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Indian Journal of Public Health Oct 2023A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are...
BACKGROUND
A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are reluctant to pretest counseling.
OBJECTIVES
This study has been taken up to explore the barriers and possible solutions to improve the utilization of Facility based integrated counseling and testing center (F-ICTC) counseling services.
MATERIALS AND METHODS
Phase 1: In-depth interview and ranking with stakeholders from the F-ICTC center (n = 13) were conducted to identify the barriers to utilization of F-ICTC and solution for the same. Phase 2.
A
Delphi panel with experts (n = 17) was invited through mail to find out the potential solution to improve the utilization of F-ICTC counseling services.
RESULTS
Possible barriers from the stakeholders' perspectives were fear of the disease, violate the privacy, unacceptance, gender bias, fear of social stigma and discrimination, and neglect attached to the disease. At third round of Delphi experts had arrived at a consensus regarding of following possible potential solutions: 1. Those who refuse pretest counseling they should be asked to answer a set of questions(which are usually told during counseling), only those questions not answered correctly by them can be corrected, 2.conducive hospital environment, 3.zero discrimination policy, 4. group counseling for ANC mothers and patients in waiting area of the hospital,5. phone counseling for unwilling patients and relocation of testing center and health education camping.
CONCLUSION
Context-specific proactive evidence-based intervention will help in improving the proper utilization of the F-ICTC center.
Topics: Humans; Delphi Technique; Female; Counseling; Prenatal Care; Male; Pregnancy; Adult; India; Social Stigma; Interviews as Topic; Patient Acceptance of Health Care
PubMed: 38934833
DOI: 10.4103/ijph.ijph_1529_22 -
Digestive Endoscopy : Official Journal... Jun 2024There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a...
OBJECTIVES
There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a lack of clear consensus on the management of these lesions with significant geographic variability especially between Eastern and Western paradigms. We aimed to provide an international consensus to better guide management and attempt to homogenize practices.
METHODS
Two experts in interventional endoscopy spearheaded an evidence-based Delphi study on behalf of the World Endoscopy Organization Colorectal Cancer Screening Committee. A steering committee comprising six members devised 51 statements, and 43 experts from 18 countries on six continents participated in a three-round voting process. The Grading of Recommendations, Assessment, Development and Evaluations tool was used to assess evidence quality and recommendation strength. Consensus was defined as ≥80% agreement (strongly agree or agree) on a 5-point Likert scale.
RESULTS
Forty-two statements reached consensus after three rounds of voting. Recommendations included: three statements on training and competency; 10 statements on preresection evaluation, including optical diagnosis, classification, and staging of LSTs; 14 statements on endoscopic resection indications and technique, including statements on en bloc and piecemeal resection decision-making; seven statements on postresection evaluation; and eight statements on postresection care.
CONCLUSIONS
An international expert consensus based on the current available evidence has been developed to guide the evaluation, resection, and follow-up of LSTs. This may provide guiding principles for the global management of these lesions and standardize current practices.
PubMed: 38934243
DOI: 10.1111/den.14826 -
British Journal of Biomedical Science 2024The Biomedical Scientist (BMS) role is established in healthcare, working in laboratory environments to provide diagnostic testing and to monitor treatment effects on a...
INTRODUCTION
The Biomedical Scientist (BMS) role is established in healthcare, working in laboratory environments to provide diagnostic testing and to monitor treatment effects on a patients' health. The profession is subject to several professional standards which highlight the importance of working in the best interests of the patient and service user. However, Biomedical Scientists have little or no patient contact. This study aimed to determine how Biomedical Scientists evidence that they meet the professional standards and support the achievement of patient outcomes.
MATERIALS AND METHODS
This study utilised a Delphi method to explore the opinions of professional stakeholders to determine whether there was consensus for how this professional group contributes to patient outcomes and offers evidence that they are working in the best interests of the patient. The qualitative 1st round of the study consisted of focus groups and interviews with staff and students on the BSc Biomedical Science awards, Professional, Statutory and Regulatory body (PSRB) representatives and Biomedical Scientists from the National Health Service (NHS). The first-round responses were analysed using thematic analysis which then generated attitude statements which participants scored using a 5-point Likert scale in the 2nd round. Consensus or divergence of opinion was determined based upon a 70% consensus level within each participant group and overall.
