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Carrad A, Schram A, Townsend B, Harris P, Baum F, Rychetnik L, Allender S, Pescud M, Friel S. Monitoring privilege for health equity: building consensus on indicators to monitor socioeconomic advantage through a modified Delphi survey. Soc Sci Med 2025; 379:118193. [PMID: 40382868 DOI: 10.1016/j.socscimed.2025.118193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 04/16/2025] [Accepted: 05/11/2025] [Indexed: 05/20/2025]
Abstract
The World Health Organization's Commission on Social Determinants of Health highlighted the need to measure and monitor the inequitable distribution of power, money, and resources across society. Efforts to monitor health inequity focus on disadvantage rather than advantage or privilege, and on proximal health outcomes rather than distal social and structural determinants of health. This study aimed to identify a comprehensive set of key indicators to measure and monitor socioeconomic advantage. Following a literature review to establish an initial set of indicators (n = 79), we used a three-round, online Delphi survey to build consensus among a panel of participants with diverse disciplinary backgrounds and with expertise related to socioeconomic inequity. Participants rated indicators for relevance to the concept of socioeconomic advantage using a seven-point Likert scale and ranked priority indicators among selected indicator categories. Thirty-one, 21 and 15 experts-predominantly from Australia- participated in the first, second and third round, respectively. Sixty-four of 76 indicators reached consensus, including all indicators within the 'Wealth' and 'Income/wealth inequality' categories. Priority rankings of economic indicators were clear: gross income and disposable income were the highest ranked income indicators; net wealth was the highest ranked wealth indicator. Ranking of 'Connections and signalling indicators' was less distinct; however, elite secondary schooling, and attendance at exclusive events received the highest mean ranks. Monitoring of these socioeconomic advantage indicators is crucial for identifying whether policy and governance is ultimately shifting the dial on equitably distributing resources for improving health equity outcomes.
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Affiliation(s)
- Amy Carrad
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Acton, ACT, 2601, Australia.
| | - Ashley Schram
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Acton, ACT, 2601, Australia.
| | - Belinda Townsend
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Acton, ACT, 2601, Australia.
| | - Patrick Harris
- Centre for Health Equity and Training, Research and Evaluation (CHETRE), University of New South Wales, Locked Bag 7103, Liverpool Hospital, Liverpool BC, NSW, 1871, Australia.
| | - Fran Baum
- Stretton Health Equity & School of Social Science, University of Adelaide, Napier Building, North Terrace Campus, Adelaide, SA, 5005, Australia.
| | - Lucie Rychetnik
- Leeder Centre for Health Policy, Economics and Data, Faculty of Medicine and Health, University of Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
| | - Steven Allender
- Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3001, Australia.
| | - Melanie Pescud
- School of Allied Health, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Acton, ACT, 2601, Australia.
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Merenda T, Patris S. Guidelines on Assistive Products Useful in Pharmacy Practice to Optimize and Ensure Medication Use by Individuals With Visual Impairment: An Interdisciplinary Delphi Consensus. J Eval Clin Pract 2025; 31:e70149. [PMID: 40492978 DOI: 10.1111/jep.70149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 03/21/2025] [Accepted: 05/01/2025] [Indexed: 06/12/2025]
Abstract
RATIONALE Visual impairment represents a significant public health challenge that can affect patients ability to accurately identify medications and access essential information about them. A potential solution to address these difficulties is the utilization of assistive products. Consequently, guidelines have been developed in French for Belgian community pharmacists to enhance the safety of individuals with a visual impairment when utilizing medications. AIMS AND OBJECTIVES To build an interdisciplinary consensus on guidelines for the utilization of assistive products in pharmacy practice, with the aim of ensuring the safe administration of medications by individuals with a visual impairment. METHODS A Delphi survey for consensus building was conducted by a national panel of experts. The interdisciplinary panel was constituted of ophthalmologists with a specialization in low vision, orthoptists, ergotherapists, psychologists, and community pharmacists. The recommendations were encoded in the form of an online questionnaire and the experts were invited to indicate their degree of agreement on a 9-point Likert scale. Descriptive statistics were produced using IBM SPSS 27 software. This process was repeated until a consensus was reached between all the experts. RESULTS Four rounds of the Delphi method were necessary to the panel of 10 experts to evaluate the 47 recommendations initially submitted. Ultimately, an introduction to the guidelines and 39 recommendations, grouped into six main categories, were validated. CONCLUSION The consensus process has enabled us to obtain consolidated recommendations and to ensure their relevance, thus facilitating the dissemination of high-quality content to community pharmacists practising their profession in Belgian pharmacies.
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Affiliation(s)
- Théodora Merenda
- Unit of Clinical Pharmacy, Faculty of Medicine, Pharmacy, and Biomedical Sciences, University of Mons (UMONS), Mons, Belgium
| | - Stéphanie Patris
- Unit of Clinical Pharmacy, Faculty of Medicine, Pharmacy, and Biomedical Sciences, University of Mons (UMONS), Mons, Belgium
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Fletcher E, Sherriff A, Duijster D, de Jong‐Lenters M, Ross A. Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews. Community Dent Oral Epidemiol 2025; 53:296-306. [PMID: 39936245 PMCID: PMC12064878 DOI: 10.1111/cdoe.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/29/2025] [Accepted: 01/29/2025] [Indexed: 02/13/2025]
Abstract
BACKGROUND Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice. METHODS A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis. RESULTS From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs. CONCLUSIONS A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool.
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Affiliation(s)
- Emma Fletcher
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life SciencesUniversity of GlasgowGlasgowUK
| | - Andrea Sherriff
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life SciencesUniversity of GlasgowGlasgowUK
| | - Denise Duijster
- Department of Oral Public Health, Academic Center for Dentistry AmsterdamUniversity of Amsterdam and VU UniversityAmsterdamthe Netherlands
| | - Maddelon de Jong‐Lenters
- Department of Pediatric Dentistry, Academic Center for Dentistry AmsterdamUniversity of Amsterdam and VU UniversityAmsterdamthe Netherlands
| | - Al Ross
- School of Health, Science and WellbeingStaffordshire UniversityStoke‐on‐TrentStaffordshireUK
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Giusti R, Porzio G. Reassessing opioid conversion guidelines: narrow consensus and clinical challenges. Support Care Cancer 2025; 33:482. [PMID: 40392325 DOI: 10.1007/s00520-025-09536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Accepted: 05/08/2025] [Indexed: 05/22/2025]
Affiliation(s)
- Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Via Di Grottarossa 1035-39, 00189, Rome, Italy.
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Ehiogu U, Schöffl VR, Jones G, Buckthorpe M, Patterson S. Developing consensus for upper limb rehabilitation, physical preparation and return to climbing in adults: protocol for an international e-Delphi study. BMJ Open Sport Exerc Med 2025; 11:e002584. [PMID: 40396148 PMCID: PMC12090856 DOI: 10.1136/bmjsem-2025-002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Accepted: 04/16/2025] [Indexed: 05/22/2025] Open
Abstract
Climbing has grown into a grassroots participation sport and Olympic discipline. The high loads expressed through the upper limb may increase the risk of injury in this population. This may also affect rehabilitation and return to sport (RTS) considerations after injury. Treatment, management, rehabilitation and RTS parameters after injury are poorly documented. The aim of this study is to reach international expert consensus on the postinjury and surgical rehabilitation, physical preparation and RTS strategies in a range of climbers. This will provide a framework for the safe RTS of climbers. The study will be reported in accordance with guidance on conducting and reporting Delphi Studies guidelines. Panel members will be recruited with expertise in either the delivery of healthcare and/or physical preparation of climbers. The electronic Delphi is anticipated to consist of three irritative rounds. Round 1 will consist of open and closed questions to generate a broad range of statements on the rehabilitation, RTS and outcome measures used after climbing injury. In round 2, all participants will be provided with a summary of the current literature of the rehabilitation and RTS strategies for upper limb sports injuries. Rounds 2 and 3 will consist of a summary of the results from the previous round including any dissonance. Participants will be asked to anonymously rate responses on a 5-point Likert scale. The study steering group and patient public involvement representatives will be involved from conceptualisation until final dissemination.
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Affiliation(s)
- Uzo Ehiogu
- School of Medical Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Gareth Jones
- School of Health, Leeds Beckett University, Leeds, UK
| | - Matthew Buckthorpe
- Education and Research Department, FIFA Medical Centre of Excellence, Bologna, Italy
- St Mary’s University, London, UK
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Loftus L, Asher L, Leach M. Inducing and measuring positive affective state in domesticated equines: A Delphi consultation. Vet J 2025; 312:106370. [PMID: 40339901 DOI: 10.1016/j.tvjl.2025.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 05/05/2025] [Accepted: 05/05/2025] [Indexed: 05/10/2025]
Abstract
Over the last twenty years the definition of good animal welfare has advanced from the 'absence of negative welfare states' to the aim of identifying the presence of positive welfare states; however, research on positive animal welfare is relatively new. Consequently, through expert consultation, this study aimed to synthesise knowledge regarding domesticated equine emotional state, specifically methods to induce and measure positive affective states, which could be of significant benefit to equine welfare across sectors. A Delphi consultation of experts in the field of equine behaviour, welfare and affective state was undertaken to derive consensus agreement on definitions used when considering positive affective state in equines and methods suitable for inducing and measuring these states within experimental investigations. Ninety-three international experts participated in a robust three-round Delphi consultation with data gathered analysed qualitatively (thematic analysis) and quantitatively (ranking data, consensus benchmarks and Content Validity Index (CVI) / Content Validity Ratio (CVR) analyses). Retention rates were high (78 %), and consensus (minimum 70 % agreement) was reached within Round three of the consultation. Nineteen methods for inducing positive affect reached consensus (provision of high value food, an affiliative companion and a substrate to roll in where the highest ranked), and twelve behavioural (assessment of body language, facial actions and horse-horse interactions were ranked highest) and three physiological (evaluation of heart rate, heart rate variability and respiratory rate) variables for measuring positive affect also reached consensus. This consultation highlights several important considerations surrounding the induction and measurement of positive affective state in equines, including consideration of the individual's personality and individual preference within any measures of affective state. We therefore recommend that establishing individual preference should be a prerequisite of research into positive affective states. It is anticipated that the results of this study can be used to provide new direction for research on positive affective states by providing expert agreed methods and measures for policy and practice through expert agreed approaches to induce positive affect in horses.
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Affiliation(s)
- Loni Loftus
- School of Natural and Environmental Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK; Royal (Dick) School of Veterinary Studies and the Roslin institute, Easter Bush Campus, University of Edinburgh, Midlothian EH25 9RG, UK; University Centre Askham Bryan, Askham Bryan, York YO23 3FR, UK.
| | - Lucy Asher
- School of Natural and Environmental Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Matthew Leach
- Comparative Biology Centre, Medical School, Framlington Place, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
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van de Schraaf SAJ, Rhodius-Meester HFM, Muller M, Visser-Meily JMA, de Vugt ME, Sizoo EM, Hertogh CMPM. What do Professionals Think of Specific Care Recommendations for Vascular Cognitive Impairment? A Delphi Study With Health Care Professionals. J Am Med Dir Assoc 2025; 26:105546. [PMID: 40088940 DOI: 10.1016/j.jamda.2025.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 02/07/2025] [Accepted: 02/09/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVES Vascular cognitive impairment (VCI) is an umbrella term covering all cognitive impairment from mild cognitive deficits to dementia due to vascular etiologies. VCI is highly prevalent within dementia and stroke care pathways, but specific recommendations for care for people with VCI are lacking. Therefore, we formulated specific recommendations for care for people with VCI and tested these in a panel of health care professionals. DESIGN Modified Delphi study. SETTING AND PARTICIPANTS Purposefully sampled health care professionals in the dementia and stroke fields. METHODS Based on Dutch care standards for dementia and stroke and previous studies, the research team formulated 27 statements. In 3 rounds, participants were asked on a 4-point Likert scale how much they agreed with statements. They could elaborate on their answer in open fields. After each round, level of agreement was calculated. Subsequently, it was evaluated whether consensus was reached. Qualitative data guided potential modifications to the statements and was analyzed for overarching themes in argumentation. RESULTS Thirty-four participants (primary and secondary care physicians, nurses, psychologists, occupational therapists, and case managers in dementia care) were included in the expert panel. Of the formulated statements, 23 were accepted after 3 rounds. Accepted statements included recommendations on recognition and management of specific symptoms, awareness of care opportunities in and collaboration between care pathways and networks, and the importance of timely care. Some nuancing comments were raised on feasibility and specificity of the recommendations. CONCLUSIONS AND IMPLICATIONS Experts agreed on multiple specific recommendations for VCI care across the patient journey, balancing specific and targeted care with further integration of the different care networks. Despite some concerns on feasibility and the balance between disease-centered and person-centered care, the expert-agreed statements can provide guidance in striving toward tailored care and aid in bringing together stroke and dementia networks for people with VCI.
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Affiliation(s)
- Sara A J van de Schraaf
- Amsterdam UMC, Location VUmc, Medicine for Older People, Amsterdam, the Netherlands; Amsterdam UMC, Location VUmc, Internal Medicine, Geriatric Medicine Section, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands.
| | - Hanneke F M Rhodius-Meester
- Amsterdam UMC, Location VUmc, Internal Medicine, Geriatric Medicine Section, Amsterdam, the Netherlands; Alzheimer Center Amsterdam, Neurology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Majon Muller
- Amsterdam UMC, Location VUmc, Internal Medicine, Geriatric Medicine Section, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Centre Utrecht, Utrecht, the Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marjolein E de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eefje M Sizoo
- Amsterdam UMC, Location VUmc, Medicine for Older People, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Amsterdam UMC, Location VUmc, Medicine for Older People, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
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Burvenich R, Heytens S, Bos DAG, Van Roy K, Struyf T, Toelen J, De Sutter A, Verbakel JY. Safety netting advice for acutely ill children presenting to ambulatory care: exploring parents' opinions, ideas, and expectations through focus group interviews. BMC PRIMARY CARE 2025; 26:135. [PMID: 40295955 PMCID: PMC12036273 DOI: 10.1186/s12875-025-02803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/26/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Safety netting advice (SNA) is an essential component of the management of acutely ill children in ambulatory care. However, healthcare professionals use a variety of SNA methods, leading to inconsistencies within and across organisations. Much research has explored the perspective on SNA of parents from the UK, but such research is lacking outside the UK context. METHODS We conducted focus groups with Belgian parents of children 6 months to 12 years old, who were recruited through maximum variation sampling. We transcribed the interviews verbatim. Using a combination of inductive and deductive 'in vivo' coding we developed themes from the data. As per the Grounded Theory approach, we reiterated between data collection, coding, and analysis. After participant validation of provisional themes, we constructed the final thematic framework. RESULTS Through six focus groups with 30 parents, we identified five themes: (1) Relevant background information; (2) To know what to expect, what to look out for; (3) Instructions on child homecare and when to revisit a physician; (4) Physicians who consider parents' perspectives and contexts; (5) A reliable source that provides SNA only when necessary, possibly in a multimodal way. CONCLUSIONS We identified five themes from Belgian parents' views on SNA, aligning with prior UK research. These findings form an evidence base for developing a consensus statement on the content and form of SNA supported by both parents and experts from high-income countries.
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Affiliation(s)
- Ruben Burvenich
- Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, Leuven, 3000, Belgium.
- Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium.
| | - Stefan Heytens
- Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium
| | - David A G Bos
- Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, Leuven, 3000, Belgium
| | - Kaatje Van Roy
- Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium
| | - Thomas Struyf
- Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, Leuven, 3000, Belgium
| | - Jaan Toelen
- Leuven Child and Youth Institute, KU Leuven, 49 Herestraat, Leuven, 3000, Belgium
- Department of Development and Regeneration, KU Leuven, 49 Herestraat, Leuven, 3000, Belgium
- Department of Pediatrics, University Hospitals Leuven, 49 Herestraat, Leuven, 3000, Belgium
| | - An De Sutter
- Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium
| | - Jan Y Verbakel
- Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, Leuven, 3000, Belgium
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Cheng K, Xie R, Xu Z, Zhang Y, Gui L. Developing an element system of hospital resilience to medical run in major emerging infectious diseases: a Delphi study. BMC Infect Dis 2025; 25:612. [PMID: 40289136 PMCID: PMC12036257 DOI: 10.1186/s12879-025-10993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 04/17/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Major emerging infectious diseases often trigger the "medical run", presenting significant challenges to health systems. Developing hospital resilience is crucial for enhancing the capacity to manage such crises. Therefore, this research aimed to construct an element system of hospital resilience to medical run in major emerging infectious diseases. METHODS Utilizing the 4R conceptual model and literature content analysis, a preliminary draft for hospital resilience was developed. Subsequently, a two-round Delphi survey involving 18 Chinese experts across various fields refined this system. The Standard for Conducting And Reporting Delphi Studies (CREDES) guided this process. The weights of each element were determined using the analytic hierarchy process. RESULTS The effective recovery rate for both Delphi rounds were 100% (18/18), with an authority coefficient of 0.9159. The first round revealed a Kendall's concordance coefficient for total elements of 0.136 (P < 0.05); the second round showed a coefficient of 0.214 (P < 0.05). The final element system included four primary elements (Resourcefulness, Redundancy, Robustness, Recovery), 21 secondary elements, and 65 tertiary elements, with weights of 0.2908, 0.2056, 0.4348, and 0.0688, respectively. CONCLUSIONS This study constructed the element system of hospital resilience to medical run in major emerging infectious diseases. The results are designed to elucidate the components of hospital resilience in the context of major emerging infectious disease, which can help mitigate the impact of medical run. The study will provide hospitals with a checklist and assessment program for enhancing resilience, offering significant implications for the development of hospital training and management strategies.
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Affiliation(s)
- Kangyao Cheng
- School of Nursing, Naval Medical University, No.800 Xiangyin Road, Shanghai, 200433, China
| | - Rui Xie
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Shanghai, 201203, China
| | - Ziwei Xu
- School of Nursing, Naval Medical University, No.800 Xiangyin Road, Shanghai, 200433, China
| | - Yanyan Zhang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Shanghai, 201203, China
| | - Li Gui
- School of Nursing, Naval Medical University, No.800 Xiangyin Road, Shanghai, 200433, China.
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Tanninen A, Kouvonen A, Nordquist H. Competence expected from advanced-level paramedics by emergency medical services managers in Finland: a modified Delphi study. Scand J Trauma Resusc Emerg Med 2025; 33:62. [PMID: 40234977 PMCID: PMC12001490 DOI: 10.1186/s13049-025-01384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 04/05/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND Competence is a critical attribute for paramedics in emergency medical services (EMSs) because of the complex and diverse demands of the prehospital environment. This study aimed to identify and rank the key competencies expected of advanced-level paramedics as perceived by EMS managers. METHODS The modified Delphi study included three rounds conducted between October 2022 and June 2023. The panel consisted of 44 EMS managers, all working as superiors in EMS organizations across Finland. RESULTS In Round 1, 44 experts (100% response rate) evaluated 43 claims, with a consensus (≥ 75%) reached on five claims. The open-ended responses generated seven additional claims. In Round 2, 45 claims were reviewed; however, no consensus was reached. In Round 3, the top 15 claims from previous rounds were reevaluated (95% response rate), with assessment of patient conditions via the ABCDE protocol ranking highest. The experts also emphasized patient-centered care, safe environments, and systematic approaches in EMS. CONCLUSIONS This study used the Delphi method to identify essential competencies for advanced-level paramedics, emphasizing patient assessment via the ABCDE protocol. This highlights the importance of core skills and nontechnical competencies such as supervision and well-being, stressing the need for continuous updates in paramedic training.
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Affiliation(s)
- Antti Tanninen
- Department of Public Health, University of Helsinki, Helsinki, Finland.
- LAB University of Applied Sciences, Lappeenranta, Finland.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Hilla Nordquist
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
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He J, Wu S, Ni R, Luo X. Development of an evaluation programme for the intelligent management of mobile infectious disease hospitals in response to public health emergencies: a Delphi study. BMJ Open 2025; 15:e094769. [PMID: 40187787 PMCID: PMC11973746 DOI: 10.1136/bmjopen-2024-094769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 03/24/2025] [Indexed: 04/07/2025] Open
Abstract
OBJECTIVES To construct a scientific and practical intelligent management assessment programme for mobile infectious disease hospitals and explore pathways to enhance their management effectiveness. DESIGN A preliminary pool of indicators was developed based on policy documents issued by the Chinese government. Two rounds of Delphi expert consultations were conducted via email between February and August 2024. These indicators were then refined using the margin method. Finally, a hierarchical analysis was employed to assign weights to each indicator. SETTING AND PARTICIPANTS In line with the policy guidance of the Chinese government, an initial set of assessment indicators for smart management of mobile infectious disease hospitals was established. 32 experts with extensive knowledge in the construction of smart management systems for such hospitals were chosen to participate in the Delphi study, offering a comprehensive professional perspective. RESULTS The Cr values were 0.860 (Round 1) and 0.894 (Round 2), demonstrating the accuracy and reliability of the expert consultations. The coordination coefficient among the experts was statistically significant at the p<0.01 level, reflecting a high degree of consensus. In total, 29 assessment items for the smart management of mobile infectious disease hospitals were finalised. CONCLUSIONS A comprehensive set of indicators for assessing smart management in mobile infectious disease hospitals has been developed. This system is scientific, logical and dependable, providing effective guidance for the smart development of such hospitals. It not only improves the quality and efficiency of medical services but also safeguards patients' health rights.
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Affiliation(s)
- Juanling He
- Medical Department of the First Affiliated Hospital of the Army Medical University, Chongqing, Shapingba, China
| | - Sifeng Wu
- Medical Department of the First Affiliated Hospital of the Army Medical University, Chongqing, Shapingba, China
| | - Rongrong Ni
- Medical Department of the First Affiliated Hospital of the Army Medical University, Chongqing, Shapingba, China
| | - Xu Luo
- Office of the 958th Hospital, Army Medical University, Chongqing, Shapingba, China
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Lavabre K, Marjanovic N, Oriot D, Chenu M, Gransagne A, Gentilleau M, Moreau A, Contal P, Mimoz O, Drugeon B. Creation and validation of a roadside rescue skills scale for training pre-hospital medical teams: the RoadRes-Q scale. Scand J Trauma Resusc Emerg Med 2025; 33:56. [PMID: 40181455 PMCID: PMC11966812 DOI: 10.1186/s13049-025-01370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 03/18/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND Road traffic injuries are the leading cause of death among young people worldwide. While advances in vehicle safety have reduced some of the risks, the speed and quality of pre-hospital care are critical to prevent fatalities. In France, patients are cared for by medical teams and firefighters who must work together as closely as possible to ensure the best possible survival rate. However, there is a lack of standardised scales to assess the performance of these multidisciplinary teams. This study aimed to create and validate a roadside rescue skills assessment scale, the RoadRes-Q scale, for healthcare teams. METHODS We used a two-round Delphi method to develop the RoadRes-Q scale. A panel of 9 international roadside rescue experts, including 7 firefighters and 2 engineers in road rescue equipment, agreed to participate. The scale covers five key areas: healthcare provider protection, site securing, vehicle securing, first aid delivery, and patient extrication. The final version was tested during two one-day simulation-based training sessions, each involving 22 participants: 6 healthcare staff, 14 firefighters, and 2 simulated victims. Assessors completed the scale during and after each scenario, focusing on internal consistency and inter-observer reliability. RESULTS The RoadRes-Q scale consists of 60 items. Internal consistency was excellent (Cronbach's alpha of 0.86), indicating that items were non-redundant and consistently measured the required competencies. However, inter-observer reliability was low (intra-class correlation coefficient of 0.48), suggesting variability between assessors. Satisfaction among participants to the simulation-based training courses was high, and their knowledge increased. CONCLUSIONS The RoadRes-Q scale proved to be a valid and reliable scale for evaluating both technical and non-technical skills. While internal consistency was strong, improvements are needed in inter-observer reliability. Structured training for assessors and video-based assessments could enhance reproducibility. The RoadRes-Q scale has the potential for assessing the quality and safety of care provided by healthcare teams in roadside rescue situations. REGISTRATION As the study did not involve interventional research or patient participation, ethics committee approval was not required, but it received approval from the scientific referents of the Faculty of Medicine of Poitiers, and participants provided informed consent for using their anonymised data.
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Affiliation(s)
- Killien Lavabre
- Service des urgences adultes et SAS 86 / SMUR, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Nicolas Marjanovic
- Service des urgences adultes et SAS 86 / SMUR, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
- INSERM CIC-1402, IS- ALIVE, Université de Poitiers, Poitiers, France
- ABS Lab, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Denis Oriot
- ABS Lab, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Mathilde Chenu
- Service des Urgences et SAMU, Hôpital Saint Louis, La Rochelle, France
| | - Adrien Gransagne
- Service Départemental d'Incendie et de Secours 86, Chasseneuil du Poitou, France
| | - Michel Gentilleau
- Service Départemental d'Incendie et de Secours 86, Chasseneuil du Poitou, France
| | - Anthony Moreau
- Service Départemental d'Incendie et de Secours 86, Chasseneuil du Poitou, France
| | - Paul Contal
- Service des urgences adultes et SAS 86 / SMUR, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
- ABS Lab, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Olivier Mimoz
- Service des urgences adultes et SAS 86 / SMUR, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
- PHAR2 - INSERM U1070, Université de Poitiers, Poitiers, France
| | - Bertrand Drugeon
- Service des urgences adultes et SAS 86 / SMUR, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France.
- ABS Lab, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.
- PHAR2 - INSERM U1070, Université de Poitiers, Poitiers, France.
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Patel S, Sukumar V, P. SS, Bhandoria G, Chatterjee A, Deo SVS, Garach N, Guru A, Kumar N, Kumar R, Rajagopal AK, Kumar S, Mehta S, Mishra D, Pawar A, Prabhu A, Sinukumar S, Solanki S, Sharma V, Sheshadri RA, Bhatt A. The INDEPSO-ISPSM Consensus on Peritoneal Malignancies-Methodology. Indian J Surg Oncol 2025; 16:651-659. [PMID: 40337050 PMCID: PMC12052956 DOI: 10.1007/s13193-024-02118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 10/17/2024] [Indexed: 12/02/2024] Open
Abstract
The numerous international guidelines on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) do not cover many clinically relevant issues for which evidence is limited and some regional issues (HIPEC in limited resource settings, age-limit for CRS, etc.). We describe the methodology of a consensus CRS and HIPEC for peritoneal malignancies carried out under the aegis of the two national societies for peritoneal oncology-INDEPSO and ISPSM. The modified Delphi technique was used with two rounds of voting. Eight key topics were selected by a working group of 29 members. Questionnaires comprising of closed-ended questions were disseminated through the online SurveyMonkey (http://www.surveymonkey.com) platform. A panel of 56 surgical, gastrointestinal, and gynecologic oncologists with a minimum of 5 years of experience with CRS-HIPEC voted on 260 questions. A consensus was reached if any of the options received 70% or more votes (> 90% = strong consensus). The response rate was 98.2% in round I and 94.6% in round II. A consensus was achieved on 80.7% questions after two rounds (43.0% after round I; 36.9% after round II). It was the highest in the enhanced recovery after surgery (ERAS) section (93.3%) and the lowest (68.0%) for ovarian cancer. A strong consensus was reached on 59 (22.6%) questions (highest for the technical section (34.2%); lowest in the ERAS section (16.6%)). This consensus which had a high rate of participation should be a useful clinical resource for surgeons treating peritoneal malignancies in India and other regions with a similar demographic and socioeconomic background. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-024-02118-2.
