Operational failures in general practice: a consensus-building study on the priorities for improvement.

BACKGROUND: System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. AIM: To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice. DESIGN AND SETTING: Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England. METHOD: Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median. RESULTS: Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms. CONCLUSION: This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.

New consensus definition on defining and measuring care for children with paediatric feeding disorder.

AIM: This study addresses the absence of a definition of care for children with feeding disorders, limited agreement on key performance indicators (KPIs), and the lack of data linked to those KPIs. METHODS: Clinicians, consumers and researchers involved in outpatient feeding care in New South Wales (NSW), Australia were invited to participate in a two-Phase study. In Phase 1, a modified Delphi method was used. Two rounds of voting resulted in a new consensus definition of a multidisciplinary paediatric feeding clinic. Three further rounds voting determined relevant KPIs. In Phase 2, the KPIs were piloted prospectively in 10 clinics. RESULTS: Twenty-six clinicians, consumers and researchers participated in Phase 1. Participation across five voting rounds declined from 92% to 60% and a valid definition and KPI set were created. In Phase 2, the definition and KPIs were piloted in 10 clinics over 6 weeks. Data for 110 patients were collected. The final KPI set of 28 measures proposed covers clinical features, patient demographics and medical issues, parent-child interaction and outcome measures. CONCLUSIONS: A new definition of a multidisciplinary paediatric feeding clinic is now available, linked to a standardised KPI set covering relevant performance measures. These proved viable in baseline data collection for 10 clinics across NSW. This sets a foundation for further data collection, systematic measurement of care provision and outcomes, and research needed to deliver care improvement for children with paediatric feeding disorder.

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study.

BACKGROUND: Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. AIMS: The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. METHODS AND PROCEDURES: A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. OUTCOMES AND RESULTS: The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. CONCLUSIONS AND IMPLICATIONS: The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. WHAT THIS PAPER ADDS: What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

[Strengthening leadership for educational management in the Americas: an action research strategyFortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação]. / Fortalecimiento del liderazgo para la gestión educativa en las Américas: una estrategia de investigación-acción.

The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives.The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas.A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations.The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course.The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

A formação de recursos humanos em saúde é uma preocupação recorrente. O Campus Virtual de Saúde Pública (CVSP) é a plataforma educacional da Organização Pan-Americana da Saúde (OPAS), que busca melhorar a acessibilidade à educação em saúde pública, com ênfase na formação de lideranças educacionais voltadas para o planejamento, a implementação e a avaliação de políticas e ações educacionais.O objetivo deste documento é apresentar os resultados de uma consulta com especialistas sobre o curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud" [Liderança para a Gestão Educacional em Organizações de Saúde], como parte de uma estratégia para fortalecer as capacidades de liderança para gestão educacional na Região das Américas proposta pelo CVPS/OPAS.Foi realizado um estudo qualitativo de pesquisa-ação utilizando o método Delphi com duas rodadas de consultas, uma virtual e outra presencial, a especialistas em gestão educacional em organizações de saúde.Os resultados mostram a relevância de oito dimensões de análise: perfil do público-alvo; competências; abordagem e conteúdo; atividades; avaliação de e para as aprendizagens; adaptabilidade; implementação; e acompanhamento durante e após o curso.A participação de atores de diferentes esferas geopolíticas no delineamento e na implementação de uma proposta educacional regional promove a transformação do contexto de aplicação e aumenta seu potencial de adoção. Destaca-se o posicionamento estratégico do curso como catalisador na criação e consolidação de uma rede integrada de organizações para fortalecer a liderança educacional na Região das Américas e a adequação da estratégia metodológica empregada para melhorar a qualidade da formação de recursos humanos em saúde.

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study.

BACKGROUND: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM: To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.

Strategic Communication for Local Public Health Services in Portugal: A Delphi Study.

