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1.
Codas ; 32(6): e20190158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206772

RESUMO

PURPOSE: The aim of this study was to identify the most typical and relevant categories of the International Classification of Functioning, Disability and Health (ICF) for patients with 22q11.2 Deletion Syndrome. METHODS: Based on the Delphi technique an expert survey through e-mail was performed among health professionals' specialists in the 22q11.2DS. Data were collected in 2 rounds. Answers were analysed for the degree of consensus. RESULTS: 7 Experts recruited through e-mail distribution lists of professional organizations and personal networks participated in the study. Categories in all ICF components that were considered typical and/or relevant by at least 80% of the responders were added to a pilot ICF instrument for children with 22q11.2DS, with a total of 145 ICF categories. CONCLUSION: a list of ICF categories that are considered relevant and typical for 22q11.2DS condition by international experts was created. This is an important step towards identifying ICF Core Sets for chronic paediatric conditions in Brazil.


Assuntos
Síndrome de DiGeorge , Pessoas com Deficiência , Atividades Cotidianas , Brasil , Criança , Técnica Delfos , Avaliação da Deficiência , Exercício Físico , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde
2.
PLoS One ; 15(11): e0242212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180833

RESUMO

BACKGROUND: Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE: To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS: An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS: Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION: This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.


Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/economia , Estudos de Tempo e Movimento , Algoritmos , Técnica Delfos , Desinfecção , Higiene das Mãos , Humanos , Programas de Rastreamento , Equipamento de Proteção Individual , Saneamento
3.
BMJ Open ; 10(11): e042626, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184088

RESUMO

BACKGROUND: To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care. METHODS: The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems. RESULTS: The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is. CONCLUSIONS: Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing. TRIAL REGISTRATION NUMBER: NCT04435041.


Assuntos
Lista de Checagem , Infecções por Coronavirus/diagnóstico , Escore de Alerta Precoce , Pneumonia Viral/diagnóstico , Telemedicina , Betacoronavirus , Confusão , Infecções por Coronavirus/fisiopatologia , Técnica Delfos , Progressão da Doença , Dispneia , Febre , Frequência Cardíaca , Humanos , Hipóxia , Mialgia , Pandemias , Pneumonia Viral/fisiopatologia , Pesquisa Qualitativa , Medição de Risco , Fatores de Risco , Fatores de Tempo , Reino Unido
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(10): 1081-1086, 2020 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-33115193

RESUMO

Objective: To establish the nutrition literacy core items for Chinese pregnant women. Methods: The framework system and preliminary items of nutrition literacy were established through literature review and experts consultation. E-Delphi method was used to determine the nutrition literacy items.11 experts in the field of maternal and child nutrition, obstetrics and gynecology, health education and nutrition and diseases were invited to score the importance of each nutrition literacy item via Email. The judgment basis and familiarity of experts towards the items, active coefficient, authority coefficient and harmony coefficient were evaluated and analyzed to generate the final list of nutrition literacy items. Results: The active coefficients of consultation in two rounds were 81.8% (9/11) and 87.5% (8/9).The authority coefficients were (0.86±0.11) and (0.85±0.06).The average scores of importance were (4.32±0.84) and (4.58±0.57) and the harmony coefficients were 0.387 (χ²=90.472, P<0.001) and 0.290 (χ²=46.752, P=0.002) respectively. After the second round of consultation, all selected items met the inclusion criteria. We identified the final list of nutrition literacy items consisting of 3 scales (basic knowledge and concept, lifestyles and dietary behaviors, and basic skills), 10 sub-scales (basic nutrition concept, food and nutrition knowledge, nutrition and disease knowledge, lifestyles, dietary behaviors, preparation for breastfeeding, gestational weight management, gestational disease management, acquisition, understanding and application of nutrition information, judgement of nutrition information, and nutrition decision making) with 24 items in total. Conclusions: The framework system and core items of nutrition literacy are established for Chinese pregnant women based on E-Delphi method. The experts involved in the consultation process present a performance with good representativeness, enthusiasm and authority. All experts' opinions are coordinated and unified, which could satisfy the demand of developing nutrition literacy core items for target population.