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Affiliation(s)
- Swapnil Patel
- Department of Surgical Oncology, Upkar Hospital and Cancer Institute, Varanasi, India
| | - Vivek Sukumar
- Department of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - Somashekhar S. P.
- Department of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
| | - Geetu Bhandoria
- Department of Gynecologic Oncology, Command Hospital, Kolkata, India
| | | | | | - Niharika Garach
- Department of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - Arvind Guru
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Center, Chandigarh, India
| | - Neha Kumar
- Department of Gynaecologic Oncology, Amrita Hospital, Faridabad, India
| | - Rohit Kumar
- Department of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
| | - Ashwin K. Rajagopal
- Department of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
| | - Sanjeev Kumar
- Department of Surgical Oncology, Manipal Hospital, New Delhi, India
| | - Sanket Mehta
- Department of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - Deepti Mishra
- Department of Surgical Oncology, Thangam Cancer Center, Namakkal, India
| | - Ajinkya Pawar
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Aruna Prabhu
- Department of Surgical Oncology, Thangam Cancer Center, Namakkal, India
| | - Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Sohan Solanki
- Department of Anesthesiology, Tata Memorial Hospital, Mumbai, India
| | - Vivekanand Sharma
- Department of Colorectal Surgery, East Suffolk and North Essex NHS Foundation, Colchester, UK
| | | | - Aditi Bhatt
- Department of Surgical Oncology, Shalby Cancer and Research Institute, SG Highway, Ahmedabad, 380015 India
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14
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Bell E, Briffa K, McLoughlin J, Fary R. Physiotherapy of the Trunk Related to Sitting Function After Stroke: A Delphi Study. Clin Rehabil 2025; 39:524-535. [PMID: 40017404 PMCID: PMC12018712 DOI: 10.1177/02692155251322263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 01/31/2025] [Indexed: 03/01/2025]
Abstract
ObjectiveTo develop consensus statements from a Delphi panel about physiotherapy of the trunk related to sitting function for people with subacute stroke, with the express aim of facilitating treatment choices by novice physiotherapists.DesignA four-round e-Delphi study using free-text responses and 5-point Likert scales for agreement.ParticipantsTwenty-six panel members with expertise in clinical and/or research in neurological rehabilitation.Main measuresRound 1 consisted of 5 free-text questions. Subsequent rounds ascertained agreement and consensus on statements formulated from Round 1 responses. Consensus was defined a priori as ≥70% agreement. Round 3 presented an additional two clinical observation queries related to the statements for comment.ResultsTwenty participants completed all four rounds. Nineteen of 26 participants (73%) thought physiotherapy of the trunk was important through all stages of recovery after stroke. Different interpretations about what constitutes physiotherapy of the trunk following stroke were identified. Fourteen statements of agreement regarding physiotherapy of the trunk were formulated. The majority of statements involved different activities in sitting such as control of movement over the base of support and reaching with the unaffected arm. In addition to the statements of agreement clinical observations for implementation of the statements were developed.ConclusionsIn the absence of detail in clinical guidelines and a wide range of interventions in systematic reviews, this study provides clear and specific options for novice physiotherapists of treatment of the trunk related to functional task practice in sitting and as preparation for sit to stand.
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Affiliation(s)
- Elizabeth Bell
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Kathy Briffa
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robyn Fary
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
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15
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Nyberg A, Jirwe M, Fagerdahl A, Otten V, Haney M, Olofsson B. Perioperative patient safety indicators-A Delphi study. J Clin Nurs 2025; 34:1351-1363. [PMID: 38757741 PMCID: PMC11933514 DOI: 10.1111/jocn.17212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
AIM To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. DESIGN A modified Delphi method. METHODS A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. RESULTS The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. CONCLUSION Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. IMPACT The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. REPORTING METHOD The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anette Nyberg
- Department of NursingUmeå UniversityUmeåSweden
- Department of Diagnostics and Intervention, Anaesthesiology and Intensive Care MedicineUmeå UniversityUmeåSweden
| | - Maria Jirwe
- Department of Health SciencesSwedish Red Cross UniversityHuddingeSweden
- Department of Neurobiology, Care Sciences and Society, Division of NursingKarolinska InstitutetSolnaSweden
| | - Ami Fagerdahl
- Department of Clinical Research and Education, SödersjukhusetKarolinska InstitutetSolnaSweden
| | - Volker Otten
- Department of Diagnostics and Intervention, OrthopaedicsUmeå UniversityUmeåSweden
| | - Michael Haney
- Department of Diagnostics and Intervention, Anaesthesiology and Intensive Care MedicineUmeå UniversityUmeåSweden
| | - Birgitta Olofsson
- Department of NursingUmeå UniversityUmeåSweden
- Department of Diagnostics and Intervention, OrthopaedicsUmeå UniversityUmeåSweden
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De Poli C, Oyebode J, Airoldi M, Stevens M, Capstick A, Mays N, Clark M, Driessen A, Rivas C, Penhale B, Fletcher JR, Russell AM. Fitting a square peg in a round hole? A mixed-methods study on research ethics and collaborative health and social care research involving 'vulnerable' groups. Health Res Policy Syst 2025; 23:40. [PMID: 40170089 PMCID: PMC11963353 DOI: 10.1186/s12961-025-01290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/29/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Current research ethics frameworks that oversee health and social care research, in the United Kingdom and internationally, originated in biomedical research, having positivist underpinnings and an orientation towards experimental research. Limitations of these frameworks have been extensively documented including with regard to health and social care research that adopts collaborative approaches. This article contributes to debates about how the research ethics system deals with collaborative research with groups labelled or potentially perceived as vulnerable, and identifies practical recommendations to ensure a better fit between principles and practices of research ethics and those of collaborative research. METHODS We conducted a two-round online Delphi study with 35 academic researchers with experience of collaborative research involving vulnerable groups and of seeking research ethics approval in England (United Kingdom), followed by a focus group with eight members of the Delphi panel. The Delphi questionnaire, organised in 12 themes, comprised 66 statements about how researchers experience research ethics review and how the research ethics system could be improved. The focus group discussed the results of the Delphi study to generate practical recommendations. RESULTS By the end of the second Delphi round, only one statement relating to the experience of the current research ethics system reached consensus, signalling heterogeneous experiences among researchers working in this field. A total of 32 statements on potential improvements reached consensus. The focus group discussed the 14 Delphi statements with the highest levels of consensus and generated 12 practical recommendations that we grouped into three clusters (1. Endorsing the 'collaborative' dimension of collaborative research; 2. Allowing flexibility; and 3. Strengthening the relational and ongoing nature of ethical research practice). CONCLUSIONS This work provides further empirical evidence of how the research ethics system deals with collaborative research involving 'vulnerable' groups. It also offers practical recommendations to ensure that the collaborative dimension of such research receives proper ethical scrutiny, to introduce a degree of flexibility in research ethics processes and supporting documents, and to replace formal, one-off research ethics approvals with ongoing, situated, relational ethical processes and practices.
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Affiliation(s)
- Chiara De Poli
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Jan Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom
| | - Mara Airoldi
- Blavatnik School of Government, Radcliffe Observatory Quarter, University of Oxford, 120 Walton St, Oxford, OX2 6GG, United Kingdom
| | - Martin Stevens
- The NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, Virginia Woolf Building, Kingsway, London, WC2B 6LE, United Kingdom
| | - Andrea Capstick
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom
| | - Nicholas Mays
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Michael Clark
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom
| | - Annelieke Driessen
- Anthropology Department, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Carol Rivas
- Social Research Institute, University College London, 27 Woburn Square, London, WC1H 0AA, United Kingdom
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - James R Fletcher
- School of Management, University of Bath, Convocation Avenue, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Amy M Russell
- Faculty of Medicine & Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, United Kingdom
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17
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Pang H, Wang W, Gao S, Zheng X. Development and application of a questionnaire on the smart care needs of older adults living in long-term care communities. Geriatr Nurs 2025; 63:51-60. [PMID: 40156981 DOI: 10.1016/j.gerinurse.2025.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 02/04/2025] [Accepted: 03/19/2025] [Indexed: 04/01/2025]
Abstract
Considering the current global aging of society, the demand for promoting smart care-a technology based care and knowledge system-among older adults living in long-term care (LTC) communities highlights the urgent need to assess the smart care needs of older adults. This study developed a questionnaire applicable to this context, tested it, and initially applied its reliability. We assessed the questionnaire's discriminant validity, content validity, consistency reliability, folding half reliability, and test-retest reliability, using a cross-sectional survey (260 older adults). Using a different cross-sectional participant group (418 older adults), we validated the factor analysis of the finalized questionnaire and its preliminary application. The results showed that the total mean score of the smart care needs of older adults in LTC communities was 67.55±13.81 (a medium level). We ultimately assessed the questionnaire to be a reliable tool for assessing the smart care needs of older adults in LTC communities.
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Affiliation(s)
- Hui Pang
- College of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, 250399, Shandong, PR China; Jining No.1 People's Hospital, Jining, 272002, Shandong, PR China.
| | - Wenjun Wang
- College of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, 250399, Shandong, PR China; Weifang Nursing Vocational College, Weifang, 261045, Shandong, PR China.
| | - Shuhong Gao
- Jining No.1 People's Hospital, Jining, 272002, Shandong, PR China
| | - Xiao Zheng
- Jiezhuang Street Elderly Service Center, Jining, 272002, Shandong, PR China
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18
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Wodnik BK, Namyalo PK, Michaelides O, Essue BM, Kane S, Di Ruggiero E. Implementation science research priorities for Universal Health Coverage: methodological lessons from the design and implementation of a multicountry modified Delphi study. Health Policy Plan 2025; 40:422-427. [PMID: 39658269 PMCID: PMC11886793 DOI: 10.1093/heapol/czae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 11/21/2024] [Accepted: 12/07/2024] [Indexed: 12/12/2024] Open
Abstract
Delphi studies are rapidly gaining prominence in global health research. However, researchers' modifications to the Delphi method are often not well-described or justified, limiting opportunities to systematically learn from these studies when the methods are applied to other topics and settings. This paper aims to describe an approach to implementing a modified Delphi study and reflect on the research process in the context of a multicountry study of implementation science research priorities to advance Universal Health Coverage (UHC). We review trends in the use of the modified Delphi method in global health research, outline our three-phased modified Delphi approach, and share reflections on five decision points for implementing the study: (I) identifying and recruiting participants for the expert panel, (II) addressing participant attrition between rounds, (III) justifying the most appropriate cutoff points, (IV) incorporating new items raised by participants in open-ended survey sections, and (V) ensuring maximum variation in perspective in the panel of experts. Insights from this work foster greater understanding of the underlying assumptions for, and interpretation of, 'modified' in modified Delphi studies. This study will encourage critical dialogue about points of methodological contention in Delphi methodology and thus are relevant for scaling the use of modified Delphi studies in public health, including global health research.
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Affiliation(s)
- Breanna K Wodnik
- Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada
- Centre for Global Health, University of Toronto, 155 College St, Suite 408, Toronto, ON M5T 3M6, Canada
| | - Prossy Kiddu Namyalo
- Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada
- Centre for Global Health, University of Toronto, 155 College St, Suite 408, Toronto, ON M5T 3M6, Canada
| | - Ophelia Michaelides
- Centre for Global Health, University of Toronto, 155 College St, Suite 408, Toronto, ON M5T 3M6, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Suite 500, Toronto, ON M5T 3M7, Canada
| | - Beverley M Essue
- Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada
- Centre for Global Health, University of Toronto, 155 College St, Suite 408, Toronto, ON M5T 3M6, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Suite 500, Toronto, ON M5T 3M7, Canada
| | - Sumit Kane
- Nossal Institute For Global Health, Melbourne School Of Population And Global Health, The University Of Melbourne, Parkville, Victoria 3010, Australia
| | - Erica Di Ruggiero
- Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada
- Centre for Global Health, University of Toronto, 155 College St, Suite 408, Toronto, ON M5T 3M6, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Suite 500, Toronto, ON M5T 3M7, Canada
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19
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Wei Y, An Y, Cao Q, Feng W, Wang D, Zhu D. Developing a professional competency framework for general practitioners in tertiary hospitals in China: a modified Delphi study. BMJ Open 2025; 15:e082736. [PMID: 40037672 PMCID: PMC11881187 DOI: 10.1136/bmjopen-2023-082736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/23/2024] [Indexed: 03/06/2025] Open
Abstract
OBJECTIVE At present, the competency of general practitioners (GPs) in tertiary hospitals has not been reported, and there is no suitable competency evaluation tool. This study was conducted to develop a professional competency framework for GPs in tertiary hospitals. DESIGN A modified Delphi method was adopted in the study. PARTICIPANTS Considering the expert authority, a wide range of sources, expert qualification and willingness, 20 eligible experts were invited and 19 experts agreed to participate in this study. RESULTS 19 experts (the median age of the experts was 51 (49, 57) years and 84.2% were women) participated in both two rounds of Delphi survey. From the literature review, 4 primary indicators, 14 secondary indicators and 48 tertiary indicators were identified. In the first round, all indicators achieved consensus except for the secondary indicator '3.3 Data processing', which did not achieve 70.0% agreement in both of importance (63.2% agreement) and feasibility (63.2% agreement). After the first round of the Delphi survey, the description of 7 secondary indicators and 11 tertiary indicators was modified. Two secondary indicators and two tertiary indicators were merged, respectively. One secondary indicator was deleted due to not achieving consensus level, and seven new tertiary indicators were suggested to be added by more than two experts. After the second round of the Delphi survey, all three levels of indicators achieved consensus in terms of importance and feasibility. Finally, the professional competency framework for GPs in tertiary hospitals in China was constructed including 4 primary indicators, 12 secondary indicators and 54 tertiary indicators. CONCLUSION The professional competency framework for GPs in tertiary hospitals in China was successfully constructed in this study with good scientific soundness and rationality. It is expected to be used in medical education, general practice research, quality improvement and more broadly within the healthcare system to reflect the competency of GPs in tertiary hospital.
