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Nursing Open Jun 2024To develop a comprehensive training course for training ICU nurses in prone positioning. (Review)
Review
AIM
To develop a comprehensive training course for training ICU nurses in prone positioning.
DESIGN
A mixed study combining semi-structured interviews and two rounds of Delphi surveys.
METHODS
We constructed a questionnaire after collecting data through a literature review and semi-structured interviews. We used the Delphi expert correspondence method to conduct two rounds of research among 17 experts in the field of critical illness. Data collection took place between May and August 2022.
RESULTS
The effective questionnaire recovery rate was 88.2%. The expert authority coefficient was 0.876; the Kendall coordination coefficient was 0.402; the average importance score for each index ranged from 4.00 to 4.93; and the coefficient of variation for each index ranged from 0.05 to 0.19. We established 13 second-level indicators and 41 third-level indicators on prone position ventilation training according to three aspects: training contents, training methods and training assessment. The training system of prone mechanical ventilation for ICU nurses established in this study will provide an effective framework for training and evaluating the practical ability of prone mechanical ventilation for ICU nurses.
Topics: Humans; Delphi Technique; Prone Position; Respiration, Artificial; Intensive Care Units; Surveys and Questionnaires; Female; Male; Adult; Patient Positioning; Critical Care Nursing
PubMed: 38859665
DOI: 10.1002/nop2.2208 -
Trials Jun 2024Surgical handover is associated with a significant risk of care failures. Existing research displays methodological deficiencies and little consensus on the outcomes...
BACKGROUND
Surgical handover is associated with a significant risk of care failures. Existing research displays methodological deficiencies and little consensus on the outcomes that should be used to evaluate interventions in this area. This paper reports a protocol to develop a core outcome set (COS) to support standardisation, comparability, and evidence synthesis in future studies of surgical handover between doctors.
METHODS
This study adheres to the Core Outcome Measures in Effectiveness Trials (COMET) initiative guidance for COS development, including the COS-Standards for Development (COS-STAD) and Reporting (COS-STAR) recommendations. It has been registered prospectively on the COMET database and will be led by an international steering group that includes surgical healthcare professionals, researchers, and patient and public partners. An initial list of reported outcomes was generated through a systematic review of interventions to improve surgical handover (PROSPERO: CRD42022363198). Findings of a qualitative evidence synthesis of patient and public perspectives on handover will augment this list, followed by a real-time Delphi survey involving all stakeholder groups. Each Delphi participant will then be invited to take part in at least one online consensus meeting to finalise the COS.
ETHICS AND DISSEMINATION
This study was approved by the Royal College of Surgeons in Ireland (RCSI) Research Ethics Committee (202309015, 7th November 2023). Results will be presented at surgical scientific meetings and submitted to a peer-reviewed journal. A plain English summary will be disseminated through national websites and social media. The authors aim to integrate the COS into the handover curriculum of the Irish national surgical training body and ensure it is shared internationally with other postgraduate surgical training programmes. Collaborators will be encouraged to share the findings with relevant national health service functions and national bodies.
DISCUSSION
This study will represent the first published COS for interventions to improve surgical handover, the first use of a real-time Delphi survey in a surgical context, and will support the generation of better-quality evidence to inform best practice.
TRIAL REGISTRATION
Core Outcome Measures in Effectiveness Trials (COMET) initiative 2675. http://www.comet-initiative.org/Studies/Details/2675 .
Topics: Humans; Patient Handoff; Delphi Technique; Consensus; Research Design; Surgical Procedures, Operative; Stakeholder Participation; Endpoint Determination
PubMed: 38858749
DOI: 10.1186/s13063-024-08201-x -
BMJ Open Jun 2024Heterogeneous outcome reporting is common in clinical trials focused on cardiac rehabilitation for myocardial infarction (MI); this practice often results in the...
INTRODUCTION
Heterogeneous outcome reporting is common in clinical trials focused on cardiac rehabilitation for myocardial infarction (MI); this practice often results in the exclusion of data from clinical trials in systematic reviews. Developing a core outcome set (COS) may solve this problem.
METHODS AND ANALYSIS
We will first identify a preliminary list of outcomes through a systematic review. Next, we will conduct semistructured interviews with patients to explore additional potential outcomes deemed important by patients. Then, we will engage various stakeholders such as clinicians, researchers and methodologists in two Delphi survey tends to refine and prioritise the identified outcomes. Subsequently, we will gather insights directly from patients with MI by administering plain language patient surveys; patients will be involved in questionnaire development. Finally, we will hold two face-to-face consensus meetings for patients and other stakeholders to develop the final COS for cardiac rehabilitation in MI.