RESULTS
Following analysis of the 2nd round data, there was divergence of opinion across all stakeholders, with consensus rates being highest in the Biomedical Scientist group (72.7% of statements reached 70% consensus), followed by the student group (54.5% of statements reached 70% consensus) and lowest in the academic group (40.9% of statements reached 70% consensus).
DISCUSSION
This demonstrates a theory-practice gap in both the academic and student groups, suggesting that graduates are insufficiently prepared for their post-graduate role. This gap was particularly evident when discussing topics such as how Biomedical Scientists contribute to patient care, professional registration and working as part of the multi-disciplinary team (MDT). The identification of a theory-practice gap in the education of Biomedical Scientists is a novel finding, indicating that students may graduate with insufficient understanding of the Biomedical Scientist role.
Topics: Humans; Biomedical Research; Delphi Technique; Focus Groups; Consensus; Research Personnel; Male; Female
PubMed: 38933755
DOI: 10.3389/bjbs.2024.12629 -
The Journal of the Association of... Jun 2024Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized...
Association of Physicians of India Expert Recommendations on Oral Fluid, Electrolytes, and Energy Management during Transition Care and Discharge for Hospitalized Patients with Nondiarrheal Illnesses.
Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized and under-managed, both in outpatient departments (OPDs) and inpatient departments (IPDs). Postadmission dehydration is associated with longer hospital stays and higher inhospital mortality rates. Recognizing and understanding dehydration in hospitalized patients is necessary due to the adverse outcomes associated with this condition. In this article, we aimed to develop practical consensus recommendations on the role of oral fluid, electrolyte, and energy (FEE) management in hospitalized patients with FEE deficits in NDI. The modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising eight experts from India formed the panel. Relevant clinical questions within three major domains were formulated for presentation and discussion: (1) burden and factors contributing to dehydration in hospitalized patients; (2) assessment of fluid and electrolyte losses and increased energy requirements in hospitalized patients; and (3) management of FEE deficits in hospitalized patients [at admission, during intravenous (IV) therapy, IV to oral de-escalation, and discharge]. The consensus level was classified into agreement (mean score ≥4), no consensus (mean score <4), and exclusion (mean score <4 after the third round of discussion). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that the most common factors contributing to dehydration in patients with NDI hospitalized in IPDs include decreased oral fluid intake, increased fluid loss due to the illness, insensible fluid loss, and a lack of awareness among doctors about dehydration, which can result in poor fluid intake. Time constraints, discontinuity of care, lack of awareness of the principles of fluid balance, lack of formal procedures for enforcing hydration schemes, and lack of adequate training are most often barriers to the assessment of hydration status in hospital settings. Experts used hydration biomarkers, such as changes in body weight, serum, or plasma osmolality; fluid intake; and fluid balance charts; along with urine output, frequency, quantity, and color, to determine hydration status in hospital settings. Experts agreed that appropriate FEE supplementation in the form of ready-to-drink (RTD) fluids can restore FEE deficits and shorten the length of hospital stays in hospitalized patients at admission, during de-escalation from IV to oral therapy, and at discharge. RTD electrolyte solutions with known concentrations of electrolytes and energy are good choices to avoid taste fatigue and replenish FEE in hospitalized patients during transition care and at discharge.
Topics: Humans; Fluid Therapy; India; Dehydration; Hospitalization; Patient Discharge; Electrolytes; Consensus; Delphi Technique
PubMed: 38932735
DOI: 10.59556/japi.72.0571 -
The Journal of the Association of... Jun 2024Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of...