INTRODUCTION: Strategic communication plays a decisive role in public health planning and project implementation. However, Portuguese Local Public Health Units, which are responsible for community interventions, still lack guidance models, tools, specialized resources, and training in health communication. The aim of this study was to develop a conceptual model of strategic organizational communication for local public health services, in Portugal. METHODS: This study presents a conceptual model of strategic organizational communication for Local Public Health Units, which was developed through a three-round, modified Delphi online panel. Thirty-seven Portuguese specialists in public health, communication, and community members were invited to analyse a proposed framework, based on an up-to-date literature review. High retention rates were observed in all rounds (first = 22 valid participations; second = 21 valid participations; third = 18 valid participations). RESULTS: Most participants believed that Portuguese Public Health Units were not prepared to communicate effectively and that they would benefit from adequate planning and identification of a communication lead or team. Websites and social media were also identified as essential for effective communication. The validated conceptual model integrated different partners in health and in the community, with emphasis on the relationships with the national network of health authorities, other Public Health Units, primary health care units, municipalities, and schools. The preferred channels identified for communicating with these partners included interpersonal relationships, email, and mobile phone. No consensus was obtained for preferred communication channels between Local Public Health Units and the media. CONCLUSION: Strategic planning based on the proposed conceptual model involving different stakeholders, has potential to improve the effectiveness of internal and external communication and facilitate the implementation of public health programs and projects. The proposed model needs to be validated in Local Public Health Units, considering the potential human, material, and financial constraints.

Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Monitoring Access to Child Medicines: Introducing a Standardized Set of Age-Appropriate Medicines.

Monitoring access to pediatric medicines as part of the Sustainable Development Goal (SDG) agenda for 2030 requires surveying age-appropriate medicines. This study aimed to develop tracer sets of essential age-appropriate medicines for use in SDG indicator 3.b.3 or in conjunction with other methodologies for monitoring access to medicines. Two sets of medicines were developed, one for young children (1 month to 5 years) and one for school-aged children (5-12 years). Priority diseases were selected based on the global burden of disease and linked to active ingredients of first choice according to treatment guidelines and the World Health Organization (WHO) Model List of Essential Medicines for Children (EMLc). To ensure clinical relevance, the Delphi technique was employed to identify areas of (dis)agreement among clinical pediatric experts. During two consultation rounds, experts were invited to indicate (dis)agreement. Five experts per age group were largely in agreement with the initial selections, but various therapeutic alternatives were suggested for addition. A second consultation round with five experts did not lead to major adjustments. The final sets included 26 treatment options for both groups. Specific age-appropriate formulations were selected from the WHO EMLc 2023. These two globally representative tracer sets of medicines consider the particular needs of children and could aid countries in the critical monitoring of accessibility to pediatric medicines.

Identifying teaching competencies for medical residents using a modified Delphi method.

PURPOSE: This study aimed to identify the teaching competencies of medical residents. METHODS: A modified Delphi study was conducted from January to March 2017. Twenty-four panelists (six medical educators, program directors, chief residents, and residents each) from various facilities in Japan participated in the study. The consensus criterion for this study was that more than 80% of the panelists gave a rating of 6 or higher on the 7-point Likert scale ("not at all important" to "extremely important") without any comments. The modified Delphi approach resulted in a list of 27 resident teaching competencies after three rounds. These competencies were categorized based on Harden and Crosby's 12 roles of medical teachers. RESULTS: Our study revealed that, of the 12 roles, residents were primarily viewed as "clinical or practical teachers," "teaching role models," "on-the-job role models," "learning facilitators," and "student assessors." CONCLUSION: The 27 resident teaching competencies indicate the importance of educational proximity for residents as teachers. It is expected that this finding will contribute to competency-based resident-as-teacher education.

Identifying and ranking of the main organizational resilience indicators in the hospital during the COVID-19 pandemic: A study using fuzzy Delphi technique (FDT) and fuzzy analytical hierarchy process (FAHP).

Resilience in a hospital is referred to as the capability to withstand and respond to disasters while maintaining critical functions. The current study aims to identify and prioritize the defining indicators of organizational resilience in dealing with the critical conditions of the COVID-19 pandemic. First, a literature review and semi-structured interviews with experts were performed for the identification of the primary indicators affecting the hospital's organizational resilience in critical conditions caused by the COVID-19 disease. Next, the fuzzy Delphi technique (FDT) was used to determine the effective and final indicators with a 70% agreement level. Finally, the indicators were weighted and prioritized using the FAHP method. The results shows that three indicators of leadership and management (NW = 0.092), preparedness (NW = 0.080), and learning from previous experiences (NW = 0.078) had the greatest impact on the organizational resilience of the hospital, respectively. Three indicators of logistics support, fallibility culture, creativity, and innovation with the final weights of 0.56, 0.054, and 0.053 gained the least importance, respectively. It can be concluded that a higher level of leadership and management, preparedness, and learning from previous experiences in the conditions of the COVID-19 pandemic can help control this crisis.

Neuropsychological assessment of aggressive offenders: a Delphi consensus study.

Objective: This study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression. Methods: An international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability. Results: The panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed. Conclusions: This research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify.

Case study on communicating with research ethics committees about minimizing risk through software: an application for record linkage in secondary data analysis.

Objective: In retrospective secondary data analysis studies, researchers often seek waiver of consent from institutional Review Boards (IRB) and minimize risk by utilizing complex software. Yet, little is known about the perspectives of IRB experts on these approaches. To facilitate effective communication about risk mitigation strategies using software, we conducted two studies with IRB experts to co-create appropriate language when describing a software to IRBs. Materials and Methods: We conducted structured focus groups with IRB experts to solicit ideas on questions regarding benefits, risks, and informational needs. Based on these results, we developed a template IRB application and template responses for a generic study using privacy-enhancing software. We then conducted a three-round Delphi study to refine the template IRB application and the template responses based on expert panel feedback. To facilitate participants' deliberation, we shared the revisions and a summary of participants' feedback during each Delphi round. Results: 11 experts in two focus groups generated 13 ideas on risks, benefits, and informational needs. 17 experts participated in the Delphi study with 13 completing all rounds. Most agreed that privacy-enhancing software will minimize risk, but regardless all secondary data studies have an inherent risk of unexpected disclosures. The majority (84.6%) noted that subjects in retrospective secondary data studies experience no greater risks than the risks experienced in ordinary life in the modern digital society. Hence, all retrospective data-only studies with no contact with subjects would be minimal risk studies. Conclusion: First, we found fundamental disagreements in how some IRB experts view risks in secondary data research. Such disagreements are consequential because they can affect determination outcomes and might suggest IRBs at different institutions might come to different conclusions regarding similar study protocols. Second, the highest ranked risks and benefits of privacy-enhancing software in our study were societal rather than individual. The highest ranked benefits were facilitating more research and promoting responsible data governance practices. The highest ranked risks were risk of invalid results from systematic user error or erroneous algorithms. These societal considerations are typically more characteristic of public health ethics as opposed to the bioethical approach of research ethics, possibly reflecting the difficulty applying a bioethical approach (eg, informed consent) in secondary data studies. Finally, the development of privacy-enhancing technology for secondary data research depends on effective communication and collaboration between the privacy experts and technology developers. Privacy is a complex issue that requires a holistic approach that is best addressed through privacy-by-design principles. Privacy expert participation is important yet often neglected in this design process. This study suggests best practice strategies for engaging the privacy community through co-developing companion documents for software through participatory design to facilitate transparency and communication. In this case study, the final template IRB application and responses we released with the open-source software can be easily adapted by researchers to better communicate with their IRB when using the software. This can help increase responsible data governance practices when many software developers are not research ethics experts.

Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study.

AIM: To construct a nursing assessment framework for patients in anaesthesia recovery period. DESIGN: A three-round modified Delphi method was employed to capture the consensus of 22 panellists. METHODS: The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini-clinical evaluation exercise (mini-CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post-anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. RESULTS: This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History-taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. CONCLUSION: The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The assessment framework constructed in this study could be used for the process evaluation of post-anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. REPORTING METHOD: The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Development and Testing of Step, Error, and Event Frameworks to Evaluate Technical Performance in Peripheral Endovascular Interventions.