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Affiliation(s)
- Yun Wei
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
| | - Yanhua An
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
| | - Qiumei Cao
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
| | - Wei Feng
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
| | - Dawei Wang
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
| | - Dan Zhu
- Department of General Practice, Beijing Tongren Hospital CMU, Beijing, China
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20
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Davis MP, Davies A, McPherson ML, Reddy AS, Paice JA, Roeland EJ, Walsh D, Mercadante S, Case AA, Arnold RM, Satomi E, Crawford G, Bruera E, Bohlke K, Ripamonti C. Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline. Support Care Cancer 2025; 33:243. [PMID: 40029420 DOI: 10.1007/s00520-025-09286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Accepted: 02/18/2025] [Indexed: 03/05/2025]
Abstract
PURPOSE To standardize and improve the safety and efficacy of opioid conversion in people with cancer. METHODS The Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), Hospice and Palliative Nurses Association (HPNA), and Network Italiano Cure di Supporto in Oncologia (NICSO) convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. The systematic review focused on randomized and non-randomized studies published from database inception to June 2022. A modified Delphi approach was used to develop and finalize recommendations. Recommendations developed by the Expert Panel underwent two rounds of consensus voting before being finalized. RESULTS The systematic review, published separately, identified 208 eligible studies. These studies provided mixed and inclusive findings regarding optimal approaches to opioid conversion. In consensus voting, 58 of 84 statements met or exceeded the required 75% level of agreement and were accepted. This process demonstrated some consistencies in conversion ratios between particular opioids internationally, but also uncovered variability in opioid conversion ratios among experts, particularly for methadone. RECOMMENDATIONS The recommendations address three main topics: pre-conversion assessments, strategies for conversion, and post-conversion assessments. The goal is to reduce the relative risk of overdosing or under-dosing opioids when converting from one opioid to another or converting administration routes. The strength of the evidence from the trials is modest, and there are large clinical practice and research gaps. The panel hopes this guideline will establish an international best practice baseline that can be built upon by new research and better-designed trials. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
| | | | | | - Akhila S Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Judith A Paice
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR, USA
| | - Declan Walsh
- Atrium Health, Levine Cancer Center, Charlotte, NC, USA
| | | | - Amy A Case
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Gregory Crawford
- Northern Adelaide Local Health Network, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Carla Ripamonti
- Network Italiano Cure Di Supporto in Oncologia (NICSO), Universita' Degli Studi Di Brescia, Brescia, Italy
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21
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Wu J, Shao J, Chen D, Xue E, Fu Y, Zhang H, Xu Q, Liu C, Ye Z. Developing an integrated care conceptual framework for older adults with multimorbidity within china's integrated delivery system. Age Ageing 2025; 54:afaf060. [PMID: 40091182 DOI: 10.1093/ageing/afaf060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND The definition of China's integrated delivery system remains abstract since it was proposed in 2021, lacking detailed clarification on essential concepts such as specific contents and main providers of services for older adults with multimorbidity. AIM To develop an integrated care conceptual framework for older adults with multimorbidity within China's integrated delivery system. METHODS A scoping review, semi-structured interviews and a modified e-Delphi study were used to explore specific contents of integrated care for older adults with multimorbidity. A social network analysis was conducted to identify healthcare providers with the greatest potential to play a central role in the integrated care for older adults with multimorbidity. Finally, an integrated care conceptual framework was established based on specific contents and main providers. RESULTS The center of the framework represents the people-centered and need-oriented connotation of China's integrated delivery system. The first circle reflects three significant characteristics of the integrated delivery system, namely care comprehensiveness, care coordination, and care continuity. The second circle includes main providers of integrated care, which are expected to play a central role in professional collaboration and information diffusion. The outermost circle consists of specific contents of integrated care, including clinical practice, human workforce, organisational collaboration, information technology, regulations and policies. CONCLUSION The framework derived from this study is expected to promote the understanding and implementation of integrated care for older adults with multimorbidity within the Chinese context. The service content of integrated care related to clinical practice also offers valuable references for other countries.
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Affiliation(s)
- Jingjie Wu
- Nursing Department, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- Nursing Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Jing Shao
- Nursing Research Institute, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dandan Chen
- Nursing Research Institute, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Erxu Xue
- Nursing Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yujia Fu
- Nursing Research Institute, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hui Zhang
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Qinhong Xu
- Nursing Department, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Chunbo Liu
- Nursing Department, Women and Children's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Zhihong Ye
- Nursing Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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22
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DiFabio D, Moodie S, O'Hagan R, Servais M, Tremblay P, Glista D. Unlocking the Potential of Pediatric Virtual Care: An e-Delphi Study on a Virtual Caregiver Participation Framework in Audiology. Am J Audiol 2025; 34:37-50. [PMID: 39556036 DOI: 10.1044/2024_aja-24-00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Abstract
PURPOSE Virtual service delivery models in audiology have become more accessible due to recent technological advancement and improved system-level uptake following COVID-19. Although current evidence identifies the benefits of virtual care to families with children who are d/Deaf or hard of hearing and supports its use in practice, this delivery model is still underutilized. This research aimed to gain consensus on an evidence-informed virtual caregiver participation framework developed from a scoping review of the communication sciences and disorders literature. METHOD A two-round modified e-Delphi study was conducted to survey 26 knowledge users from four different countries with experience in virtual audiology care, including caregivers, audiologists, researchers, and organizational leaders. The study employed Delphi techniques, building from a scoping review to synthesize existing literature informing the knowledge gap, including online surveys and team discussions. Consensus was defined numerically (75% agreement) and by comparing and interpreting text-based responses. RESULTS The resulting framework grouped nine categories of caregiver participation in virtual care according to three main readiness domains: core readiness (opportunities to participate, perceived value, and willingness to participate), engagement readiness (child capacity, family-provider relationship, and role in the care process), and structural readiness (environment for participation, support, and technology). CONCLUSION This work adds novel contributions to the field, through the development of a framework for caregiver participation in virtual audiology care, that can be used to support family involvement and will guide clinical tool development and future research efforts.
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Affiliation(s)
- Danielle DiFabio
- Faculty of Health Sciences, School of Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Sheila Moodie
- Faculty of Health Sciences, School of Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- National Centre for Audiology, Western University, London, Ontario, Canada
| | - Robin O'Hagan
- National Centre for Audiology, Western University, London, Ontario, Canada
| | - Michelle Servais
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- National Centre for Audiology, Western University, London, Ontario, Canada
- TVCC, London, Ontario, Canada
| | - Paul Tremblay
- Department of Psychology, Western University, London, Ontario, Canada
| | - Danielle Glista
- Faculty of Health Sciences, School of Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- National Centre for Audiology, Western University, London, Ontario, Canada
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Pidd DJ, Adams CL, East CE, Wilson IM, Newton MS. Enhancing woman-centred care for pregnant women who have experienced a previous traumatic birth: An Australian Modified Delphi Study. Midwifery 2025; 142:104303. [PMID: 39870051 DOI: 10.1016/j.midw.2025.104303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 01/05/2025] [Accepted: 01/20/2025] [Indexed: 01/29/2025]
Abstract
BACKGROUND Childbirth is often characterised as a time of joy. However, some women have a traumatic birth experience, resulting in ongoing psychological symptoms of distress. This can affect women's mental and physical health in subsequent pregnancies; however, a woman-centred approach has the potential to heal. This study aims to design a means to identify and determine the elements important to creating a woman-centred care pathway in the next pregnancy. METHODS A modified Delphi study was undertaken, informed by a scoping review that identified common needs and care gaps for women with a traumatic birth experience. An expert panel was purposively recruited in Australia, comprising women with traumatic birth experience (n = 9) and multidisciplinary health care professionals (n = 9). Over four iterative online rounds, questions and proposals on developing a screening tool and elements to improve women's care experience were put to the panel. Consensus was agreed at 75 % of aligned votes. Qualitative data were analysed using content analysis. RESULTS A screening tool was developed by consensus incorporating a question on women's previous birth experience and a validated tool on fear of birth. Eleven elements that would facilitate a woman-centred approach following a traumatic birth were identified, and a woman-centred individualised maternity care planning guide was co-designed. CONCLUSION The modified Delphi process achieved consensus on a care pathway to identify women early in their subsequent pregnancy and a woman-centred individualised maternity care planning guide. A proof-of-concept of this woman-centred pathway will be tested in an antenatal clinic setting in Melbourne, Australia.
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Affiliation(s)
- Deborah J Pidd
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia.
| | - Catina L Adams
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia
| | - Christine E East
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Ingrid M Wilson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Singapore Institute of Technology, Singapore
| | - Michelle S Newton
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia
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Mesa-Del-Castillo M, Candela FJC, Martínez-Cañavate A, Rivas-Juesas C, Cabrera HL, Tortajada-Girbés M, Moreno JML, Folqué MDM, Morales-Tirado A, Tabar AI. A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 1. Allergol Immunopathol (Madr) 2025; 53:124-140. [PMID: 40088031 DOI: 10.15586/aei.v53i2.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/15/2024] [Indexed: 03/17/2025]
Abstract
BACKGROUND The study aimed to evaluate the level of agreement between specialists in pediatric allergology regarding the diagnosis and indications for pollen allergen immunotherapy (AIT) of polysensitized children in Spain. MATERIALS AND METHODS A Delphi study was performed using an online survey designed by a committee of pediatric AIT experts: 46 and 44 panelists participated in rounds 1 and 2, respectively. In round 1, 204 statements on 8 dimensions were evaluated (Diagnosis; Therapeutic management; Pollens - Part I; Mites; Moulds; Animals; Hymenoptera venom; and Mixtures - Part II). A total of 148 statements were finally accepted after round 2. Panel members rated their level of agreement with assessments on a 9-point Likert scale based on acceptance by ≥ 66.7% of them. RESULTS According to the results, the polysensitization determination in allergic patients is confirmed by clinical history, skin prick test, total and specific IgE, and molecular diagnostics. Clinical assessments are recommended for the AIT effectiveness evaluation. Follow-ups should be performed 6 months after AIT initiation. According to experts, pollens are the most representative allergens in allergic rhinitis but AIT is more effective in bronchial asthma treatment. The IgE levels are positively related to the intensity of the symptomatology and the efficacy of Grass AIT. In pollen mixtures, a maximum mixture of three AIT allergens is established between Grass, Olive, and Cupressaceae. Mixing pollen from Platanus acerifolia and Parietaria is not recommended. CONCLUSIONS This study provides, where evidence is lacking, current expert-based opinions on clinical decision-making for managing pollen AIT in polysensitized children.
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Affiliation(s)
| | | | - Ana Martínez-Cañavate
- Unidad de Alergia Infantil, Hospital Materno Infantil Virgen de las Nieves de Granada, Spain
| | - Cristina Rivas-Juesas
- Unidad de Neumología y Alergología Pediátrica, Servicio de Pediatría, Hospital de Sagunto, Valencia, Spain
| | | | - Miguel Tortajada-Girbés
- Sección de Neumología y Alergología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Manuel Lucas Moreno
- Sección Alergia Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario Virgen Arrixaca. Murcia, Spain
| | - Maria Del Mar Folqué
- Servicio de Alergología Pediátrica e Inmunología Clínica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana Morales-Tirado
- Servicio de Pediatría, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Ana I Tabar
- Servicio Alergología. Hospital Universitario de Navarra (HUN), Pamplona, Spain
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25
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Arends CR, Van Aperen K, van der Molen L, van den Brekel MWM, Stuiver MM. Limited consensus on the diagnosis and treatment of lymphedema after head and neck cancer: results from an International Delphi study. Disabil Rehabil 2025; 47:1234-1242. [PMID: 38874330 DOI: 10.1080/09638288.2024.2366004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To explore current practice variation and degree of consensus among international clinical experts regarding the diagnosis, classification, measurement, and treatment of head and neck lymphedema (HNL) after head and neck cancer treatment. MATERIALS AND METHODS We conducted an online Delphi study. Eligible participants were clinical researchers who had (co)authored at least one publication on HNL and healthcare professionals who had treated at least five patients with HNL the last two years. The first round was to collect views about current best practices. The second and third rounds delved deeper into these topics using statements with 7-point adjective rating scales. RESULTS An expert panel of seventeen participants (7 clinicians, 8 researchers, and 2 others) from 8 countries completed all rounds. Regarding diagnosis, there was limited consensus on most subjects, with palpation being most endorsed. No consensus was reached on the need to use standardized classification systems. As a treatment method, complex decongestive therapy (CDT) was the most commonly used in practice and investigated in the literature. However, no consensus was reached on the importance of aspects of CDT. CONCLUSIONS There is substantial intra- and international practice variation in the management of HNL. This calls for more robust evidence and guidelines.