BACKGROUND
Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of hospitalization and mortality, only a few international guidelines provide recommendations regarding oral fluids, electrolytes, and energy (FEE) management in adults/geriatrics with dehydration due to nondiarrheal causes. Currently, there is a lack of comprehensive recommendations on the role of oral FEE in nondiarrheal dehydration in adult and geriatric Indian patients.
MATERIALS AND METHODS
A modified Delphi approach was designed using an online questionnaire-based survey followed by a virtual meeting, and another round of online surveys was used to develop this consensus recommendation. In round one, 130 statements, including 21 open-ended questions, were circulated among ten national experts who were asked to either strongly agree, agree, disagree, or strongly disagree with statements and provide responses to open-ended questions. The consensus was predefined at 75% agreement (pooling "strongly agree" and "agree" responses). Presentation of relevant literature was done during a virtual discussion, and some statements (the ones that did not achieve predefined agreement) were actively discussed and deliberately debated to arrive at conclusive statements. Those statements that did not reach consensus were revised and recirculated during round two.
RESULTS
Consensus was achieved for 130/130 statements covering various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic nondiarrheal illness. However, one statement was not added as a recommendation in the final consensus (129/130) as further literature review did not find any supporting data. Oral FEE should be recommended as part of core treatment from day 1 of acute nondiarrheal illness and started at the earliest feasibility in chronic illnesses for improved patient outcomes. Appropriately formulated fluids with known electrolyte and energy content, quality standards, and improved palatability may further impact patient compliance and could be a good option.
CONCLUSION
These consensus recommendations provide guidance for oral FEE recommendations in Indian adult/geriatric patients with various nondiarrheal illnesses.
Topics: Humans; Delphi Technique; Dehydration; Fluid Therapy; India; Consensus; Aged; Adult; Diarrhea; Electrolytes
PubMed: 38932734
DOI: 10.59556/japi.72.0394 -
Nurse Researcher Jun 2024Nominal group technique (NGT) is widely used in healthcare research to facilitate decision-making and consensus-building. Traditional NGT requires face-to-face...
BACKGROUND
Nominal group technique (NGT) is widely used in healthcare research to facilitate decision-making and consensus-building. Traditional NGT requires face-to-face interaction and its limitations include potential biases, logistical challenges and high costs. The COVID-19 pandemic necessitated a shift to virtual methods, which led to the development of virtual nominal group technique (vNGT). Aim To reflect on the use of vNGT, particularly in the context of Ghader et al (2023 ), to understand its effectiveness in overcoming the limitations of traditional NGT and on its applicability in pandemic-affected scenarios.
METHOD
This paper reviews and discusses literature on the use and effectiveness of NGT compared to other consensus-building methods and examines the emergence of vNGT in overcoming the limitations of traditional NGT. The authors also reflect on their use of vNGT in a study to identify cardiovascular research priorities in the UAE and provide details of its implementation.
DISCUSSION
vNGT bridges the gap between the localised nature of traditional NGT and the global reach of the Delphi technique. It allows for the inclusion of diverse participants, saves costs and offers time-efficiency. The study demonstrated vNGT's adaptability, with participants engaging in idea generation, discussion and prioritisation using online tools. However, challenges persist with vNGT, including reduced accessibility for certain demographics, timing issues across time zones and technical difficulties.
CONCLUSION
vNGT successfully integrates the interactive, consensus-building aspects of NGT with the broad reach of Delphi. It can be valuable in research and decision-making, especially in an era of increased remote collaboration.
IMPLICATIONS FOR PRACTICE
vNGT can significantly impact healthcare research and policy formulation by enabling more inclusive, cost-effective and timely consensus-building processes. However, considerations for accessibility and technical support are crucial for its wider adoption and effectiveness.
PubMed: 38932484
DOI: 10.7748/nr.2024.e1933 -
Medicina (Kaunas, Lithuania) Jun 2024The coronavirus disease 2019 (COVID-19) preventive measures affected various aspects of people's lives, while also representing an important risk factor for people's...
