[Consensus update of the POPI tool]. / Mise à jour par consensus de l'outil POPI.

Medication errors are one of the causes of iatrogenic medication use in children. The POPI tool for detecting inappropriate drug prescriptions and prescription omissions in paediatrics was the first tool to be published in this field in 2014. Our aim was to update the POPI tool for French use based on current recommendations and practice. Criteria were removed, updated or added based on recommendations from learned societies and national bodies. The two-round Delphi method was used to reach a consensus of experts. The level of agreement of the healthcare professionals' proposals was rated on a 9-point Likert scale. In the first round, only proposals with a median agreement of 7 to 9 and an agreement of more than 65% were retained. In the second round, only those with a median agreement of 7 to 9 and over 75% agreement were retained. The POPI tool now includes eight categories (various, infectiology, gastroenterology, pneumonology, dermatology, neurology/pedopsychiatry, haematology and excipients). All the criteria were supported by bibliographical references. They were submitted to 20 French healthcare professionals: 9 pharmacists and 11 doctors (17 hospital-based and 3 self-employed). After two rounds of Delphi testing, 166 criteria were retained and validated (111 inappropriate prescriptions and 55 omissions). In conclusion, this study made it possible to update the POPI tool, which is still available for assessing paediatric prescriptions.

[Investigating postvention best practices : The Delphi method]. / Examen des meilleures pratiques de postvention : méthode Delphi.

BACKGROUND: Postvention aims to implement services adapted to the needs of a population that may be vulnerable after suicide. While a plethora of postvention programs exist, they are generally based less on solid evidence than on the judgment of health professionals. Using the Delphi method, an Australian study obtained a consensus among experts as to which postvention actions are to be engineered in a postvention program. Since no similar study has been carried out for programs in French-speaking countries, it seemed important to reproduce the same type of study and to compare the respective results. The present study is aimed at establishing a French inventory of postvention actions and at achieving a consensus among experts as to the actions to be included in a postvention program. METHODS: A systematic review of the scientific literature (PRISMA method) and the gray literature (documentation on the WEB) made it possible to identify the different actions that have been included in various postvention programs. Using the DELPHI method, experts endeavored to assess their relevance. RESULTS: An inventory of 190 postvention actions was established and they were classified according to a sequential axis (pre-event, at the time of the event, and post-event), according to type of action (environment-centered or people-centered). The experts identified 128 actions to be included in a postvention program. CONCLUSION: Convergence was observed among the experts, as they identified the practices to be encouraged following a suicide. When comparing the results in French-speaking countries to the 548 actions selected in the Australian study, we observe similarities between the two studies regarding types of postvention actions. This study provides an update for health professionals on the most relevant practices to be included in a postvention program.

Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.

OBJECTIVE: To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. METHOD: A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia. RESULTS: Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting. CONCLUSION: Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting.

[Development of a measuring tool for performance anxiety in obstetrics]. / Développement d'un outil d'évaluation de l'anxiété de performance en obstétrique.

OBJECTIVE: Developing a measuring tool for physician's performance anxiety during obstetrical procedures, as a self-administered questionnaire. METHODS: We used the Delphi method. First, we did a literature review to identify the items to submit for the first round. A panel of experts was asked to rate the relevance of items from one to six. For the first round of Delphi, items were retained if more than 70% of respondents assigned a five or six rating. Items were excluded if more than 70% of respondents assigned a one or two rating. All the other items, plus those suggested by the panel, were submitted to a second round of Delphi. The same item selection conditions were applied to the second round. RESULTS: The overall response rate to the Delphi was 79% (19 respondents). At the end of the first round, 14 items were consensually relevant, no item was consensually irrelevant. For the second round, the 18 items that did not find consensus and seven new items suggested by the experts in the first round were submitted. At the end of the second round, nine items were retained by consensus as relevant. CONCLUSION: This study defined by consensus 23 items for a self-questionnaire to measure specific performance anxiety in obstetrics divided into five dimensions: perceived stress, assessment of the risk of complications, medico-legal risk, impact of the healthcare team and peers, self-confidence and decision-making confidence. We intend to validate this tool in real population.

["Red code" C-sections: A new tool developed with Delphi method is enabling analysis of practices]. / Césariennes « code rouge ¼ : création d'une grille de pertinence par méthode Delphi permettant l'analyse de pratique.

