STANDING Collaboration: a study protocol for developing clinical standards.

INTRODUCTION: Despite widespread availability of clinical practice guidelines (CPGs), considerable gaps continue between the care that is recommended ('appropriate care') and the care provided. Problems with current CPGs are commonly cited as barriers to providing 'appropriate care'.Our study aims to develop and test an alternative method to keep CPGs accessible and up to date. This method aims to mitigate existing problems by using a single process to develop clinical standards (embodied in clinical indicators) collaboratively with researchers, healthcare professionals, patients and consumers. A transparent and inclusive online curated (purpose-designed, custom-built, wiki-type) system will use an ongoing and iterative documentation process to facilitate synthesis of up-to-date information and make available its provenance. All participants are required to declare conflicts of interest. This protocol describes three phases: engagement of relevant stakeholders; design of a process to develop clinical standards (embodied in indicators) for 'appropriate care' for common medical conditions; and evaluation of our processes, products and feasibility. METHODS AND ANALYSIS: A modified e-Delphi process will be used to gain consensus on 'appropriate care' for a range of common medical conditions. Clinical standards and indicators will be developed through searches of national and international guidelines, and formulated with explicit criteria for inclusion, exclusion, time frame and setting. Healthcare professionals and consumers will review the indicators via the wiki-based modified e-Delphi process. Reviewers will declare conflicts of interest which will be recorded and managed according to an established protocol. The provenance of all indicators and suggestions included or excluded will be logged from indicator inception to finalisation. A mixed-methods formative evaluation of our research methodology will be undertaken. ETHICS AND DISSEMINATION: Human Research Ethics Committee approval has been received from the University of South Australia. We will submit the results of the study to relevant journals and offer national and international presentations.

The PaArticular Scales - A new outcome measure to quantify the impact of joint contractures on activities and participation in individuals in geriatric care: Development and Rasch analysis.

BACKGROUND: Joint contractures are frequent conditions in individuals in geriatric care settings and are associated with activity limitations and participation restrictions. As such, relevant intervention programs should address these aspects, and the effectiveness of such programs should be determined by assessing improvement in activities and participation. However, no patient-centred and psychometrically sound outcome measures for this purpose are available so far. OBJECTIVES: The objectives of this study were to develop and to validate a new outcome measure, the PaArticular Scales, to quantify activities and participation in older individuals with joint contractures. Specific aims were (A) to operationalize the content of an International Classification of Functioning, Disability and Health-based standard set towards meaningful questions and to combine them to a questionnaire and (B) to assess the psychometric properties of the developed questionnaire, in detail to evaluate test-retest reliability, objectivity, internal consistency reliability and criterion validity. DESIGN: Operationalization was reached by an expert consensus conference and a subsequent expert Delphi survey. Psychometric properties were assessed in a cross-sectional study. SETTINGS: Nursing homes, geriatric rehabilitation facilities. PARTICIPANTS: 23 experts (nurses, physicians, physical and occupational therapists) participated in the consensus conference and the Delphi survey. A total of 191 individuals with joint contractures (as confirmed by physician, nurse or physical therapist) between 65 and 102 years, living in nursing homes or as patients in geriatric rehabilitation were enrolled in the cross-sectional study. METHODS: Rasch Partial Credit Modelling. RESULTS: The consensus conference and Delphi survey resulted in a questionnaire with 86 items of the International Classification of Functioning, Disability and Health. Test-retest-reliability among those was acceptable (Cohen's weighted kappa: 0.779). The Rasch analysis revealed two independent interval-scaled scales with 24 items for the Activities scale and 11 items for the Participation scale with high internal consistency reliability. Cronbach's alpha was 0.96 for the Activities scale and 0.92 for the Participation scale. Criterion validity was -0.40 and -0.30 for the Activities scale and for the Participation scale, respectively. CONCLUSIONS: The PaArticular Scales, a new patient-centred and psychometric sound outcome measures to comprehensively assess the impact of joint contractures in geriatric care, are available now. These developed scales will serve as primary outcomes in a scheduled evaluation of a complex intervention to improve participation and quality of life in nursing home residents with joint contractures.

OFSEP, a nationwide cohort of people with multiple sclerosis: Consensus minimal MRI protocol.

Multiple sclerosis (MS) is most generally considered as a severe disease with high physical and mental risks of disability. Since the end of the 1990s, several high cost long-term disease-modifying treatments provided some clinical efficiency. However, patient's follow-up was needed for the detection and the assessment of their side-effects. The "Observatoire français de la sclérose en plaques" (OFSEP) project aims to improve the clinical, biological and imaging systematic longitudinal follow-up of patients. It should increase the quality, efficiency and safety of patients' care, with a unique opportunity of large scale, about 41,000 patients followed in 62 French centers using the European Database for Multiple Sclerosis (EDMUS) software. OFSEP is divided into three working groups (clinical, biological and imaging). The imaging working group defines standards for routine MRI follow-up in the whole cohort and contains three subgroups: acquisition, workflow, and data processing. A common and feasible brain and spinal cord acquisition protocol has been defined by the acquisition group, and accepted by the OFSEP steering and scientific committees. This protocol can be implemented in all French MRI centers. The major MRI manufacturers have agreed to provide the dedicated collection of sequences as an "OFSEP box" with every software upgrade or new MRI machine. The new OFSEP protocol will provide a unique opportunity to study a population-based collection of data from people with MS.

Oficinas educativas sobre HIV/Aids: uma proposta de intervencao para idosos / Educative workshops on HIV/Aids: proposing interventions for elderly

O objetivo do estudo foi avaliar a eficácia de uma oficina educativa sobre HIV/aids em um grupo de idosos. A população incluiu 471 indivíduos entre 60 e 91 anos composta principalmente por mulheres (83,1%). Procedeu-se a aplicação e reaplicação de um questionário organizado em cinco domínios, antes e após as oficinas. O teste de McNemar foi utilizado para comparar as respostas pré e pós-oficina (p<0,05) no programa estatístico STATA 12. Dentre os domínios, a maior variação (202,72%) ocorreu no domínio "conceito" sobre a fase assintomática da infecção. No domínio "transmissão", a variação foi de 168,53% para a transmissão do HIV por picada de mosquito. No domínio "prevenção", na questão sobre existência do preservativo feminino, a variação foi de 44%. O domínio "vulnerabilidade" indicou 34,93% na questão da aids relacionada a grupos específicos. No domínio "tratamento", a abordagem da cura para a aids obteve 50,85% de variação. A realização das oficinas demonstrou ser uma intervenção eficaz nos domínios "conceito", "transmissão", "prevenção", "vulnerabilidade" e "tratamento" nos idosos participantes da pesquisa.

This study aimed to evaluate the effectiveness of educational workshops instructing about HIV/Aids in a group of elderly. The population included 471 individuals between 60 and 91 years old, mostly women (83.1%). A questionnaire comprising five domains was answered by participants before and after taking the educational workshops. McNemar test was used to assess differences between pre-and post-workshop, through thr software STATA 12 (p<0.05). The greatest variation (202.72%) was observed in the "concept" domain related to the asymptomatic infection phase. Regarding "HIV transmission", the variation was 168.53%. The domain "prevention" had variation of 44% concerning the existence of female condom. The "vulnerability" domain inquired about Aids association in specific groups, and a difference of 34.93% was observed. In the "treatment" domain, when inquiring about Aids cure, 50.85% variation was observed. The educational workshops were effective for the domains "concept", "transmission", "prevention", "vulnerability" and "treatment" in a group of elderly.

Expert consensus-building for developing guidelines: lessons learned from a dengue economics workshop / Unificación de las opiniones de los expertos para la formulación de directrices: enseñanzas extraídas de un taller sobre los aspectos económicos del dengue

A workshop with 20 experts of diverse backgrounds from five countries in the Americas was convened for two-and-a-half days in March 2012 to discuss and develop a standardized methodology for assessing the economic cost of dengue. This article discusses a number of factors that contributed to the workshop's success, including: engaging the experts at various stages of the process; convening a multidisciplinary group to reduce expert bias and provide a more comprehensive and integrated approach; facilitating guided small- and large-group discussions; developing effective cross-cultural collectivism, trust, communication, and empathy across the expert panel; establishing clear lines of responsibilities within each group of experts; breaking down the complex issues into smaller and simpler ideas; providing ample background materials in multiple languages prior to the workshop. Challenges and areas for improvement are also covered.

