s)
- Derek Kunz
- Georgetown University School of Medicine, Washington, DC, USA
| | - Manoj Pariyadath
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mary Wittler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kim Askew
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Manthey
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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25
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Wiangkham T, Duda J, Haque MS, Rushton A. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study. BMJ Open 2016; 6:e011764. [PMID: 27630069 PMCID: PMC5030579 DOI: 10.1136/bmjopen-2016-011764] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/04/2022] Open
Abstract
OBJECTIVE To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. DESIGN Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. SETTING Online international survey. PARTICIPANTS A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. RESULTS 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. CONCLUSIONS Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial.
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Affiliation(s)
- Taweewat Wiangkham
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - M Sayeed Haque
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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26
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Khodyakov D, Stockdale SE, Smith N, Booth M, Altman L, Rubenstein LV. Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel. Health Expect 2016; 20:130-145. [PMID: 26914249 PMCID: PMC5217877 DOI: 10.1111/hex.12444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Accepted: 01/06/2016] [Indexed: 11/28/2022] Open
Abstract
CONTEXT There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. FINDINGS Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. CONCLUSIONS Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care.
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Affiliation(s)
| | - Susan E Stockdale
- VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nina Smith
- Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
| | | | - Lisa Altman
- VA Greater Los Angeles Healthcare System (GLA), Office of Healthcare Transformation and Innovation, Los Angeles, CA, USA.,The David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Lisa V Rubenstein
- RAND Corporation, Santa Monica, CA, USA.,VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
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