OBJECTIVE: Tools for endovascular performance assessment are necessary in competency based education. This study aimed to develop and test a detailed analysis tool to assess steps, errors, and events in peripheral endovascular interventions (PVI). METHODS: A modified Delphi consensus was used to identify steps, errors, and events in iliac-femoral-popliteal endovascular interventions. International experts in vascular surgery, interventional radiology, cardiology, and angiology were identified, based on their scientific track record. In an initial open ended survey round, experts volunteered a comprehensive list of steps, errors, and events. The items were then rated on a five point Likert scale until consensus was reached with a pre-defined threshold (Cronbach's alpha > 0.7) and > 70% expert agreement. An experienced endovascular surgeon applied the finalised frameworks on 10 previously videorecorded elective PVI cases. RESULTS: The expert consensus panel was formed by 28 of 98 invited proceduralists, consisting of three angiologists, seven interventional radiologists, five cardiologists, and 13 vascular surgeons, with 29% from North America and 71% from Europe. The Delphi process was completed after three rounds (Cronbach's alpha; αsteps = 0.79; αerrors = 0.90; αevents = 0.90), with 15, 26, and 18 items included in the final step (73 - 100% agreement), error (73 - 100% agreement), and event (73 - 100% agreement) frameworks, respectively. The median rating time per case was 4.3 hours (interquartile range [IQR] 3.2, 5 hours). A median of 55 steps (IQR 40, 67), 27 errors (IQR 21, 49), and two events (IQR 1, 6) were identified per case. CONCLUSION: An evaluation tool for the procedural steps, errors, and events in iliac-femoral-popliteal endovascular procedures was developed through a modified Delphi consensus and applied to recorded intra-operative data to identify hazardous steps, common errors, and events. Procedural mastery may be promoted by using the frameworks to provide endovascular proceduralists with detailed technical performance feedback.

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations.

OBJECTIVE: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. METHODS: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. RESULTS: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3-5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. CONCLUSIONS: The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.

The Assessment of Awareness and Attitudes About the Use of Denture Adhesives Amongst Dental Practitioners in Northern Maharashtra: A Delphi Technique.

AIM: The goal of this research was to facilitate dialogue and interaction among a group of dental practitioners about their views on denture adhesives, with the objective of reaching a collective consensus through the application of the Delphi Method. METHODS: This investigation employed the Delphi Technique, involving multiple rounds of questionnaires sent to a panel of experts. The objective was to establish a consensus (defined as over 70% agreement) or to explore the different viewpoints on the subject. A comprehensive Delphi questionnaire comprising 22 items was distributed to the Dental Practitioners. The questionnaire covered five key areas concerning denture adhesives: (1) overall perceptions; (2) the role in the development of clinical conditions; (3) specific applications and potential misuses; (4) their importance in denture services, including educating patients about denture adhesives; and (5) a general assessment of their clinical applications. RESULTS: All 31 panellists, chosen randomly, unanimously agreed to participate, with each of them actively involved in all three rounds of the survey. The panellists reached a consensus and definitively concluded that denture adhesives (1) are beneficial for enhancing the fit and comfort of the prosthesis and are not used to mask the underlying denture problems; (2) cause diseases such as denture stomatitis, candidiasis, and resorption of alveolar bone; (3) have the potential for increasing retention, function, and reducing patient anxiety. However, the panellists did not achieve a consensus on whether denture adhesives cause nausea and gagging in the patients; (4) education is very important for patients with both ill-fitting and well-fitting dentures; (5) are a beneficial adjunct to dentists when fabricating dentures. CONCLUSION: The expert panel of distinguished dental practitioners determined that denture adhesives play a valuable supportive role in the field of denture prosthetics, serving important functions during both the creation and post-insertion stages of dentures.

Establishment of Standards for the Referral of Large Non-Pedunculated Colorectal Polyps: An International Expert Consensus Using a Modified Delphi Process.

BACKGROUND AND AIMS: Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large non-pedunculated colorectal polyps are often referred to expert centres for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of our study was to establish minimum expected standards for the referral of LNPCP for potential ER. METHODS: A Delphi methodology was employed to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and three rounds of surveys were conducted to achieve consensus, with quantitative and qualitative data analysed for each round. RESULTS: A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographics, relevant medications, lesion factors, photodocumentation and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements ranged from 7.04 to 9.29 out of 10, with high percentages of experts considering most statements as a very high priority. Subgroup analysis by continent revealed some variations in consensus rates among experts from different regions. CONCLUSION: The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.