ETHICS AND DISSEMINATION
The Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine approved this study (2022DZMEC-349). The final COS will be published in a peer-reviewed journal and disseminated in conferences.
TRIAL REGISTRATION
We registered this study in the Core Outcome Measures in Effectiveness Trials Initiative (COMET) platform.
REGISTRATION NUMBER
1725 (http://www.comet-initiative.org/studies/details/1725).
Topics: Humans; Myocardial Infarction; Cardiac Rehabilitation; Delphi Technique; Research Design; Systematic Reviews as Topic; Outcome Assessment, Health Care; Surveys and Questionnaires
PubMed: 38858159
DOI: 10.1136/bmjopen-2023-083633 -
Archivos Argentinos de Pediatria Aug 2024Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it...
Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it manifests, leads to difficulties in its approach, with the risk of under- or over-diagnosis. Professionals from various areas intervene in this process and their interaction is recommended. That is why the objective of this consensus has been to reflect the updated knowledge in an interdisciplinary mode, generating recommendations for its correct diagnosis. We have worked with the Delphi method to add to the scientific evidence, the experience from neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology. We think that this interdisciplinary approach will be of practical use and will promote more comprehensive care for these patients.
Topics: Child; Humans; Infant; Infant, Newborn; Consensus; Delphi Technique; Milk Hypersensitivity
PubMed: 38857102
DOI: 10.5546/aap.2024-10403 -
The Journal of Manual & Manipulative... Jun 2024An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical... (Review)
Review
INTRODUCTION
An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) - to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions.
METHOD
A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes).
RESULTS
Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.1. It is not recommended to perform:• Spinal manipulation and mobilisation on infants.• Cervical and lumbar spine manipulation on children.•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:• Spinal mobilisation and manipulation on adolescents;• Spinal mobilisation on children; or• Thoracic manipulation on children for neck-back pain only.3. No high certainty evidence to recommend these interventions was available.Reports of mild to severe harms exist; however, risk rates could not be determined.
CONCLUSION
Specific directives to guide physiotherapists' clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.
Topics: Humans; Manipulation, Spinal; Child; Adolescent; Infant; Child, Preschool; Physical Therapists; Evidence-Based Practice; Pediatrics; Delphi Technique; Musculoskeletal Diseases
PubMed: 38855972
DOI: 10.1080/10669817.2024.2332026 -
World Journal of Gastroenterology May 2024This editorial delves into the research article by Zeng published in the latest issue of . The manuscript contributes significantly to addressing the global health...
This editorial delves into the research article by Zeng published in the latest issue of . The manuscript contributes significantly to addressing the global health issue of nonalcoholic fatty liver disease (NAFLD) by introducing and validating the Exercise and Diet Adherence Scale (EDAS). The article effectively conveys the importance of the study, highlighting the prevalence of NAFLD, the lack of approved drugs for its treatment, and the crucial role of lifestyle correction. The use of the Delphi method for scale deve-lopment and the subsequent evaluation of its reliability add scientific rigor to the methodology. The results demonstrate that the scale is correlated with key lifestyle indicators, which makes it a promising tool for assessing patient adherence to interventions. The identification of specific score thresholds for predicting adherence to daily calorie intake and exercise adds practical value to the scale. The differentiation among scores indicative of good, average, and poor adherence enhances its clinical applicability. In conclusion, the manuscript introduces EDAS, a valuable instrument that can contribute substantially to the field of NAFLD research and clinical practice.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Exercise; Patient Compliance; Reproducibility of Results; Life Style; Delphi Technique; Diet; Surveys and Questionnaires
PubMed: 38855158
DOI: 10.3748/wjg.v30.i20.2629 -
International Journal of Chronic... 2024The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve...
Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process.
BACKGROUND
The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve self-management.
PURPOSE
This study was a survey to prioritize the relevance of factors associated with non-adherence to COPD self-management using the Delphi technique and analytic hierarchy process (AHP).