The coronavirus disease 2019 (COVID-19) preventive measures affected various aspects of people's lives, while also representing an important risk factor for people's mental health. In the present study, we examined the negative psychological consequences of the preventive measures on people's mental health and the protective factors that strengthened their mental health and well-being during the pandemic. A study, using a combination of qualitative and quantitative methods based on a Delphi protocol, was conducted with a sample of Slovenian professionals who worked with people from different demographic groups (i.e., children and adolescents, emerging adults, the adult working population, the elderly) during the pandemic. We conducted (i) a qualitative study involving semi-structured interviews with 11 professionals and (ii) a quantitative study where 73 professionals completed a structured online questionnaire. Experts recognized the disruption of informal face-to-face social contacts as the measure with the greatest impact on people's lives across all groups studied, the effect being particularly evident in relation to individuals' development period and socio-demographic characteristics. An individual's ability to adapt to change and emotional support provided by family or other close persons contributed significantly to maintaining mental health and well-being during the pandemic. Considering the interplay of various COVID-19-related risk and protective factors for mental health, enabling and promoting the maintenance and development of social relationships (including through alternative pathways) should be a priority aspect of (mental health) intervention for all demographic groups.
Topics: Humans; COVID-19; Delphi Technique; Mental Health; Adult; Male; Female; Adolescent; Aged; Slovenia; Middle Aged; SARS-CoV-2; Pandemics; Surveys and Questionnaires; Young Adult; Child
PubMed: 38929595
DOI: 10.3390/medicina60060978 -
BMC Medical Education Jun 2024Medical professionalism is a core competency for medical students during clerkships for further professional development. Given that the behavior-based framework could...
BACKGROUND
Medical professionalism is a core competency for medical students during clerkships for further professional development. Given that the behavior-based framework could provide clear insight and is easy to assess, the study aimed to create a self-administered scale to measure the professional behaviors of medical students during their clerkships.
METHODS
A comprehensive literature review on medical professional behaviors in English or Chinese and Delphi interviews were used to develop the initial version of the Self-Administered Scale for Professional Behavior of Medical Students During Clerkships. The reliability and validity analysis based on a survey of medical students from China, Cronbach's α calculations, and Confirmatory Factor Analysis (CFA) specifically were conducted to finalize the scale. The associations of professional behaviors with gender, medical programs, and clerkship duration were examined using Wilcoxon rank-sum tests.
RESULTS
We included 121 studies and extracted 57 medical professionalism assessment tools, initially forming a pool of 48 items. To refine these items, eighteen experts participated in two rounds of Delphi interviews, ultimately narrowing down the item pool to 24 items. A total of 492 participants effectively completed the questionnaire. One item was removed due to its correlated item-total correlation (CITC) value, resulting in a final scale containing 23 items with six domains: Respect, Altruism, Communication and Collaboration, Integrity, Duty, and Excellence. The overall Cronbach's alpha value was 0.98, ranging from 0.88 to 0.95 for each domain. The fit indices (χ/df = 4.07, CFI = 0.96, TLI = 0.95, RMSEA = 0.08, and SRMR = 0.02) signified a good fit for the six-domain model. Medical students' professional behavior was significantly associated with gender (p = 0.03) and clerkship duration (p = 0.001).
CONCLUSION
The scale was demonstrated to be reliable and valid in assessing the professional behaviors of Chinese medical students during clerkships.
Topics: Humans; Clinical Clerkship; Students, Medical; Professionalism; Female; Male; Reproducibility of Results; Surveys and Questionnaires; Delphi Technique; China; Psychometrics; Adult; Clinical Competence
PubMed: 38926701
DOI: 10.1186/s12909-024-05676-9 -
BMJ Open Jun 2024Primary sclerosing cholangitis (PSC) is a progressive immune-mediated liver disease, for which no medical therapy has been shown to slow disease progression. However,...