OBJECTIVE: In France, C-sections are classified through a color code according to their degree of urgency. A red-classified C-section is triggered when life of mother or fetus is immediately threatened These cases happen very rarely and represent less than 1% of total deliveries. Many French maternity hospitals are above this rate. This risky procedure should remain an exception. The main purpose of this study is to develop a new tool enabling to determine the relevance of red C-sections in order to improve obstetrical practices. METHODS: Eleven national obstetrical experts were submitted with relevant-estimated indications of red C-sections. A two-round Delphi methodology was then used to reach a consensus on a new table of relevance. RESULTS: Five different groups of indications were proposed to the panel of experts. After two rounds, four groups achieved a consensus by being qualified "very relevant" or "relevant" by more than 80% of the 11 experts. CONCLUSION: The aim of this new consensual table of relevance is to improve quality of care. It allows to evaluate the relevance of red C-sections and determine when red C-sections are non-relevant but it particularly helps teams to identify ways of improvements. Finally, this tool enables a reproductible analysis that can be further intra- or inter-hospitals developed towards harmonization of practices.

[Information tool about labor and delivery designed by Delphi method]. / Élaboration d'un outil d'information sur l'accouchement : consensus par la méthode Delphi.

OBJECTIVE: The integration of couples in decision making in obstetrics is necessary to improve the experience of giving birth. The objective of this work is to elaborate a new tool to provide information to health professionals. METHODS: A 5-round Delphi method was used to define the information points. The 20 multi-disciplinary experts answered 5 surveys on the information to deliver concerning childbirth. The selected items were organized with mind mapping. RESULTS: 54 items were identified on the first round. 5 were retained after the second survey while the rest were reformulated and submitted for the third round. Amongst the 47 items submitted, 19 were retained, the rest were removed, merged or reworded. The fourth survey included 22 items of which 11 were retained. The fifth survey concerned the 11 remaining items and 2 new ones. During this round, 7 items were retained. This round made it possible to reach the consensus. In total, 42 items reached the consensus of the experts. They were then split into 5 mind maps allowing their visual organization to form the information tool. CONCLUSION: The tool elaborated in a multi-disciplinary manner offers complementary information to that already given during childbirth preparation courses. It is a framework for the information to be given that leaves the content up to each professional.

[Development of the concept of positive spirituality in health]. / Élaboration du concept de spiritualité positive en santé.

Positive spirituality has three central attributes: connectedness, meaning of life, and identity. Six factors are likely to contribute to its emergence and it can allow the development of ten positive consequences.

[Database's development for prospective national collection of clinical data on cervical cancer: A Delphi survey identifying consensual variables]. / Élaboration d'une base de recueil nationale prospective des données cliniques sur le cancer du col utérin: utilisation de la méthode Delphi pour l'identification de variables consensuelles.

INTRODUCTION: Cervical cancer (CC) is associated with poor prognosis and therapeutic morbidity in young women. The impact of European recommendations for treatments and follow-up of these patients must be assessed. There is no real-time CCU tracking basis. Main objective of our study was to identify the items of the clinical and therapeutic data necessary for the constitution of a national, dynamic and prospective clinical database allowing to characterize treatments and follow-up of patients with CC in France. METHODS: An exhaustive bibliographic research was lead with the help of the ESGO recommendations. A list of qualitative and quantitative variables characterizing CC was established. These variables were assessed by a panel of national experts from the Francogyn group, using the Delphi survey. The rate of agreement was calculated for each variable. RESULTS: 345 variables divided into 6 sections were identified and submitted to 26 experts. 17 experts responded to the three rounds of the Delphi method. A total of 273 items were validated. The majority of experts (90 %) also gave a favorable opinion on the addition of a quality of life section in the database. CONCLUSION: This is the first study identifying 273 items chosen by consensus. The items are collected in a future national gynecological database "Epigyn".

[Correspondence between general practitioners and cardiologists: Consensus from a study Delphi]. / Contenu des courriers échangés entre médecins généralistes et cardiologues : consensus d'après une étude Delphi.

AIM OF THE STUDY: To obtain a consensus from a panel of experts (GP and cardiologists) on the elements to appear on the correspondence sent by GP at the patient's first consultation with the cardiologist and on the response of the cardiologist. METHOD: A list of proposals concerning the content of the exchanges between the GP and the cardiologist was established by a scientific council of three GPs and one cardiologist, based on a review of the literature and their practices. This list was submitted for evaluation to a panel of GP and cardiologists experts using the modified RAND/UCLA Delphi method. RESULTS: Twenty nine experts (16 MG and 13 cardiologists) participated in the two evaluation rounds. For the contents of the letter written by the GP, 11 themes have reached consensus: administrative data, reason for consultation, history of the disease, recent constants, current treatments, current or previous pathologies and cardiovascular risk factors, physical activity, psychosocial context, test results, question asked to the cardiologist, cardiologist's perimeter of action. For the contents of the letter of the cardiologist's response, 11 themes were agreed: administrative data, reason for consultation, previous information, clinical examination, ECG, ultrasound, other complementary examinations, answer to the question asked by the GP, dietary treatments, proposed treatments, proposal for follow-up and management. CONCLUSION: This study have reached consensus on the elements to appear on the letters exchanged between the GP and the cardiologist.