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Affiliation(s)
- Coralie R Arends
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kaat Van Aperen
- Laboratory of Experimental Radiotherapy, Department of Oncology, University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Leuven, Leuven, Belgium
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Centre for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Centre for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre for Quality of Life and Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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26
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Papaioannou AI, Loukides S, Vassilakopoulos T, Tzanakis N, Kostikas K, Hillas G, On behalf of the Triple Therapy for COPD Delphi Expert Panel. A Delphi Consensus Project to Capture Greek Experts' Opinion on the Position of Triple Therapies in COPD: Why, When and to Whom. Int J Chron Obstruct Pulmon Dis 2025; 20:457-471. [PMID: 40041472 PMCID: PMC11878287 DOI: 10.2147/copd.s481337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 02/05/2025] [Indexed: 03/06/2025] Open
Abstract
Background In recent years, COPD treatment has become more personalized considering specific patient's characteristics. Aim and Methods We have performed a DELPHI consensus project to assess the level of consensus among Greek experts on the use of triple therapy in COPD as an initial and follow-up treatment. A three-round Delphi online survey was developed. The questionnaire was developed by a 6-member steering committee, included 54 statements, and divided into 3 domains: (A) triple therapy as initial treatment (divided into subdomains examining the impact of exacerbations based on lung function, bronchodilation reversibility and/or blood eosinophil count, smoking, symptoms, and comorbidities), (B) escalation to triple therapy from dual bronchodilation and (C) de-escalation from triple therapy to dual bronchodilation. The survey was funded by AstraZeneca and was hosted and analysed by an independent external company. Results Consensus was reached in 84.8%, 63% and 80% of statements for domains A, B and C, respectively. Experts agreed that initial treatment with triple therapy is a reasonable option for specific patients, while escalation from dual bronchodilation to triple therapy could be considered, besides frequent exacerbators, also in patients with a history of one moderate exacerbation, mainly in the presence of marked bronchodilator reversibility or high blood eosinophil count. Finally, there was a consensus that de-escalation from triple therapy to dual bronchodilation was inappropriate in patients who had experienced one moderate exacerbation in the previous year. Conclusion Although consensus was generated in several statements, panelists failed to reach consensus in many aspects of the use of triple therapy, identifying areas for further research.
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Affiliation(s)
- Andriana I Papaioannou
- 1 Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Medical School, “Sotiria” Chest Hospital, Athens, Greece
| | - Stelios Loukides
- 2 Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Medical School, Attikon’ University Hospital, Athens, Greece
| | - Theodoros Vassilakopoulos
- Laboratory of Physiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Critical Care and Pulmonary (2nd) Department, HENRY DUNANT Hospital Center, Athens, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University of Crete Heraklion, Crete, Greece
| | | | - Georgios Hillas
- 5 Pulmonary Department, “sotiria” Chest Hospital, Athens, Greece
| | - On behalf of the Triple Therapy for COPD Delphi Expert Panel
- 1 Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Medical School, “Sotiria” Chest Hospital, Athens, Greece
- 2 Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Medical School, Attikon’ University Hospital, Athens, Greece
- Laboratory of Physiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Critical Care and Pulmonary (2nd) Department, HENRY DUNANT Hospital Center, Athens, Greece
- Department of Respiratory Medicine, University of Crete Heraklion, Crete, Greece
- Department of Respiratory Medicine, University of Ioannina, Ioannina, Greece
- 5 Pulmonary Department, “sotiria” Chest Hospital, Athens, Greece
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27
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Odgers S, Thomas Y, Tokolahi E. Mothering Occupations Ranked for Maternal Confidence. Occup Ther Health Care 2025:1-17. [PMID: 39976424 DOI: 10.1080/07380577.2025.2465968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 02/08/2025] [Indexed: 02/21/2025]
Abstract
This study exploring the impact of everyday mothering occupations on maternal confidence may have implications for maternal wellbeing, with New Zealand mothers positioned as experts to rank the occupations that evoke feelings of maternal confidence. This study was investigating general mothering experiences, and therefore did not screen for mothers at risk. Delphi surveys were used as a facilitation technique to reach consensus. Participants (N = 7) were presented with a list of mothering occupations informed by literature and additional items previously identified by participants and asked to rank the items for their efficacy at evoking feelings of maternal confidence. A second ranking round was completed, following the collated response from the first ranking. Consensus was reached between surveys. The top nine of 47 items did not change their ranked positions and a list of the top mothering occupations for evoking maternal confidence, as ranked by a panel of mothers, was developed. This study found that mothers ranked co-occupations and watching their babies highly for evoking feelings of maternal confidence. The influence on maternal confidence of specific occupations and tasks demonstrates the potential value of occupational therapy input during the perinatal phase.
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Affiliation(s)
| | - Yvonne Thomas
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
| | - Ema Tokolahi
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
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Iken AR, Gademan MGJ, Snoeker BAM, Vliet Vlieland TPM, Poolman RW, Advisory Board members of the Dutch Orthopedic Association’s third Health Research Agenda working group. Prioritizing orthopaedic evidence uncertainties : expert consensus based on a modified DELPHI study and a focus group. Bone Jt Open 2025; 6:206-214. [PMID: 39963902 PMCID: PMC11833740 DOI: 10.1302/2633-1462.62.bjo-2024-0053.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
Aims To develop a multidisciplinary health research agenda (HRA) utilizing expertise from various disciplines to identify and prioritize evidence uncertainties in orthopaedics, thereby reducing research waste. Methods We employed a novel, structured framework to develop a HRA. We started by systematically collecting all evidence uncertainties from stakeholders with an interest in orthopaedic care, categorizing them into 13 sub-themes defined by the Dutch Orthopaedic Association (NOV). Subsequently, a modified two-phased Delphi study (two rounds per phase), adhering to the Conducting and REporting DElphi Studies (CREDES) guideline, was conducted. In Phase 1, board members assessed the collected evidence uncertainties on a three-point Likert scale to confirm knowledge gaps. In Phase 2, diverse stakeholders, including orthopaedic surgeons, rated the confirmed knowledge gaps on a seven-point Likert scale. Panel members rated one self-selected sub-theme and two randomly assigned sub-themes. The results from Phase 2 were ranked based on the overall average score for each uncertainty. Finally, a focus group discussion with patient associations' representatives identified their top-ranked uncertainty from a predefined consensus process, leading to the final HRA. An advisory board, the Federation of Medical Specialists, and the NOV research coordinator oversaw the process. Results Of the 687 collected evidence uncertainties, 160 (zero to 33 per theme) were confirmed by 41 panel members (three to five per theme). In Phase 2, 124 panel members prioritized 41 evidence uncertainties (zero to five per theme). The focus group members identified 12 key evidence uncertainties leading to the final HRA. The remaining 29 evidence uncertainties will be addressed after research on the HRA's prioritized evidence uncertainty is completed. Conclusion Our framework resulted in a multidisciplinary HRA, enabling an inclusive approach to consensus-building among healthcare professionals and patients on future research priorities within orthopaedic care. We anticipate this innovative framework will enhance inclusivity and transparency, leading to broader acceptance and optimized resource allocation, ultimately reducing research waste.
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Affiliation(s)
- Annabelle R. Iken
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike G. J. Gademan
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Barbara A. M. Snoeker
- Department of Clinical Epidemiology, Amsterdam Medical Center, Amsterdam, Netherlands
| | - Thea P. M. Vliet Vlieland
- Department of Innovation, Quality and Research, Basalt Rehabilitation Center, The Hague, Netherlands
- Department of Orthopedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
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Requejo-Salinas N, Fernández-Matías R, Cadogan A, Chester R, Roy JS, Struyf F, Bateman M, Balster S, Haik MN, Seitz AL, Bisset L, Camargo PR, Brismée JM, May S, Walker T, Wassinger C, Lenssen R, Powell JK, McCreesh K, Gibson J, Ludewig PM, La Touche R, Lluch-Girbés E. Neck or Shoulder? Establishing Consensus for Spine Screening in Patients With Shoulder Pain: An International Modified Delphi Study. Phys Ther 2025; 105:pzae133. [PMID: 39239842 DOI: 10.1093/ptj/pzae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/27/2024] [Accepted: 07/31/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain. METHODS A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7. RESULTS Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus. CONCLUSION International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine. IMPACT This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, C/ La Salle, 10, 28023 Madrid, Spain
- International Doctoral School, Rey Juan Carlos University, Alcorcón, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Calle Budapest 1, 28922 Alcorcón, Madrid, Spain
| | - Angela Cadogan
- Advance Physiotherapy, 156 Bealey Avenue, Christchurch 8013, New Zealand
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec City, Canada
- Faculty of Medicine, Université Laval, Québec City, Canada
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Simon Balster
- Melbourne Shoulder Group, Monash University, Prahran, Victoria, Australia
| | - Melina Nevoeiro Haik
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Amee L Seitz
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Leanne Bisset
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Stephen May
- Independent Physiotherapy Consultant, Sheffield, UK
| | - Tom Walker
- IG Medical, Ilkley Moor Medical Practice, West Yorkshire, England
| | - Craig Wassinger
- Physical Therapy, East Tennessee State University, Johnston City, Tennessee, USA
| | - Ross Lenssen
- Melbourne Shoulder Group, Monash University, Prahran, Victoria, Australia
| | - Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Paula M Ludewig
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, C/ La Salle, 10, 28023 Madrid, Spain
- Neuroscience and Craneofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Klein MR, Loke DE, Barsuk JH, Adler MD, McGaghie WC, Salzman DH. Twelve tips for developing simulation-based mastery learning clinical skills checklists. MEDICAL TEACHER 2025; 47:212-217. [PMID: 38670308 DOI: 10.1080/0142159x.2024.2345270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Simulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid decisions. The following twelve tips are intended to help educators create defensible and effective clinical skills checklists for use in mastery learning curricula. These tips focus on defining the scope of a checklist using established principles of curriculum development, crafting the checklist based on a literature review and expert input, revising and testing the checklist, and recruiting judges to set a minimum passing standard. While this article has a particular focus on mastery learning, with the exception of the tips related to standard setting, the general principles discussed apply to the development of any clinical skills checklist.
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Affiliation(s)
- Matthew R Klein
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Dana E Loke
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jeffrey H Barsuk
- Department of Medicine (Hospital Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark D Adler
- Department of Pediatrics (Emergency Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William C McGaghie
- Department of Medical Education and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David H Salzman
- Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Crunden E, Coleman S, Schoonhoven L, Worsley PR. Reporting medical device-related pressure ulcers: An international Delphi consensus study. J Tissue Viability 2025; 34:100834. [PMID: 39658467 DOI: 10.1016/j.jtv.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 11/21/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Pressure ulcers that are caused from the application of medical devices for diagnostic or therapeutic purposes are commonly observed in acute care environments. Despite an improved understanding of the factors causing these wounds, there is no current consensus on reporting. OBJECTIVE To develop an international consensus for reporting medical device related pressure ulcers. DESIGN A modified RAND/UCLA Delphi study. SETTINGS International experts from clinical, academic and industrial stakeholder. PARTICIPANTS 95 international clinicians and tissue viability experts. METHODS A Delphi survey was developed through literature review and qualitative synthesis. It was electronically disseminated through gate keepers to international experts in the field, with three rounds of consensus feedback. Median values and Disagreement Index from Likert scales were used to establish consensus. RESULTS The panel achieved consensus for reporting MDRPUs which included 30 items across 5 Themes which included i) Recording medical device care, ii) Reporting medical device-related pressure ulcer, iii) Device specific reporting, iv) Ulcer reporting and v) patient information. CONCLUSIONS This is the first international study to develop consensus on medical device related pressure ulcer reporting. This could be used to support standardised international reporting to improve care standards. TWEETABLE ABSTRACT This international Delphi consensus study established a core reporting data set for medical device related pressure ulcers. This study will inform the design of future reporting tools to support standardised practice.e.g. TWEETABLE ABSTRACT international consensus on medical device related pressure injury monitoring @EPUAP@NPIAP@SkinSensing.
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Affiliation(s)
- Ewa Crunden
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK. https://twitter.com/PeteWors
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Kim EJ, Kang J. Infection control nursing competency model for nurses in intensive care units: A Delphi study. Am J Infect Control 2025; 53:203-209. [PMID: 39369824 DOI: 10.1016/j.ajic.2024.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 09/30/2024] [Accepted: 09/30/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Intensive care unit (ICU) nurses require advanced expertise and skills in critical care and need infection control nursing competency (ICNC). Given the lack of research on it, this study aimed to develop a model of ICU nurses' ICNC. METHODS A Delphi panel consisting of experts in intensive care nursing and infection control was organized to provide discerning and professional perspective on ICNC. Approved by the Institutional Review Board, a 3-round Delphi survey was conducted via email from July to December 2023. The content validity ratio and the coefficient of variation were calculated for panel responses. RESULTS Among 17, 15 nurses (88.2%) participated and completed the surveys. About 80% were female, and the panel had an average working experience of 14.2years specifically in the ICUs or infection control departments at hospitals. After the initial round, a preliminary model was developed, consisting of 10 main components and 59 subelements. After eliminating 5 elements with content validity ratio values below 0.49 in the second survey, the final model, consisting of 10 main components and 54 subelements, was confirmed in the third survey. CONCLUSIONS ICU nurses' ICNC can be understood based on this study's results, and further research can be designed to improve this competency.
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Affiliation(s)
- Eun Jo Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - JaHyun Kang
- College of Nursing, Seoul National University, Seoul, South Korea; Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.