Assuntos
Letramento em Saúde , Alfabetização , Estado Nutricional , Gestantes , Criança , Técnica Delfos , Feminino , Humanos , Estilo de Vida , Gravidez
5.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(10): 1087-1092, 2020 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-33115194

RESUMO

Objective: To establish the nutrition literacy core items for Chinese lactating women. Methods: The framework system and preliminary items of nutrition literacy were established through literature review and experts consultation. E-Delphi method was used to determine the nutrition literacy items. 11 experts in the field of maternal and child nutrition, obstetrics and gynecology, health education and nutrition and diseases were invited to score the importance of each nutrition literacy item via Email. The judgment basis and familiarity of experts towards the items, active coefficient, authority coefficient and harmony coefficient were evaluated and analyzed to generate the final list of nutrition literacy items. Results: The active coefficients of consultation in two rounds were 81.8% (9/11) and 87.5% (8/9). The authority coefficients were (0.86±0.11) and (0.85±0.06). The average scores of importance were (4.03±1.24) and (4.64±0.50)and the harmony coefficients were 0.556 (χ²=163.42, P<0.001) and 0.40 (χ²=64.41, P<0.001). After the second round of consultation, all selected items met the inclusion criteria. We identified the final list of nutrition literacy items consisting of 3 scales (basic knowledge and concept, lifestyles and dietary behaviors, and basic skills), 10 subscales (basic nutrition concept, food and nutrition knowledge, feeding knowledge, lifestyles, dietary behaviors, feeding behaviors, weight management, complementary food production, acquisition, understanding and application of nutrition information, judgement of nutrition information, and nutrition decision making) with 24 items in total. Conclusions: The framework system and core items of nutrition literacy were established for Chinese lactating women based on E-Delphi method. The experts involved in the consultation process presented a performance with good representativeness, enthusiasm and authority. All experts' opinions are coordinated and unified, which could satisfy the demand of developing nutrition literacy core items for target population.


Assuntos
Letramento em Saúde , Lactação , Estado Nutricional , Criança , Técnica Delfos , Feminino , Educação em Saúde , Humanos , Estilo de Vida , Inquéritos e Questionários
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(10): 1093-1097, 2020 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-33115195

RESUMO

Objective: To establish the nutrition literacy core items for preschool children in China. Methods: The framework system and preliminary items of nutrition literacy were established through literature review and experts consultation. E-Delphi method was used to determine the nutrition literacy items. Nine experts in the field of nutrition, child and adolescent health, health education were invited to score the importance of each nutrition literacy item via Email. The judgment basis and familiarity of experts towards the items, active coefficient, authority coefficient and harmony coefficient were evaluated and analyzed to generate the final list of nutrition literacy items. Results: In the first round of E-Delphi consultation, the active coefficient and authority coefficient were 88.9%(8/9) and(0.88±0.07).The harmony coefficient was 0.350 (χ2=36.432, P=0.001). In the second round, the active coefficient and authority coefficient were 100% (9/9) and (0.89±0.11).The harmony coefficient was 0.347 (χ2=34.330, P<0.001). After qualitative and quantitative analyses, we identified the final list of nutrition literacy items consisting of two scales (basic knowledge, lifestyles and dietary behaviors), six subscales (food knowledge, food characteristic, food choice, dietary behavior, dietary safety, and physical activity)with 14 items in total. Conclusion: The framework system and core items of nutrition literacy are established for Chinese preschool children, which could provide a reference basis for the implementation of nutrition education project and the establishment of standardized evaluation tools.


Assuntos
Letramento em Saúde , Estado Nutricional , Adolescente , Pré-Escolar , China , Técnica Delfos , Dieta , Exercício Físico , Humanos , Inquéritos e Questionários
7.
BMC Psychol ; 8(1): 105, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023667

RESUMO

BACKGROUND: Trauma has a major impact on the mental health and wellbeing of people globally. Friends, family and members of the public are often well positioned to provide initial assistance if someone is experiencing extreme distress following a potentially traumatic event. Expert consensus guidelines for high income, Western countries on how to do this were published in 2008. The aim of the current study was to re-develop these guidelines to ensure they are current and reflect best practice. METHODS: The Delphi consensus method was used to determine which helping statements should be included in the guidelines. Helping statements were derived from a systematic search of literature that considered how a member of the public could help someone experiencing extreme distress following a potentially traumatic event. Two expert panels, comprising 28 mental health professionals with expertise in managing trauma and 26 consumer advocates, rated each statement. Statements were accepted for inclusion in the guidelines if they were endorsed by at least 80% of each panel. RESULTS: Out of 183 statements, 103 were endorsed as appropriate helping actions in providing assistance to someone experiencing extreme distress following a potentially traumatic event. These statements were used to form the re-developed guidelines. CONCLUSION: This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 103 helping actions, compared to 65 previously. The updated guidelines better represent the complexities of experiencing trauma and the considered approach required when providing first aid after a potentially traumatic event. The additional guidance on providing initial assistance, talking about the trauma, offering short-term assistance and seeking appropriate professional help reflects current knowledge. A notable addition is the inclusion of content on how a first aider can assist after a disclosure of abuse. The guidelines are available to the public and will inform future updates of Mental Health First Aid training courses.