BACKGROUND
Primary sclerosing cholangitis (PSC) is a progressive immune-mediated liver disease, for which no medical therapy has been shown to slow disease progression. However, the horizon for new therapies is encouraging, with several innovative clinical trials in progress. Despite these advancements, there is considerable heterogeneity in the outcomes studied, with lack of consensus as to what outcomes to measure, when to measure and how to measure. Furthermore, there has been a paradigm shift in PSC treatment targets over recent years, moving from biochemistry-based endpoints to histological assessment of liver fibrosis, imaging-based biomarkers and patient-reported outcome measures. The abundance of new interventional trials and evolving endpoints pose opportunities for all stakeholders involved in evaluating novel therapies. To this effect, there is a need to harmonise measures used in clinical trials through the development of a core outcome set (COS).
METHODS AND ANALYSIS
Synthesis of a PSC-specific COS will be conducted in four stages. Initially, a systematic literature review will be performed to identify outcomes previously used in PSC trials, followed by semistructured qualitative interviews conducted with key stakeholders. The latter may include patients, clinicians, researchers, pharmaceutical industry representatives and healthcare payers and regulatory agencies, to identify additional outcomes of importance. Using the outcomes generated from the literature review and stakeholder interviews, an international two-round Delphi survey will be conducted to prioritise outcomes for inclusion in the COS. Finally, a consensus meeting will be convened to ratify the COS and disseminate findings for application in future PSC trials.
ETHICS AND DISSEMINATION
Ethical approval has been granted by the East Midlands-Leicester Central Research Ethics Committee (Ref: 24/EM/0126) for this study. The COS from this study will be widely disseminated including publication in peer-reviewed journals, international conferences, promotion through patient-support groups and made available on the Core Outcomes Measurement in Effectiveness Trials (COMET) database.
TRIAL REGISTRATION NUMBER
1239.
Topics: Humans; Cholangitis, Sclerosing; Research Design; Clinical Trials as Topic; Delphi Technique; Outcome Assessment, Health Care; Endpoint Determination; Systematic Reviews as Topic
PubMed: 38926149
DOI: 10.1136/bmjopen-2023-080143 -
BMJ Open Jun 2024Guidelines are important tools for supporting quality management in the care of patients with cancer. However, in clinical practice barriers exist to their...
Implementation of quality indicators for palliative care for patients with incurable cancer at palliative care units in Germany (Quincie): a study protocol for a mixed-methods study.
INTRODUCTION
Guidelines are important tools for supporting quality management in the care of patients with cancer. However, in clinical practice barriers exist to their implementation. Consequently, Quincie aims at: (1) gaining a comprehensive picture of the implementation of quality indicators from the national guideline on palliative care for patients with incurable cancer in palliative care units and (2) describing the factors that facilitate and hinder their implementation to develop recommendations.
METHODS AND ANALYSIS
The Quincie study follows a mixed-methods approach across two study phases. In phase 1, routinely collected data of 845 patients with incurable cancer from eight palliative care units in the commuting area of the Comprehensive Cancer Centre Lower Saxony will be analysed, regarding the implementation of 10 quality indicators from the national guideline on palliative care. Structural characteristics of the palliative care units will also be collected. In phase 2, recommendations for the practical implementation of the quality indicators, focusing on the achievement of the quality objectives identified in phase 1, will be developed in an implementation workshop. These recommendations will be subsequently agreed on via a Delphi survey.
ETHICS AND DISSEMINATION
Ethical approval has been given by the ethics committee of the Hannover Medical School (first vote, No. 10567_BO_K_2022) and other relevant institutions. The results will provide urgently needed insights on the implementation of the national guideline on palliative care in clinical care and on the factors that facilitate and hinder this implementation. The results are expected to promote better care for patients with incurable cancer. The results will be directly reported to the participating palliative care units and will be published in relevant peer-reviewed journals. They will also be presented at national conferences.
TRIAL REGISTRATION NUMBER
German Clinical Trials Register (DRKS00029965).
Topics: Humans; Palliative Care; Neoplasms; Germany; Quality Indicators, Health Care; Research Design; Delphi Technique
PubMed: 38925702
DOI: 10.1136/bmjopen-2023-077457