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Taylor J, Caprioli T, Damant J, Hamashima Y, Jasim S, Smith N, Toma M. Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey. BMJ Open 2025; 15:e090243. [PMID: 39880458 PMCID: PMC11781119 DOI: 10.1136/bmjopen-2024-090243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 12/02/2024] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Older adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care. However, there is a lack of formal agreement around the key principles that should inform the development of care plans in care homes for older adults. Using a modified Delphi survey, we intend to generate consensus on a set of key principles that should inform the care planning process. METHODS AND ANALYSIS A two-stage modified Delphi survey will be used to try to reach a consensus on a set of key principles to inform care planning within older adult care homes in England. An interdisciplinary panel of approximately 50 people with experience in care planning will be convened and invited to provide feedback on a set of key principles. We will use an iterative, quasi-anonymous, multistage approach with controlled feedback. In the first round, panellists will be asked to provide feedback on a draft document whose contents have been informed by a systematic scoping review and consultations with care home staff. The first round will be administered and subsequently analysed. The results from the first round will be fed back to the panel members and panellists will be asked to complete a second survey. In each round, panel members will use a 5-point unipolar scale to rate their agreement with the item. Consensus will be considered if ≥75% of participants rate an item as 4-5. ETHICS AND DISSEMINATION This study to which this protocol relates has been granted ethical approval by the University of Kent's Division for the Study of Law, Society and Social Justice Research Committee Ethics Panel (reference: 1006) on 9 April 2024. The results of this project will be disseminated through conferences and one or more peer-reviewed journals. In a subsequent research phase, the research team plans to share the key principles document developed through this modified Delphi survey with care home residents and their families and friends. We plan to invite their feedback through a series of focus groups with a view to developing a related document for the family and friends of care home residents.
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Affiliation(s)
- Jonathan Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Thais Caprioli
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Jacqueline Damant
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Yuri Hamashima
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Sarah Jasim
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Nick Smith
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Madalina Toma
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Cordero-García C, de Torres I, Formigo-Couceiro J, Guirao L, Romero-Torres MD, Otero-Villaverde S, Herrera A, Santa C, Mena-Rodriguez A. Delphi Consensus on the Management of Spanish Patients with Post-Stroke Hemiplegic Shoulder Pain Treated with Botulinum Toxin A: Result Study. Toxins (Basel) 2025; 17:40. [PMID: 39852993 PMCID: PMC11769552 DOI: 10.3390/toxins17010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/20/2024] [Accepted: 12/24/2024] [Indexed: 01/26/2025] Open
Abstract
The study aimed to identify expert opinions and obtain recommendations on the management of post-stroke hemiplegic shoulder pain (HSP) and treatment with botulinum toxin A (BoNT-A). A multicenter Delphi study was conducted using an online survey designed by a committee of experts with at least 10 years of experience in post-stroke HSP management with BoNT-A in Spain. Forty-seven panelists (specialists with at least 5 years of experience in post-stroke HSP management with BoNT-A) rated their level of agreement in two rounds based on acceptance by ≥66.7% of them. In round 1, 245 statements on three dimensions were evaluated (diagnosis, treatment, and follow-up of the HSP patients treated with BoNT-A). A total of 159 statements (70.9%) were finally accepted after round 2. Experts recommended BoNT-A as soon as spasticity affects daily activities. They considered ultrasound as the preferred guided technique. Experts recommended regular assessments using validated scales and patient-reported outcomes to evaluate treatment goals and safety. In case of lack of response, experts suggested increasing the dose or number of treated muscles or considering alternative treatments. These consensus-based recommendations offer clinicians an approach to the management of post-stroke HSP with BoNT-A, supporting informed decision making.
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Affiliation(s)
- Carlos Cordero-García
- Juan Ramón Jiménez University Hospital, Ronda Exterior Norte s/n, 21005 Huelva, Spain;
| | - Irene de Torres
- Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain;
| | | | - Lluis Guirao
- Mútua Terrassa University Hospital, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain;
| | | | | | - Alberto Herrera
- Ipsen, Avda. Burgos, 21, 28036 Madrid, Spain; (A.H.); (C.S.)
| | - Cristina Santa
- Ipsen, Avda. Burgos, 21, 28036 Madrid, Spain; (A.H.); (C.S.)
| | - Antonio Mena-Rodriguez
- Doctor Negrín University Hospital of Gran Canaria, Pl. Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
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Joshi C. The Power of Delphi and Advocacy: Consensus in SCN8A-Related Epilepsy and Neurodevelopmental Disorders. Epilepsy Curr 2025; 25:32-35. [PMID: 39545017 PMCID: PMC11558651 DOI: 10.1177/15357597241293310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2024] Open
Abstract
Original Article Citation: Global modified Delphi consensus on diagnosis, phenotypes, and treatment of SCN8A-related epilepsy and/or neurodevelopmental disorders G. Conecker, M. Y. Xia, J. Hecker, C. Achkar, C. Cukiert, S. Devries, et al. Epilepsia 2024 Vol. 65 Issue 8 Pages 2322-2338 Global modified-Delphi consensus on comorbidities and prognosis of SCN8A-related epilepsy and/or neurodevelopmental disorders G. Conecker, M. Y. Xia, J. Hecker, C. Achkar, C. Cukiert, S. Devries, et al. Epilepsia 2024 Vol. 65 Issue 8 Pages 2308-2321 Original Article Abstract: OBJECTIVE : We aimed to develop consensus for diagnosis/management of SCN8A-related disorders. Utilizing a modified Delphi process, a global cohort of experienced clinicians and caregivers provided input on diagnosis, phenotypes, treatment, and management of SCN8A-related disorders. METHODS : A Core Panel (13 clinicians, one researcher, six caregivers), divided into three subgroups (diagnosis/phenotypes, treatment, comorbidities/prognosis), performed a literature review and developed questions for the modified Delphi process. Twenty-eight expert clinicians, one researcher, and 13 caregivers from 16 countries participated in the subsequent three survey rounds. We defined consensus as follows: strong consensus, ≥80% fully agree; moderate consensus, ≥80% fully/partially agree, <10% disagree; and modest consensus, 67%-79% fully/partially agree, <10% disagree. RESULTS : Early diagnosis is important for long-term clinical outcomes in SCN8A-related disorders. There are five phenotypes: three with early seizure onset (severe developmental and epileptic encephalopathy [DEE], mild/moderate DEE, self-limited (familial) infantile epilepsy [SeL(F)IE]) and two with later/no seizure onset (neurodevelopmental delay with generalized epilepsy [NDDwGE], NDD without epilepsy [NDDwoE]). Caregivers represented six patients with severe DEE, five mild/moderate DEE, one NDDwGE, and one NDDwoE. Phenotypes vary by age at seizures/developmental delay onset, seizure type, electroencephalographic/magnetic resonance imaging findings, and first-line treatment. Gain of function (GOF) versus loss of function (LOF) is valuable for informing treatment. Sodium channel blockers are optimal first-line treatment for GOF, severe DEE, mild/moderate DEE, and SeL(F)IE; levetiracetam is relatively contraindicated in GOF patients. First-line treatment for NDDwGE is valproate, ethosuximide, or lamotrigine; sodium channel blockers are relatively contraindicated in LOF patients. SIGNIFICANCE : This is the first-ever global consensus for the diagnosis and treatment of SCN8A-related disorders. This consensus will reduce knowledge gaps in disease recognition and inform preferred treatment across this heterogeneous disorder. Consensus of this type allows more clinicians to provide evidence-based care and empowers SCN8A families to advocate for their children. OBJECTIVES : We aimed to develop consensus on comorbidities (frequency, severity, and prognosis) and overall outcomes in epilepsy, development, and cognition for the five phenotypes of SCN8A-related disorders. METHODS : A core panel consisting of 13 clinicians, 1 researcher, and 6 caregivers was formed and split into three workgroups. One group focused on comorbidities and prognosis. All groups performed a literature review and developed questions for use in a modified-Delphi process. Twenty-eight clinicians, one researcher, and 13 caregivers from 16 countries participated in three rounds of the modified-Delphi process. Consensus was defined as follows: strong consensus ≥80% fully agree; moderate consensus ≥80% fully or partially agree, <10% disagree; and modest consensus 67%-79% fully or partially agree, <10% disagree. RESULTS : Consensus was reached on the presence of 14 comorbidities in patients with Severe Developmental and Epileptic Encephalopathy (Severe DEE) spanning non-seizure neurological disorders and other organ systems; impacts were mostly severe and unlikely to improve or resolve. Across Mild/Moderate Developmental and Epileptic Encephalopathy (Mild/Moderate DEE), Neurodevelopmental Delay with Generalized Epilepsy (NDDwGE), and NDD without Epilepsy (NDDwoE) phenotypes, cognitive and sleep-related comorbidities as well as fine and gross motor delays may be present but are less severe and more likely to improve compared to Severe DEE. There was no consensus on comorbidities in the SeL(F)IE phenotype but strong consensus that seizures would largely resolve. Seizure freedom is rare in patients with Severe DEE but may occur in some with Mild/Moderate DEE and NDDwGE. SIGNIFICANCE: Significant comorbidities are present in most phenotypes of SCN8A-related disorders but are most severe and pervasive in the Severe DEE phenotype. We hope that this work will improve recognition, early intervention, and long-term management for patients with these comorbidities and provide the basis for future evidence-based studies on optimal treatments of SCN8A-related disorders. Identifying the prognosis of patients with SCN8A-related disorders will also improve care and quality-of-life for patients and their caregivers.
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Affiliation(s)
- Charuta Joshi
- Department of Pediatrics
- Childrens Medical Center Dallas The University of Texas Southwestern
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Alderman JE, Palmer J, Laws E, McCradden MD, Ordish J, Ghassemi M, Pfohl SR, Rostamzadeh N, Cole-Lewis H, Glocker B, Calvert M, Pollard TJ, Gill J, Gath J, Adebajo A, Beng J, Leung CH, Kuku S, Farmer LA, Matin RN, Mateen BA, McKay F, Heller K, Karthikesalingam A, Treanor D, Mackintosh M, Oakden-Rayner L, Pearson R, Manrai AK, Myles P, Kumuthini J, Kapacee Z, Sebire NJ, Nazer LH, Seah J, Akbari A, Berman L, Gichoya JW, Righetto L, Samuel D, Wasswa W, Charalambides M, Arora A, Pujari S, Summers C, Sapey E, Wilkinson S, Thakker V, Denniston A, Liu X. Tackling algorithmic bias and promoting transparency in health datasets: the STANDING Together consensus recommendations. Lancet Digit Health 2025; 7:e64-e88. [PMID: 39701919 PMCID: PMC11668905 DOI: 10.1016/s2589-7500(24)00224-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 08/13/2024] [Accepted: 10/11/2024] [Indexed: 12/21/2024]
Abstract
Without careful dissection of the ways in which biases can be encoded into artificial intelligence (AI) health technologies, there is a risk of perpetuating existing health inequalities at scale. One major source of bias is the data that underpins such technologies. The STANDING Together recommendations aim to encourage transparency regarding limitations of health datasets and proactive evaluation of their effect across population groups. Draft recommendation items were informed by a systematic review and stakeholder survey. The recommendations were developed using a Delphi approach, supplemented by a public consultation and international interview study. Overall, more than 350 representatives from 58 countries provided input into this initiative. 194 Delphi participants from 25 countries voted and provided comments on 32 candidate items across three electronic survey rounds and one in-person consensus meeting. The 29 STANDING Together consensus recommendations are presented here in two parts. Recommendations for Documentation of Health Datasets provide guidance for dataset curators to enable transparency around data composition and limitations. Recommendations for Use of Health Datasets aim to enable identification and mitigation of algorithmic biases that might exacerbate health inequalities. These recommendations are intended to prompt proactive inquiry rather than acting as a checklist. We hope to raise awareness that no dataset is free of limitations, so transparent communication of data limitations should be perceived as valuable, and absence of this information as a limitation. We hope that adoption of the STANDING Together recommendations by stakeholders across the AI health technology lifecycle will enable everyone in society to benefit from technologies which are safe and effective.
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Affiliation(s)
- Joseph E Alderman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; University of Birmingham, Birmingham, UK
| | - Joanne Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; University of Birmingham, Birmingham, UK
| | - Elinor Laws
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; University of Birmingham, Birmingham, UK
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - Johan Ordish
- University of Birmingham, Birmingham, UK; Roche Diagnostics, Rotkreuz, Switzerland; Hughes Hall, Cambridge, UK
| | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Melanie Calvert
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK; NIHR Applied Research Collaboration West Midlands, Birmingham, UK; NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, Birmingham, UK
| | - Tom J Pollard
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaspret Gill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jacqui Gath
- Independent Cancer Patients' Voice, London, UK; Patient and Public Contributor, Sheffield, UK
| | | | - Jude Beng
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - Stephanie Kuku
- Institute of Women's Health, University College London, London, UK
| | | | - Rubeta N Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; University of Oxford, Oxford, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK; PATH, Seattle, WA, USA; Wellcome Trust, London, UK
| | - Francis McKay
- Population Health Sciences Institute, Newcastle University, Newcastle, UK; Health Determinants Research Collaboration, Gateshead Council, Gateshead, UK
| | | | | | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK; Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, University of Adelaide, Adelaide, SA, Australia
| | - Russell Pearson
- Medicines and Healthcare products Regulatory Agency, London, UK
| | - Arjun K Manrai
- Department of Biomedical Informatics, Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Puja Myles
- Medicines and Healthcare products Regulatory Agency, London, UK
| | - Judit Kumuthini
- African Biobanks and Longitudinal Epidemiologic Ecosystem, Ibadan, Nigeria
| | | | - Neil J Sebire
- NIHR Great Ormond Street Hospital Biomedical Research Centre at UCL, University College London, London, UK
| | | | - Jarrel Seah
- Harrison.ai, Sydney, NSW, Australia; Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Wales, UK
| | - Lew Berman
- All of Us Research Program, National Institutes of Health, Office of the Director, Bethesda, MD, USA
| | - Judy W Gichoya
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Diana Samuel
- The Lancet Digital Health, The Lancet, London, UK
| | - William Wasswa
- Department of Biomedical Sciences and Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maria Charalambides
- Dermatopharmacology, Faculty of Medicine, Southampton, UK; Department of Dermatology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Anmol Arora
- School of Clinical Medicine, Cambridge, UK; University of Cambridge, Cambridge, UK
| | | | - Charlotte Summers
- Victor Phillip Dahdaleh Heart and Lung Research Institute, Cambridge, UK
| | - Elizabeth Sapey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; Centre for Patient Reported Outcomes Research, School of Health Sciences, College of Medical and Dental Sciences, Birmingham, UK; University of Birmingham, Birmingham, UK; PIONEER, HDR UK Health Data Hub in Acute Care, Birmingham, UK; NIHR Midlands Applied Research Collaboration, Acute Care Theme, West Midlands, UK; NIHR Midlands Patient Safety Collaboration, Birmingham, UK
| | - Sharon Wilkinson
- University of Southampton, Southampton, UK; National Institute for Health and Care Research, Southampton, UK
| | | | - Alastair Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK; Centre for Patient Reported Outcomes Research, School of Health Sciences, College of Medical and Dental Sciences, Birmingham, UK; University of Birmingham, Birmingham, UK; NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, London, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK; Centre for Patient Reported Outcomes Research, School of Health Sciences, College of Medical and Dental Sciences, Birmingham, UK; University of Birmingham, Birmingham, UK.
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Rheel E, De Craemer M, Deliens T, Pleysier S, Ickmans K. Establishing consensus on biopsychosocial factors associated with pediatric chronic pain: A modified Delphi study. THE JOURNAL OF PAIN 2025; 26:104703. [PMID: 39395567 DOI: 10.1016/j.jpain.2024.104703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/28/2024] [Accepted: 10/07/2024] [Indexed: 10/14/2024]
Abstract
A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.
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Affiliation(s)
- Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Marieke De Craemer
- 24-Hour Movement Behaviors in Clinical Populations (MOVEUP24), Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Tom Deliens
- Movement & Nutrition for Health & Performance research group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Sophie Pleysier
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Movement & Nutrition for Health & Performance research group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Conjaerts JAP, Videler AC, Schepman R, Elfeddali I, Rosowsky E, van Alphen SPJ. Clinical Staging for Personality Disorders in Older Adults. J Geriatr Psychiatry Neurol 2025; 38:32-43. [PMID: 38809516 DOI: 10.1177/08919887241254467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults. METHODS/DESIGN The study employed an international Delphi methodology with three rounds and involved 21 experts. RESULTS Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD. CONCLUSION The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.
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Affiliation(s)
- Jeroen A P Conjaerts
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Roel Schepman
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
| | - Iman Elfeddali
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Erlene Rosowsky
- Department of Clinical Psychology William James College, Newton, MA, USA
| | - Sebastiaan P J van Alphen
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Personality and Psychopathology Research Group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Schemer L, Harrison LE, Hess CW, Neville AJ, Jehl N, Ma RSL, Glombiewski JA, Simons LE. Reaching experts for enhanced referral (REFER) to pain psychology: a modified Delphi approach with multidisciplinary paediatric pain providers at a specialised center in the USA. BMJ Paediatr Open 2024; 8:e003020. [PMID: 39725452 DOI: 10.1136/bmjpo-2024-003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 12/09/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND To minimise the referral gap to pain psychology, the purpose of this study was to describe clinician-perceived patient suitability for pain psychology referral, develop a referral plan and outline essential elements of a referral conversation via a modified Delphi approach with multidisciplinary paediatric pain providers. METHODS We employed a three-round modified Delphi approach consulting multidisciplinary paediatric pain providers (n=18) including physicians, psychologists, physical therapists, occupational therapists and nurse practitioners (PT, OT, NP). Based on the responses to an online survey (Round 1), initial statements regarding the pain psychology referral process were developed. These statements were revised in three separate panels (MD panel, PSY panel, PT, OT, NP panel; Round 2). A priori consensus criteria were verified for each statement within and between groups using anonymous responses to a concluding online survey (Round 3). RESULTS Approximately one-third of the statements (35%) reached consensus across all panels. For example, paediatric pain providers agreed that referrals should be communicated verbally, along with written materials, and that pain should be explained early from a biopsychosocial perspective. Paediatric pain providers also suggested minimising barriers through a flexible, stepped-care approach that adapts the delivery of pain psychology beyond traditional models. However, most statements reached consensus in only one or two panels (52%), indicating a lack of consensus across disciplines. The data suggest that it was comparatively easier to reach an overall consensus on statements formulating an ideal referral process to pain psychology (50%) than on statements characterising patient suitability (13%). CONCLUSIONS Paediatric pain providers developed an actionable plan for pain psychology referrals. This plan could bridge referral gaps and improve access to pain psychology treatment. Given the low provider consensus on patient suitability, further research is warranted to understand pain psychology referral decision-making, including differing perceptions of patient suitability across disciplines.
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Affiliation(s)
- Lea Schemer
- Department for Clinical Psychology and Psychotherapy, Rheinland-Pfälzische Technische Universität (RPTU) Kaiserslautern-Landau, Landau, Germany
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alexandra J Neville
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Jehl
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ryan S L Ma
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Julia A Glombiewski
- Department for Clinical Psychology and Psychotherapy, Rheinland-Pfälzische Technische Universität (RPTU) Kaiserslautern-Landau, Landau, Germany
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Oda S, Kawakami A, Ashida K, Tanaka M. Death rattle: palliative nursing practices Delphi study. BMJ Support Palliat Care 2024; 14:e2888-e2895. [PMID: 38565275 DOI: 10.1136/spcare-2024-004887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Interventions for patients with death rattle remain under consideration, and their families strongly acknowledge the need for improved care. However, few reports exist concerning specific and comprehensive nursing practices for them. This study aimed to clarify nursing practices for patients with death rattle and their families in hospital wards and examine each practice's importance. METHODS We used a modified Delphi method with expert nurses with extensive experience in end-of-life care. Participants were recruited using convenience and snowball sampling. First, we developed a list of nursing practices through a literature review and individual interviews. Second, we conducted the Delphi survey. Two rounds of judging were performed. Items were rated on a 9-point Likert scale (1=not important at all to 9=very important). An item was considered 'important' if at least 80% of the participants rated it ≥7. RESULTS The list comprised 40 items across 8 domains: assessment of death rattle and the distress felt by the patients, oral care, repositioning, adjustment of parenteral hydration, suctioning, administration of alleviating medications, communication with and assessment of family members who witness death rattle, and nurse's attitude towards death rattle and the relevant interventions. Of the 46 recruited experts, 42 participated in both rounds. Participants regarded 37 of the 40 items as important. CONCLUSIONS This study specifically and comprehensively identified nursing practices for patients with death rattle and their families using a modified Delphi method to support clinical nursing practice and improve the quality of care.
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Affiliation(s)
- Sumika Oda
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
| | - Aki Kawakami
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
| | - Kaoru Ashida
- Department of Nursing, Kanto Gakuin University, Yokohama, Japan
| | - Makoto Tanaka
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
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Yeoh EK, Yam CHK, Ip EMY, Chow TY, Hung CT. A study protocol for the policy intervention design and development of the implementation strategies for direct access to physiotherapists in primary care: a sequential mixed-method study using implementation mapping and a Delphi survey. Implement Sci Commun 2024; 5:141. [PMID: 39696665 DOI: 10.1186/s43058-024-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 12/10/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND In many Asian jurisdictions, patients are required to obtain referrals from registered doctors before consulting physiotherapists. In contrast, countries such as the United States, the United Kingdom, and Australia have a direct access model for physiotherapists designed across different healthcare settings and under prescribed conditions. While research has demonstrated the benefits of direct access, issues remain on the appropriate policy design for direct access in the context of patient safety and organizational challenges in the implementation. Recently the policy to allow direct access in primary care context is being considered in Hong Kong. This study aims to examine the intervention design options for the policy of direct access to physiotherapists and identify corresponding implementation strategies, to inform the appropriate intervention design for direct access to physiotherapists and the implementation strategies. METHODS We adopt a systematic process for developing the design of the policy and the implementation strategies using an Implementation Mapping approach informed by Consolidated Framework for Implementation Research (CFIR). We will conduct literature reviews to understand the different aspects of policy intervention design and employ qualitative in-depth interviews and focus group discussions to understand key stakeholders' perspectives related to the direct access model. The identified barriers and facilitators associated with policy implementation of an acceptable intervention design will inform the development of an effective implementation strategy tailored to the implementation context. Our approach will involve mapping the research evidence and the subsequent findings from the stakeholders' deliberations into the CFIR domains and referencing the Expert Recommendations for Implementing Change (ERIC) to develop the acceptable intervention characteristics and the corresponding implementation strategies. These insights will be further validated in a Delphi Expert Survey, for a consensus-based approach. DISCUSSION This study employs a sequential mixed-method approach to explore the intervention characteristics for an acceptable intervention design in the policy formulation and the corresponding implementation strategy for direct access to physiotherapists. Integrating research insights into actionable policy recommendations and refining these recommendations in a Delphi Survey will inform the appropriate policy intervention design and implementation strategy for direct access to physiotherapy services.
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Affiliation(s)
- Eng Kiong Yeoh
- The Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Carrie Ho Kwan Yam
- The Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Ethan Ming Yin Ip
- The Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Yu Chow
- The Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Tim Hung
- The Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Velarde Crézé C, Duperrex O, Lebon L, Faivre V, Pasche M, Cornuz J. A multi-stage approach to support timely health policy decisions during crisis: the fast-track Delphi. BMC Public Health 2024; 24:3412. [PMID: 39696176 DOI: 10.1186/s12889-024-20903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 11/29/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Scientists can play an important role in policymaking by providing evidence and consensual expert opinion on the state of scientific knowledge. Delphi surveys have been widely used to develop consensus on a topical issue, yet not compatible with public health crisis situations requiring rapid decisions. We developed a fast-track Delphi process, providing experts with a structured approach to rapidly develop and quantify consensus in support of informed policy decisions. METHODS We identified key elements of consensus-building techniques through a literature review and derived methodological procedures that served as the basis for the elaboration of the new process. Selected methodological experts provided advice on necessary adjustments. The process was pilot tested using a real-world public health issue. RESULTS The fast-track Delphi process is a hybrid approach between a conventional Delphi and the nominal group technique: one group session followed by two rounds of e-questionnaire, with predefined steps. We developed an ad hoc toolkit (REDCap templates, R code for analysis and production of reports, user guide) to overcome time constraints, which we pilot tested with experts. The feasibility test conducted in 18 days in the field of tobacco control demonstrated the applicability and usefulness of the process in real-world conditions. CONCLUSIONS We strongly believe that this fast-track Delphi process has the potential to help inform policy decisions in various types of crises, including emerging diseases or novel potentially harmful products.
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Affiliation(s)
- Camille Velarde Crézé
- Department of Health Promotion and Prevention, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, Lausanne, CH - 1010, Switzerland.
| | - Olivier Duperrex
- Department of Health Promotion and Prevention, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, Lausanne, CH - 1010, Switzerland
| | - Luc Lebon
- Department of Health Promotion and Prevention, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, Lausanne, CH - 1010, Switzerland
| | - Vincent Faivre
- Direction of Finances - Informatics Systems and Digital Transformation Unit, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Myriam Pasche
- Department of Health Promotion and Prevention, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, Lausanne, CH - 1010, Switzerland
| | - Jacques Cornuz
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Ekkunagul T, MacLeod CS, Celnik A, Chalmers J, Thomson R, Nagy J, Forget P. Processes and approaches to perioperative pain management in patients undergoing major lower extremity amputations secondary to vascular disease: a multi-specialty modified Delphi consensus study protocol. BMJ Open 2024; 14:e090289. [PMID: 39627144 PMCID: PMC11624789 DOI: 10.1136/bmjopen-2024-090289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 10/10/2024] [Indexed: 12/09/2024] Open
Abstract
INTRODUCTION Pain surrounding major lower extremity amputations (MLEAs) in the vascular surgical patient can be severe, conferring significant debilitation from the preoperative stage through to the chronic rehabilitation phase. Although there is an evolving understanding of the array of existing analgesic medications and modalities, pain management in this context continues to be challenging. A previous report in the UK revealed that MLEA pain management practices may not be optimal from the perspective of patients. There are also limitations in the comprehensiveness and quality of existing evidence, and existing practices can be heterogeneous. Identifying effective pain management approaches in MLEA has thus been recognised as a key practice and research priority. Therefore, the aim of this study protocol will be to elucidate a multi-specialty view on the perceptions, processes and approaches to perioperative pain management in patients undergoing MLEAs secondary to vascular disease in the UK. METHODS AND ANALYSIS A modified Delphi methodology will be used to gain consensus among a UK-wide multi-specialty panel of clinical experts. At least three iterative rounds of structured anonymous electronic surveys will be circulated to a minimum cohort of 40 participants across relevant specialties. Expert agreement on pre-developed consensus statements pertaining to the approaches and techniques in MLEA pain management will be sought from the first round and quantified by a 5-point Likert scale. Quantitative and qualitative analyses will be performed to evaluate the level of agreement and participant feedback, respectively. A consensus criterion of ≥75% panellist agreement with a ≤10% between-round stability will be used for each statement. The process will be repeated with the results and implementation of feedback highlighted to panellists in each subsequent round. ETHICS AND DISSEMINATION Ethical approval was not required for this study as the participants and methodology fall outwith the requirements for a National Health Service Research Ethics Committee review. The results will be disseminated in a peer-reviewed publication and presented at relevant conferences.