Assuntos
Primeiros Socorros , Guias como Assunto , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/terapia , Consenso , Técnica Delfos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
8.
East Mediterr Health J ; 26(9): 1011-1017, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-33047791

RESUMO

Background: Health professionals are at the frontline of the COVID-19 pandemic and are directly exposed to infection hazards. Therefore, they should have the essential competencies for approaching patients. Aims: The study aimed to identify essential competencies required for approaching patients with COVID-19. Methods: All postgraduate health professionals at the Syrian Virtual University SVU (n=28) were invited to participate in the study during the Covid-19 lockdown in 2020, resulting in 20 postgraduates accepting. The Delphi technique was adopted for identifying competencies in medical education and a virtual meeting was undertaken through the University Management System in order to provide instruction and create a list of competencies. Competency domains were divided into 'knowledge', 'skills', and 'attitudes' and were classified into four categories: etiology, assessment and diagnosis, management, and prognosis. Results: Fifty-two essential competencies were identified; 7 competencies on etiology, 7 related to assessment and diagnosis, 34 related to management, and 4 related to prognosis. Conclusion: It is hoped that the identified competencies would help health professionals to deliver the best health care for COVI-19 patients, as well as help policy-makers to support comprehensive training programmes that can equip health professionals with the required competencies to fight the pandemic.


Assuntos
Competência Clínica/normas , Infecções por Coronavirus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Técnica Delfos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
9.
Rev Lat Am Enfermagem ; 28: e3370, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-33027404

RESUMO

OBJECTIVE: to analyze the nursing research priorities in critical care in Brazil identified by specialists and researchers in the area, as well as to establish the consensus of the topics suggested by the experts. METHOD: a descriptive study, using the e-Delphi technique in three rounds. The research participants were 116 Brazilian nurses who are experts in critical care in the first round, ending up with 68 participants in the third round of the study. Descriptive statistics were used to analyze the demographic variables and the results of the research topics in the second round. In the final analysis, the Kappa agreement coefficient was calculated, comparing the answers between rounds two and three. RESULTS: 63 research topics were generated, grouped into 14 domains of intensive care practice in the first round, and consensus was settled in the subsequent rounds. Topics such as humanization of care (0.56), bloodstream infection control (0.54), and nursing care for polytrauma patients (0.51) were items rated above 0.50 in the agreement analysis between the topics in the two rounds using the Kappa coefficient. CONCLUSION: this study provides an important guideline for nursing research in critical care in Brazil, guiding for future research efforts in the area.


Assuntos
Pesquisa em Enfermagem , Brasil , Consenso , Cuidados Críticos , Técnica Delfos , Humanos
10.
J Vasc Interv Radiol ; 31(11): 1765-1771.e15, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32978054

RESUMO

PURPOSE: A consensus study of panelists was performed to provide a uniform protocol regarding (contra) indications, procedural parameters, perioperative care, and follow-up of irreversible electroporation (IRE) for the treatment of hepatic malignancies. MATERIALS AND METHODS: Interventional radiologists who had 2 or more publications on IRE, reporting at least 1 patient cohort in the field of hepatobiliary IRE, were recruited. The 8 panelists were asked to anonymously complete 3 iterative rounds of IRE-focused questionnaires to collect data according to a modified Delphi technique. Consensus was defined as having reached 80% or greater agreement. RESULTS: Panel members' response rates were 88%, 75%, and 88% in rounds 1, 2, and 3, respectively; consensus was reached on 124 of 136 items (91%). Percutaneous or intraoperative hepatic IRE should be considered for unresectable primary and secondary malignancies that are truly unsuitable for thermal ablation because of proximity to critical structures. Absolute contraindications are ventricular arrhythmias, cardiac stimulation devices, and congestive heart failure of New York Heart Association class 3 or higher. A metal stent outside the ablation zone should not be considered a contraindication. For the only commercially available IRE device, the recommended settings are an inter-electrode distance of 10-20 mm and an exposure length of 20 mm. After 10 test pulses, 90 treatment pulses of 1500 V/cm should be delivered continuously, with a pulse length of 70-90 µs. The first post-procedural follow-up should take place 1 month after IRE and thereafter every 3 months, using cross-sectional imaging plus tumor marker assessment. CONCLUSIONS: This article provides recommendations, created by a modified Delphi consensus study, regarding patient selection, workup, procedure, and follow-up of IRE treatment for hepatic malignancies.


Assuntos
Técnicas de Ablação/normas , Eletroporação/normas , Neoplasias Hepáticas/cirurgia , Técnicas de Ablação/efeitos adversos , