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Journal of Anatomy Jan 2024Anatomy forms a key component of veterinary curricula, but, in the context of an evolving profession, curricula are adapting and changing accordingly. There is a lack of...
Anatomy forms a key component of veterinary curricula, but, in the context of an evolving profession, curricula are adapting and changing accordingly. There is a lack of guidance for educators regarding the levels of anatomical knowledge required for a graduate to be considered safe or competent. A formal review of veterinary anatomy learning outcomes (LOs) is therefore timely to support curriculum development in this rapidly evolving field. This study aimed to create a set of LOs which reflect the recommended core requirements for a new graduate veterinarian. A consensus approach using a modified Delphi method was used. The Delphi panel consisted of 23 experienced and active veterinary anatomy educators from veterinary schools within the UK and Ireland. The process had four stages: (1) Research team review, pre-screening and modification of a list of existing LOs (adapted from the Core Regional Anatomy Syllabus) which then formed the initial set of outcomes sent for review; (2) Delphi Round 1; (3) Delphi Round 2; (4) Post-Delphi final screening and review. Qualitative data outlining the rationale for modification and rejection of LOs were analysed via content analysis. 167 LOs were initially presented to the Delphi panel in Round 1. 64 of those were accepted, 79 recommended for modification and 23 rejected. 122 LOs were presented to the Delphi panel in Round 2. Of these, 86 outcomes were accepted, 10 modified and 26 rejected. 160 LOs were ultimately accepted and form the Veterinary Anatomy Core Syllabus. Key themes arising from analysis include the removal of unnecessary detail and increased focus on the relevance of competencies required of a new veterinary graduate. The syllabus presented may be used by curriculum planners, teachers and students within veterinary education worldwide.
Topics: Humans; Anatomy, Veterinary; Delphi Technique; Anatomy, Regional; Curriculum; Education, Medical, Undergraduate; Anatomy
PubMed: 37664883
DOI: 10.1111/joa.13948 -
Journal of General Internal Medicine Nov 2023Bedside incision and drainage (I&D) of skin abscesses is a common medical procedure performed in a variety of medical settings. Yet, there is a paucity of published...
BACKGROUND
Bedside incision and drainage (I&D) of skin abscesses is a common medical procedure performed in a variety of medical settings. Yet, there is a paucity of published validated educational tools to teach and assess competency for this procedure.
OBJECTIVE
To validate an educational tool to teach and assess competency for bedside I&D of skin abscesses via the Delphi consensus and Angoff standard setting methods.
DESIGN
Expert consensus on the importance of each procedural step in the educational tool was obtained using the Delphi method, consisting of four rounds of iterative revisions based on input from a panel of experts. The passing cut-off score for a proficient provider was determined using the modified dichotomous Angoff method.
PARTICIPANTS
All participants met the minimum criteria of active involvement in resident education and performance of at least 20 skin abscess I&D's within the past 5 years. Participant specialties included general surgery, emergency medicine, and internal medicine.
MAIN MEASURES
The primary outcome was consensus on procedural steps and errors, defined as an interquartile range ≤ 2 on a 9-point Likert scale. A cut-off score was determined by the average across all respondents for the anticipated number of errors that would be committed by a provider with the level of proficiency defined in the survey. Qualitative input was incorporated into the educational tool.
KEY RESULTS
At the end of four rounds of review via the Delphi process, participants achieved consensus on 93% of items on the clinical checklist and 85% of errors on the assessment checklist. Via the modified dichotomous Angoff method, the determined passing cut-off for competency was 6 out of 22 errors.
CONCLUSION
An educational and evaluation tool for bedside I&D of skin abscesses was validated via the Delphi and Angoff methods.
Topics: Humans; Abscess; Educational Status; Surveys and Questionnaires; Checklist; Drainage; Delphi Technique; Clinical Competence
PubMed: 37592118
DOI: 10.1007/s11606-023-08205-4 -
The Bone & Joint Journal Jul 2023The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with...
AIMS
The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.
METHODS
A Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children's Orthopaedic Surgery (BSCOS). Statements were only included ('consensus in') in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded ('consensus out') if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation.
RESULTS
A total of 133 children's orthopaedic surgeons completed the first survey, and 109 the second. Out of 43 proposed statements included in the initial Delphi, 32 reached 'consensus in', 0 'consensus out', and 11 'no consensus'. These 11 statements were then reworded, amalgamated, or deleted before the second Delphi round of eight statements. All eight were accepted as 'consensus in', resulting in a total of 40 approved statements.
CONCLUSION
In the many aspects of medicine where relevant evidence is not available for clinicians to base their practice, a Delphi consensus can provide a strong body of opinion that acts as a benchmark for good quality clinical care. We would recommend clinicians managing children with musculoskeletal infection follow the guidance in the consensus statements in this article, to ensure care in all medical settings is consistent and safe.
Topics: Humans; Child; Delphi Technique; Consensus; Surveys and Questionnaires; Hospitals; United Kingdom
PubMed: 37399098
DOI: 10.1302/0301-620X.105B7.BJJ-2022-1316.R1 -
BMJ Open Gastroenterology Jan 2024Despite research, there are still controversial areas in the management of Crohn's disease (CD). (Review)
Review
BACKGROUND
Despite research, there are still controversial areas in the management of Crohn's disease (CD).
OBJECTIVE
To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD.
METHODS
Clinical controversies in the management of CD using anti-TNF therapies were identified. A comprehensive literature review was performed, and a national survey was launched to examine current clinical practices when using anti-TNF therapies. Their results were discussed by expert gastroenterologists within a nominal group meeting, and a set of statements was proposed and tested in a Delphi process.
RESULTS
Qualitative study. The survey and Delphi process were sent to 244 CD-treating physicians (response rate: 58%). A total of 14 statements were generated. All but two achieved agreement. These statements cover: (1) use of first-line non-anti-TNF biological therapy; (2) role of HLA-DQA1*05 in daily practice; (3) attitudes in primary non-response and loss of response to anti-TNF therapy due to immunogenicity; (4) use of ustekinumab or vedolizumab if a change in action mechanism is warranted; (5) anti-TNF drug level monitoring; (6) combined therapy with an immunomodulator.
CONCLUSION
This document sought to pull together the best evidence, experts' opinions, and treating physicians' attitudes when using anti-TNF therapies in patients with CD.
Topics: Humans; Crohn Disease; Tumor Necrosis Factor Inhibitors; Delphi Technique; Necrosis
PubMed: 38267072
DOI: 10.1136/bmjgast-2023-001246 -
Journal of Advanced Nursing Oct 2023To develop clinical practice recommendations for nurse-administered intramuscular injections in mental health. (Review)
Review
AIM
To develop clinical practice recommendations for nurse-administered intramuscular injections in mental health.
BACKGROUND
Intramuscular injection is the main route of long-acting injectable antipsychotics' administration that appear to improve the long-term prognosis of mental illness. Specific guidelines related to the nurse administration of intramuscular injections need to be updated and to explore not only the technical aspects of this procedure.
DESIGN
A modified RAND/University of California Los Angeles (UCLA) appropriateness method Delphi study was conducted between October 2019 and September 2020.
METHODS
A multidisciplinary steering committee conducted a literature review and developed a list of 96 recommendations. These recommendations were submitted in a two-round Delphi electronic survey to a panel of 49 experienced practicing nurses from five mental health hospitals in France. Each recommendation was rated for its appropriateness and applicability in clinical practice on a 9-point Likert scale. Consensus among nurses was evaluated. The steering committee discussed the results after each round and approved the final set of recommendations.
RESULTS
A final set of 79 specific recommendations were accepted for their appropriateness and applicability in clinical practice. Recommendations were classified in five domains: legal and quality assurance aspects, nurse-patient relationship, hygiene, pharmacology, and injection technique.
CONCLUSION
The established recommendations placed patients at the heart of the decisions concerning the intramuscular injection and underlined the need for specific training programs. Future research should focus on the integration of these recommendations in clinical practice, by both before-and-after studies and regular assessments of professional practices with relevant indicators.
IMPACT
The recommendations developed for good nursing practices explored not only the technical aspects but integrated the nurse-patient relationship. These recommendations may impact usual practices of administration of long-acting injectable antipsychotics and most of them could be applied in many countries.
NO PATIENT OR PUBLIC CONTRIBUTION
Due to the study design.
Topics: Humans; Mental Health; Injections, Intramuscular; Delphi Technique; Antipsychotic Agents; Mental Disorders
PubMed: 37209291
DOI: 10.1111/jan.15709 -
Antimicrobial Resistance and Infection... Jul 2023Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to...
Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN).
BACKGROUND
Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care.
OBJECTIVE
To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network.
METHODS
We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement.
RESULTS
The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5).
CONCLUSION
We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.