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Affiliation(s)
- Thanapon Ekkunagul
- Epidemiology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - Caitlin Sara MacLeod
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
- Division of Cardiovacular and Diabetes Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Anna Celnik
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - John Chalmers
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ross Thomson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - John Nagy
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - Patrice Forget
- Epidemiology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
- IMAGINE UR UM 103, Montpellier University, Anesthesia Critical Care, Emergency and Pain Medicine Division, University Hospital Centre Nimes, Nimes, France
- Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care Research Group, European Society of Anaesthesiology, Brussels, Belgium
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Nielsen S, Horn F, McDonald R, Eide D, Walley AY, Binswanger I, Langford AV, Prathivadi P, Wood P, Clausen T, Picco L. Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology. Res Social Adm Pharm 2024; 20:1110-1117. [PMID: 39289100 DOI: 10.1016/j.sapharm.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Opioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks. OBJECTIVE This project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings. METHODS The e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements. RESULTS A diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years' professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3. CONCLUSIONS Community pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia.
| | - Freya Horn
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Desiree Eide
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Ingrid Binswanger
- Institute of Health Research, Kaiser Permanente Colorado, 16601 East Centretech Parkway, Aurora, 80011, USA; Colorado Permanente Medical Group, 1375 E 20(th) Ave, Denver, CO, 80218, USA; University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Kaiser Permanente School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 407 Royal Parade, Parkville, Australia; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, 64 Mallett Street, Camperdown, New South Wales, Australia
| | - Pallavi Prathivadi
- Equity, Primary Care, Implementation and Community (EPIC) Research Unit, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Pene Wood
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
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Bohart S, Nielsen AH, Sørensen JL, Andreasen AS, Waldau T, Møller AM, Thomsen T. Establishing consensus on patient- and family-centered care in adult intensive care units: A Delphi survey. J Crit Care 2024; 84:154859. [PMID: 39003924 DOI: 10.1016/j.jcrc.2024.154859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To establish consensus between intensive care unit (ICU) experts on concrete patient- and family-centered care statements for adult patients and relatives in the ICU. MATERIALS AND METHODS We did a three-round Delphi survey with a panel of ICU health care professionals from 23 ICUs in Denmark. In round 1, participants answered 20 open-ended questions, based on existing evidence. Analysis of their responses generated close-ended statements, which participants primary rated on a five-point-Likert-scale, from very important to not important at all. In rounds 2 and 3., consensus was predefined as ≥75% of participants rating a statement important. RESULTS Sixty-nine participated: 38 nurses, 24 physicians, and four occupational and physiotherapists. In total 96%, 90% and 72% answered the first, second, and third rounds, respectively. In round 1, participants answers resulted in >3000 statements that were analyzed into 82 condensed statements. After participants rated the statements in round 2 and 3, 47 statements reached consensus as important. CONCLUSIONS The 47 statements rated to be important included interdisciplinary approaches to systematic information sharing and consultations with patients and family-members, with the aim being to accommodate patients and family-members´ individual needs throughout the ICU stay.
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Affiliation(s)
- Søs Bohart
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
| | - Anne Højager Nielsen
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina Waldau
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Ann Merete Møller
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Cahill LE, Kirkpatrick SI, Mah CL, Protudjer JL, Kendell C, Jung ME, Wong H, Crumley ET, Day M, Tang KTY, Huang Y, Sihag J, Brady L, Tennankore KK, Tangri N, Mollard RC, MacKay D. Development of the 10-question household foodwork interactional assessment questionnaire (FIA-Q10). Int J Behav Nutr Phys Act 2024; 21:135. [PMID: 39609806 PMCID: PMC11603983 DOI: 10.1186/s12966-024-01671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/07/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Public health nutrition recommendations and clinical dietary interventions emphasize eating healthy food at home, implicitly requiring household foodwork. Household foodwork is defined as the physical and mental tasks a household does for eating meals and snacks. Because no tools exist to measure it, how much time people spend doing household foodwork and the foodwork barriers they experience remain unknown. The objective of the present research was to develop the first stand-alone household foodwork assessment tool. METHODS Through informal interviews with partners with lived experience, clinicians, and researchers, a literature review, a stakeholder meeting of advisors, and a two-round electronic Delphi process including face/content validation by expert panelists (n = 21), we developed the 10-question household foodwork interactional assessment questionnaire (FIA-Q10). An optional accompanying module was developed to collect self-identified demographic data to provide context for understanding how social-structural positionality factors may interact to influence foodwork. RESULTS The FIA-Q10 assesses the domains of household composition, frequency of eating at home, special diets within a household, foodwork stress intensity, foodwork barriers, desired supports related to foodwork, and time use for foodwork. The FIA-Q10 measures time use for four subdomains of foodwork among individuals and their households: (1) planning, (2) getting, (3) preparing/cooking, and (4) cleaning up food. In the second Delphi round, the FIA-Q10 scored 95% for language appropriateness, 67% for visual appropriateness, 95% for relevance, 95% for representativeness, and 95% for distribution. Suggested improvements were implemented. All Delphi panelists (100%) reported they would consider using the FIA-Q10. CONCLUSIONS The FIA-Q10's development is the first step towards a standardized assessment of foodwork, enabling examination of challenges in foodwork that may impact nutrition and nutrition equity. Future research will focus on FIA-Q10 validation in multiple populations.
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Affiliation(s)
- Leah E Cahill
- Department of Medicine, Dalhousie University, 5790 University Ave, Room 225, Halifax, NS, B3H 1V7, Canada.
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada.
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada.
| | | | - Catherine L Mah
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, 5790 University Ave, Room 225, Halifax, NS, B3H 1V7, Canada
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Helen Wong
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - Ellen T Crumley
- Faculty of Management, Dalhousie University, Halifax, Canada
| | - Meghan Day
- Department of Medicine, Dalhousie University, 5790 University Ave, Room 225, Halifax, NS, B3H 1V7, Canada
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | - Karen T Y Tang
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | - Yan Huang
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | - Jyoti Sihag
- Department of Foods and Nutrition, CCS Haryana Agricultural University, Hisar, India
| | - Laura Brady
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | - Karthik K Tennankore
- Department of Medicine, Dalhousie University, 5790 University Ave, Room 225, Halifax, NS, B3H 1V7, Canada
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, Canada
| | | | - Rebecca C Mollard
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Dylan MacKay
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, Canada
- Internal Medicine Section Endocrinology, University of Manitoba, Winnipeg, Canada
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Behan FP, Bull AMJ, Beck BR, Brooke-Wavell K, Müller R, Vico L, Isaksson H, Harvey NC, Buis A, Sherman K, Jefferson G, Cleather DJ, McGregor A, Bennett AN. Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation: a Delphi study. Br J Sports Med 2024; 58:1251-1257. [PMID: 39227136 PMCID: PMC11671889 DOI: 10.1136/bjsports-2024-108721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise hip bone mineral density (BMD) loss following traumatic lower limb amputation. METHODS In three Delphi rounds, statements were presented to a panel of 13 experts from six countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3-4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the resp onse. Round 3 statements reaching ≥70% agreement were defined as consensus. RESULTS All 13 experts completed rounds 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2-3). Round 3 reached consensus on nine statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least three different resistance exercises at an intensity of 8-12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially. CONCLUSION This expert Delphi process achieved consensus on nine items related to exercise prescription to minimise hip BMD loss following traumatic lower limb amputation. These recommendations should be tested in future interventional trials.
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Affiliation(s)
- Fearghal P Behan
- Imperial College London, London, UK
- Trinity College Dublin, Dublin, Ireland
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | | | | | - Ralph Müller
- Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Laurence Vico
- Inserm U1059 SAINBIOSE, Université Jean Monnet Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | | | - Daniel J Cleather
- School of Sport, Health and Applied Science, St. Mary's University, Twickenham, London, UK
| | - Alison McGregor
- Surgery and Cancer / Human Performance Group, Imperial College London, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, UK
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Al-Hakim L, Zhang Z, Xiao J, Sengupta S, Lamb BW. A Delphi-based exploration of factors impacting blood loss and operative time in robotic prostatectomy. J Robot Surg 2024; 18:392. [PMID: 39487867 DOI: 10.1007/s11701-024-02145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 10/14/2024] [Indexed: 11/04/2024]
Abstract
This study aims to investigate factors influencing the implementation of robotic-assisted radical surgery, with a specific focus on their effects on blood loss and operative time. Radical prostatectomy was chosen as the case study due to its complexity and diverse surgical activities. The study employed a three-round Delphi approach involving 25 surgeons from three countries: UK, Australia, and China. The collected data were analysed using non-parametric tests. The Delphi study showed significant correlations between the degree of difficulty and blood loss (Z = 2.698, ρ < 0.007), as well as between team coordination and blood loss (Z = 3.499, ρ < 0.0001). However, no significant relationship was found between operative time and blood loss. Surgeons reported that neurovascular bundle (NVB) release and pelvic lymph node dissection require high team coordination. NVB release is particularly challenging and poses a higher risk of blood loss. Additionally, a large prostate increases the difficulty of prostate dissection, prolongs operative time for bladder neck and NVB dissection, and leads to a considerable overall increase in operative time. The manuscript shows that effective team coordination plays a crucial role in reducing blood loss and operative time during surgical activities. When the team coordinates well, clear and efficient verbal communication suffices, reducing the need for physical proximity during robotic-assisted surgeries.
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Affiliation(s)
- Latif Al-Hakim
- The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
- Hakim Management, 7 Tourmaline Crescent, Wheelers Hill, Melbourne, VIC, 3150, Australia.
| | - Zhewei Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiaquan Xiao
- Department of Urology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shomik Sengupta
- Sengupta Urology, Wheelers Hill, VIC, Australia
- Urology Department, Monash University, Eastern Health, Box Hill, VIC, Australia
| | - Benjamin W Lamb
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Ayan G, Baykal Ü. Managerial ethical principles and behaviours for nurse managers: A Delphi method. Nurs Ethics 2024; 31:1330-1348. [PMID: 39024653 DOI: 10.1177/09697330231197709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Managerial ethical principles and behaviours guide the roles, duties, responsibilities, behaviours, and relationships of nurse managers in healthcare institutions. RESEARCH OBJECTIVES The aim of this study was to establish the managerial ethical principles and behaviours for nurse managers. RESEARCH QUESTION What are the managerial ethical principles and behaviours for nurse managers? RESEARCH DESIGN The Delphi method, one of the qualitative research methods, was used in this study. The Delphi process consisted of two rounds. Data were collected by e-Delphi technique. PARTICIPATIONS 42 experts were included in the first Delphi round and 39 in the second Delphi round. These experts consisted of nurse managers, academicians studying in the field of ethics and nursing management. ETHICAL CONSIDERATIONS Participation in the study was voluntary and informed consent of the experts was obtained before the study. Approval was obtained from the ethics committee of the university at which the researcher worked (Approval date: 24.07.2020, Decision No: 2020/12-16). FINDINGS At the end of the Delphi rounds, eight managerial ethical principles and 29 ethical behaviours of these principles were identified. The distribution of these behaviours and principles were: justice (six behaviours), equality (two behaviours), honesty (two behaviours), fairness (two behaviours), responsibility (eight behaviours), confidentiality (two behaviours), clarity (two behaviours), and humanity (five behaviours). CONCLUSION These managerial ethical principles and behaviours are intended to guide nurse managers when providing nursing services but should be updated accordingly in line with changing conditions and developments.
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50
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Gómez Doblas JJ, García-Moll X, Bover Freire R, Juanatey CG, Morillas M, Muñoz AV, Escobar C. Delphi consensus on oral anticoagulation management in special clinical situations in the cardiology setting. Future Cardiol 2024; 20:695-708. [PMID: 39439239 PMCID: PMC11552477 DOI: 10.1080/14796678.2024.2343550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/12/2024] [Indexed: 10/25/2024] Open
Abstract
Background: Management of oral anticoagulation (OAC) can be challenging, such as in complex cases of nonvalvular atrial fibrillation (NVAF).Materials & methods: A Delphi study comprising two rounds was used for gathering expert opinion through an online questionnaire (83 items grouped in 8 dimensions) on OAC management in specific clinical settings.Results: Consensus was reached for 79 items (95%) in round 1. Experts recommended direct-acting oral anticoagulants (DOACs) for pericardioversion, uninterrupted OAC for catheter ablation, and dual therapy with a DOAC and clopidogrel after percutaneous coronary intervention. They also recommended restarting OAC with a DOAC after an intracranial haemorrhage.Conclusion: The expert-based recommendations obtained may contribute to standardizing and guiding the management of OAC in complex clinical situations in cardiology.
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Affiliation(s)
- Juan José Gómez Doblas
- Hospital Virgen de la Victoria, Campus de Teatinos, S/N, Puerto de la Torre, 29010, Málaga
| | - Xavier García-Moll
- Hospital de la Santa Creu i Sant Pau, C/de Sant Quintí, 89, Horta-Guinardó, 08025, Barcelona
| | - Ramón Bover Freire
- Hospital Clínico San Carlos, Calle del Prof Martín Lagos, S/N, Moncloa – Aravaca, 28040, Madrid, CIBERCV
| | | | - Miren Morillas
- Hospital de Galdakao, Labeaga Auzoa, 48960, Galdakao, Bizkaia
| | | | - Carlos Escobar
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
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