PATIENTS AND METHODS
A total of 15 expert panels were established to determine the priority of relevant factors in a three-round Delphi survey and an AHP. To develop the preliminary conceptual framework for non-adherence to COPD self-management, findings from a systematic literature review, a qualitative study using in-depth interviews with COPD patients, and the first round of the Delphi survey were integrated. Based on the preliminary framework, the content validity ratio (CVR) was analyzed to examine the consensus among expert panels in the second and third rounds of the Delphi survey, and the relative weight was determined by pairwise comparisons between alternative factors in the AHP.
RESULTS
In developing the preliminary conceptual framework, 8 factor categories and 53 factors were identified as relevant to non-adherence to COPD self-management. Of the 53 factors, 22 factors with a CVR of 0.49 or higher were identified in the Delphi survey. A total of 14 of the 53 factors were common to both the Delphi survey and AHP with high weights. The most notable factors were prolonged treatment, experience of treatment failure, and unknown effects of medication.
CONCLUSION
Through consensus decision-making by experts, 14 factors were identified as relevant factors associated with non-adherence to COPD self-management. A hierarchical and systematic framework incorporating factors associated with non-adherence to COPD self-management was developed in this study. Further research is needed to develop intervention strategies based on factors associated with non-adherence to COPD self-management.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Delphi Technique; Consensus; Health Knowledge, Attitudes, Practice; Male; Female; Risk Factors; Qualitative Research; Self-Management; Self Care; Aged; Patient Compliance; Middle Aged; Medication Adherence; Lung
PubMed: 38854589
DOI: 10.2147/COPD.S451332 -
Pediatrics Jul 2024To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants.
OBJECTIVE
To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants.
METHODS
We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method.
RESULTS
Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators.
CONCLUSIONS
A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.
Topics: Humans; Quality Indicators, Health Care; Delphi Technique; Consensus; Infant, Newborn; Analgesics, Opioid; Pregnancy; Female; Neonatal Abstinence Syndrome; Infant; Hospitals
PubMed: 38853654
DOI: 10.1542/peds.2024-065721 -
Pharmacotherapy May 2024Treatment options are currently limited for persons with HIV-1 (PWH) who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. Three agents have been...
Consensus recommendations for the use of novel antiretrovirals in persons with HIV who are heavily treatment-experienced and/or have multidrug-resistant HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy: An executive summary.
Treatment options are currently limited for persons with HIV-1 (PWH) who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. Three agents have been approved by the U.S. Food and Drug Administration (FDA) since 2018, representing a significant advancement for this population: ibalizumab, fostemsavir, and lenacapavir. However, there is a paucity of recommendations endorsed by national and international guidelines describing the optimal use (e.g., selection and monitoring after initiation) of these novel antiretrovirals in this population. To address this gap, a modified Delphi technique was used to develop these consensus recommendations that establish a framework for initiating and managing ibalizumab, fostemsavir, or lenacapavir in PWH who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. In addition, future areas of research are also identified and discussed in the main document.
Topics: Humans; Anti-HIV Agents; Antibodies, Monoclonal; Consensus; Delphi Technique; Drug Resistance, Multiple, Viral; HIV Infections; HIV-1; Organophosphates; Piperazines; United States; Practice Guidelines as Topic
PubMed: 38853605
DOI: 10.1002/phar.2913 -
Pharmacotherapy May 2024Treatment options are currently limited for persons with HIV-1 (PWH) who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. Three agents have been... (Review)
Review
Consensus recommendations for the use of novel antiretrovirals in persons with HIV who are heavily treatment-experienced and/or have multidrug-resistant HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy.
Treatment options are currently limited for persons with HIV-1 (PWH) who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. Three agents have been approved by the U.S. Food and Drug Administration (FDA) since 2018, representing a significant advancement for this population: ibalizumab, fostemsavir, and lenacapavir. However, there is a paucity of recommendations endorsed by national and international guidelines describing the optimal use (e.g., selection and monitoring after initiation) of these novel antiretrovirals in this population. To address this gap, a modified Delphi technique was used to develop these consensus recommendations that establish a framework for initiating and managing ibalizumab, fostemsavir, or lenacapavir in PWH who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. In addition, future areas of research are also identified and discussed.
Topics: Humans; HIV Infections; HIV-1; Drug Resistance, Multiple, Viral; Anti-HIV Agents; United States; Consensus; Delphi Technique; Antibodies, Monoclonal; Organophosphates; Piperazines
PubMed: 38853601
DOI: 10.1002/phar.2914