Topics: Humans; Feedback; Anti-Bacterial Agents; Delphi Technique; Drug Resistance, Bacterial; Primary Health Care
PubMed: 37516892
DOI: 10.1186/s13756-023-01279-z -
Hispanic Health Care International :... Dec 2023Nurses' role in the management of people with systemic lupus erythematosus (SLE) is essential. Specific guidelines for nurses have not been previously developed in... (Review)
Review
Nurses' role in the management of people with systemic lupus erythematosus (SLE) is essential. Specific guidelines for nurses have not been previously developed in Spain. This project aimed to try to develop comprehensive and validated recommendations for nurses regarding the management of people with SLE. A Delphi questionnaire with 90 general and specific recommendations was designed by the scientific committee and underwent two rounds of participation. Panellists reached a consensus on "agreement" for 85 recommendations during the first round and for 87 recommendations after the second and final rounds. Panellists agreed that people with SLE should be managed within a multidisciplinary team, and that this team should include specialized nurses. Panellists stated that most of the services lack specialized nurses. Experts identified lack of specific training programs targeted to nurses as the main barrier for application of recommendations. Panellists recommended an extended role for nurses in the management of people with SLE, including diagnosis, patient education, treatment monitoring and administration, and follow-up. This study is the first consensus that provides nursing recommendations from experts on the management of people with SLE in Europe. Design of standardized training programs targeted to nurses would facilitate the application of the recommendations.
Topics: Humans; Consensus; Delphi Technique; Lupus Erythematosus, Systemic; Surveys and Questionnaires
PubMed: 37272038
DOI: 10.1177/15404153231176001 -
Bulletin of the World Health... Aug 2023
Topics: Humans; Public Health; Delphi Technique; Global Health
PubMed: 37529023
DOI: 10.2471/BLT.23.010823 -
Hospital Pediatrics Jul 2023Pediatric interfacility transport teams facilitate access to subspecialty care, and physicians often guide management remotely as transport medical control (TMC).... (Review)
Review
BACKGROUND AND OBJECTIVE
Pediatric interfacility transport teams facilitate access to subspecialty care, and physicians often guide management remotely as transport medical control (TMC). Pediatric subspecialty fellows frequently perform TMC duties, but tools assessing competency are lacking. Our objective was to develop content validity for the items required to assess pediatric subspecialty fellows' TMC skills.
METHODS
We conducted a modified Delphi process among transport and fellow education experts in pediatric critical care medicine, pediatric emergency medicine, neonatal-perinatal medicine, and pediatric hospital medicine. The study team generated an initial list of items on the basis of a literature review and personal experience. A modified Delphi panel of transport experts was recruited to participate in 3 rounds of anonymous, online voting on the importance of the items using a 3-point Likert scale (marginal, important, essential). We defined consensus for inclusion as ≥80% agreement that an item was important/essential and consensus for exclusion as ≥80% agreement that an item was marginal.
RESULTS
The study team of 20 faculty drafted an initial list of items. Ten additional experts in each subspecialty served on the modified Delphi panel. Thirty-six items met the criteria for inclusion, with widespread agreement across subspecialties. Only 1 item, "discussed bed availability," met the criteria for inclusion among some subspecialties but not others. The study team consolidated the final list into 26 items for ease of use.
CONCLUSIONS
Through a consensus-based process among transport experts, we generated content validity for the items required to assess pediatric subspecialty fellows' TMC skills.
Topics: Infant, Newborn; Child; Humans; Education, Medical, Graduate; Physicians; Consensus; Faculty; Medicine; Delphi Technique
PubMed: 37376965
DOI: 10.1542/hpeds.2022-007102 -
Korean Journal of Medical Education Dec 2023This study aimed to reach a consensus among experts on the global health competencies for medical students in Korea. (Review)
Review
PURPOSE
This study aimed to reach a consensus among experts on the global health competencies for medical students in Korea.
METHODS
A global health competency model was developed to identify domains and competencies for medical education, and a three-round modified Delphi method was used to reach consensus among 21 experts on the essential global health competencies. The degree of convergence, degree of consensus, and content validity ratio of the model were used to reach a consensus.
RESULTS
A list of 52 competencies in 12 domains were identified according to a literature review. In the first-round Delphi survey, the global health competencies were refined to 30 competencies in eight domains. In the second round, the competencies were reduced to 24. In the final round, consensus was reached among the expert panel members, and the competencies were finalized. The global health competency domains for medical students include global burden of disease (three items), globalization of health and healthcare (five items), determinants of health (two items), healthcare in low-resource settings (two items), global health governance (three items), health as a human right (four items), cultural diversity and health (three items), and participation in global health activities (two items).
CONCLUSION
The group of experts in global health achieved a consensus that 24 global health competencies in eight domains were essential for undergraduate medical education in Korea. The domains and competencies identified herein can be used to develop an undergraduate medical education curriculum in global health.
Topics: Humans; Clinical Competence; Consensus; Global Health; Delphi Technique; Students, Medical; Curriculum; Republic of Korea
PubMed: 38062685
DOI: 10.3946/kjme.2023.275