The development of an outcome measures toolkit for spinal cord injury rehabilitation.

BACKGROUND: Spinal cord injury (SCI) is a complex medical condition that can be difficult to monitor. PURPOSE: This study aimed to establish a common set of validated outcome measures specifically for SCI clinical practice. METHOD: In a three-round online Delphi process, experts in SCI care across Canada suggested and ranked outcome measures for clinical practice. The facilitators provided feedback between rounds and determined if consensus (at least 75% agreement) was reached on a single outcome measure per clinical area. FINDINGS: One hundred and forty-eight outcome measures were initially considered for inclusion. After three rounds, consensus was reached for 23 out of 30 clinical areas. In the remaining seven, more than one outcome measure was recommended. The final toolkit comprises 33 outcome measures with sufficient measurement properties for use with a SCI population. IMPLICATIONS: An outcome measures toolkit validated specifically for SCI should lead to improved identification of best practice and enable clinicians to monitor client progress effectively.

The Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE): Construct and Content Validation Using a Modified Delphi Method.

OBJECTIVES: In order to scale-up successful innovations, more evidence is needed to evaluate programs that attempt to address the rising prevalence of diabetes and the associated burdens on patients and the healthcare system. This study aimed to assess the construct and content validity of the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE), a tool developed to guide the evaluation, design and implementation with built-in knowledge translation principles. METHODS: A modified Delphi method, including 3 individual rounds (questionnaire with 7-point agreement/importance Likert scales and/or open-ended questions) and 1 group round (open discussion) were conducted. Twelve experts in diabetes, research, knowledge translation, evaluation and policy from Canada (Ontario, Quebec and British Columbia) and Australia participated. Quantitative consensus criteria were an interquartile range of ≤1. Qualitative data were analyzed thematically and confirmed by participants. An importance scale was used to determine a priority multi-level indicator set. Items rated very or extremely important by 80% or more of the experts were reviewed in the final group round to build the final set. RESULTS: Participants reached consensus on the content and construct validity of DEFINE, including its title, overall goal, 5-step evaluation approach, medical and nonmedical determinants of health schematics, full list of indicators and associated measurement tools, priority multi-level indicator set and next steps in DEFINE's development. CONCLUSIONS: Validated by experts, DEFINE has the right theoretic components to evaluate comprehensively diabetes prevention and management programs and to support acquisition of evidence that could influence the knowledge translation of innovations to reduce the burden of diabetes.

Validation of instrument to comply institutional measures on tuberculosis infection control / Validación del instrumento para el cumplimiento de las medidas institucionales de control de la infección por tuberculosis / Validação do instrumento de conformidadedas medidas institucionais de controle de infecções por tuberculosenos prestadores de serviços de saúde / Validation de linstrument de respect des mesures institutionnelles de luttecontrelinfectiontuberculeusedans les établissements de santé

Abstract Objective To evaluate the validity and reliability of an instrument that inspect compliance with institutional tuberculosis infection control measures of Healthcare Providers in the city of Cali, Colombia. Materials and Methods Across-sectional study (psychometric type, instrument validation). The development of instrument considered sections from the Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas and Evaluation Control Tools for Hospital-Acquired Infections. The construction of the final instrument was carried out with the support of seven experts according to Delphi method, obtaining an instrument comprising three domains and a final number of 65 questions; each item was evaluated, usefulness, format, and validity of the instrument. Contents were assessed with the Aiken coefficient and reliability with Bangdiwala concordance coefficient. Rversion3.2.0 application was used. Results The instrument was concocted by 65 items referring to questions regarding administrative, environmental and respiratory measures. It holds acceptable psychometric properties, including good internal structure and suitable reliability. Conclusions A valid and reliable instrument was obtained to evaluate compliance with institutional measures on tuberculosis infection control in Healthcare Institutions in the city of Cali.

Resumen Objetivo Evaluar la validez y confiabilidad de un instrumento que inspecciona el cumplimiento de las medidas institucionales de control de infecciones para la tuberculosis en las Instituciones Prestadoras de Salud de la ciudad de Cali, Colombia. Materiales y Métodos El estudio fue de corte transversal (tipo psicométrico, validación de un instrumento). El desarrollo del instrumento consider secciones de las Guidelines for the preventing of transmission of Mycobacteriumtuberculosis in health care settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas y Evaluation Control Tools for Hospital-Acquired Infections. La construcción del instrumento final se realizó con el apoyo de 7 expertos según la metodología Delphi, obteniéndose un instrumento constituido por tres dominios y con un número final de 65 preguntas; donde se evaluó cada uno de los ítems, la utilidad, el formato y la validez del instrumento. Se evaluó el contenido con el coeficiente de Aiken y la confiabilidad con el coeficiente de concordancia de Bangdiwala. Se utilizó el aplicativo R versión3.2.0. Resultados El instrumento quedó conformado por 65 ítems que se refieren a preguntas relacionadas con las medidas administrativas, ambientales y respiratorias. Cuenta con las propiedades psicométricas aceptables, entre ellas, una buena estructura interna y una adecuada confiabilidad. Conclusiones Se obtuvo un instrumento válido y confiable para evaluar el cumplimiento de las medidas institucionales de control de infecciones para la tuberculosis en las Instituciones de Salud de la ciudad de Cali.