Se convocó un taller con 20 expertos provenientes de diversos ámbitos de cinco países de las Américas con el propósito de analizar y elaborar un método normalizado de evaluación del costo económico del dengue; la duración del taller fue de dos días y medio en marzo del 2012. En el presente artículo se analizan diversos factores que contribuyeron al éxito del taller, entre ellos la vinculación de los expertos en diversas.

Influenza among the elderly in the Americas: a consensus statement / La gripe en los ancianos de la Región de las Américas: una declaración de consenso

Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.

La gripe representa una fuerte carga para los ancianos, un segmento de la población que, según los cálculos, experimentará un rápido crecimiento en un futuro próximo. En el último decenio, la mayor parte de los países desarrollados y varios países en desarrollo han recomendado la vacunación antigripal de las personas mayores de 65 años de edad. La Organización Mundial de la Salud (OMS) estableció la meta de una cobertura de vacunación antigripal de 75% de los ancianos para el año 2010, pero no se alcanzó. En el 2011, el Grupo Consultivo Técnico de la Organización Panamericana de la Salud, Oficina Regional de la OMS para la Región de las Américas, reiteró la recomendación de la vacunación antigripal de los adultos mayores. Se ha recabado relativamente poca información sobre los aspectos inmunológicos del envejecimiento o sobre cómo reducir su repercusión, información particularmente pertinente para médicos clínicos y gerontólogos que deben afrontar de primera mano sus efectos. Para salvar esta brecha en materia de datos, en el 2012, la Americas Health Foundation (Washington, D.C., Estados Unidos) y la Fighting Infectious Diseases in Emerging Countries (fundación sin ánimo de lucro para la lucha contra las enfermedades infecciosas en los países emergentes, con sede en Miami, Florida, Estados Unidos) convocaron un grupo de expertos, médicos clínicos y gerontólogos latinoamericanos con pericia en el tema de la gripe, con objeto de debatir aspectos clave y elaborar una declaración de consenso. Las principales recomendaciones fueron mejorar la vigilancia de la gripe en toda América Latina para que pudiera cuantificarse su repercusión; y llevar a cabo la confirmación de laboratorio en todos los pacientes con síntomas similares a los de la gripe debilitados, inmunodeprimidos, con comorbilidades, con compromiso respiratorio o que hubieran sido ingresados en un hospital. El grupo de expertos también señaló que, dado que no existen datos probatorios claros en relación con los antivíricos en los ancianos, su uso debe manejarse caso por caso; que, a pesar de la reducción de la respuesta inmunitaria, la vacunación antigripal en adultos mayores sigue siendo crucial; que se deben promover las estrategias de vacunación indirecta; y que, en los establecimientos de asistencia a largo plazo, las medidas tradicionales de control de las infecciones son esenciales.

Influenza among adults in Latin America, current status, and future directions: a consensus statement / La gripe en adultos en América Latina, situación actual y tendencias futuras: una declaración de consenso

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with firsthand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientistclinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

En América Latina, la gripe en adultos es una enfermedad grave que impone una carga importante en cuanto a la morbilidad, la mortalidad y el costo. Aunque se ha escrito mucho acerca de la enfermedad en sí, se ha recopilado relativamente escasa información sobre lo que podría hacerse para reducir su repercusión en la región, en particular desde la perspectiva de los médicos con experiencia directa en afrontar sus efectos. Para compensar esta falta de información, en 2011 la Fundación Panamericana de la Salud y Educación (PAHEF) y la organización sin fines de lucro establecida en los Estados Unidos Fighting Infectious Diseases in Emerging Countries (FIDEC) organizaron una conferencia y convocaron a un panel de científicos y médicos latinoamericanos con experiencia y conocimientos especializados en la gripe en adultos en la región a fin de 1) analizar los temas principales relacionados con la enfermedad y 2) elaborar y emitir una declaración de consenso que resuma la repercusión, así como los logros actuales en el diagnóstico, la prevención y el tratamiento de la enfermedad. El panel de consenso llegó a la conclusión que se requieren esfuerzos más concertados y mejor coordinados para reducir la repercusión adversa de la gripe estacional y las pandemias futuras, que comprenden una mayor vigilancia, una participación más activa de las organizaciones gubernamentales y no gubernamentales y un esfuerzo mucho mayor para vacunar a más adultos, en especial a las personas que presentan un riesgo elevado de contraer la enfermedad. Además, se recomendó un nuevo enfoque para diagnosticar la gripe.