Resumo Objetivo Avaliar a validade e a confiabilidade de um instrumento que inspeciona o cumprimento de medidas institucionais de controle de infecção por tuberculosenasinstituições de saúde da cidade de Cali. Colombia. Materiais e métodos O estudofoi transversal (tipo psicométrico, validação de um instrumento). O desenvolvimento do instrumentoconsiderouseções dasGuidelines for the preventing of transmission of Mycobacterium tuberculosis in health care settings (CDC), Guidelines for implementation of infection control of tuberculosis in the Americas e Evaluation Control Tools for Hospital-Acquired Infections.Aconstruçãodoinstrumentofinalfoirealizadacom o apoio de 7 especialistas, conforme a metodologia Delphi, obtendoum instrumento composto por trêsdomínios e comum número final de 65 perguntas; onde cada um dos itens, a utilidade, o formato e a validade do instrumento foram avaliados. O conteúdofoi avaliado com o coeficiente de Aiken e a confiabilidadecom o coeficiente de concordância de Bangdiwala. O aplicativo R versão 3.2.0 foiusado. Resultados O instrumento foi composto por 65 itens que se referem a questões relacionadas a medidas administrativas, ambientais e respiratórias. Possui propriedades psicométricas aceitáveis, incluindo boa estrutura interna e confiabilidade adequada. Conclusões Foiobtidoum instrumento válido e confiável para avaliar o cumprimento das medidas institucionais de controle de infecção por tuberculose nasinstituições de saúde da cidade de Cali.

Résumé Objectif Évaluer la validité et la fiabilité d'un instrument qui inspecte le respect des mesures institutionnelles de contrôle des infections de la tuberculose dans les établissements de santé de la ville de Cali. Matériels et méthodes L'étude était transversale (type psychométrique, validation d'un instrument). L'élaboration de l'instrument a examiné des sections des Lignes directrices pour la prévention de la transmission de Mycobacterium tuberculosis dans les établissements de santé (CDC), des Lignes directrices pour la mise en œuvre de la lutte contre les infections de la tuberculose dans les Amériques et des outils de contrôle de l'évaluation des infections nosocomiales. La construction de l'instrument final a été réalisée avec le soutien de 7 experts selon la méthodologie Delphi, obtenant un instrument composé de trois domaines et avec un nombre final de 65 questions; où chacun des éléments, l'utilité, le format et la validité de l'instrument ont été évalués. Le contenu a été évalué avec le coefficient Aiken et la fiabilité avec le coefficient de concordance Bangdiwala. L'application R version 3.2.0 a été utilisée. Résultats L'instrument était composé de 65 éléments qui renvoient à des questions liées aux mesures administratives, environnementales et respiratoires. Il a des propriétés psychométriques acceptables, y compris une bonne structure interne et une fiabilité adéquate. Conclusions Un instrument valide et fiable a été obtenu pour évaluer le respect desmesures institutionnelles de contrôle des infections de la tuberculose dans les établissements de santé de la ville de Cali.

[Development of a tool for withholding and withdrawing life-sustaining treatment in the emergency room]. / Élaboration et validation d'une fiche d'aide à la décision de limitation ou d'arrêt des traitements aux urgences.

OBJECTIVES: Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken collegially according to ethical and juridical statements. Specific tools can support this process and our main goal was to create and validate such a tool. METHOD: We created a first version of a tool to help for treatment withholding and withdrawing decisions inspired by similar documents from literature. Every item of this tool was then assessed by a group of experts (ER physicians and nurses) using the Delphi method to reach a consensus. RESULTS: Thirty-four experts from eleven ER (academic, regional centre) were included and participate to the first round and twenty-seven to the second round. From the eighty-two-item tool, sixty-five items reach a consensus during these two rounds and were kept to constitute the final version of the tool. CONCLUSION: We have been able to create a tool to help for treatment withholding and withdrawing decisions adapted to the guidelines for end of life patient's management in the ER. This tool has been validated using a Delphi method by a group of experts from different centres. This multicentre validation will help for the diffusion and use of this tool in the different ER of the Rhône-Alpes region.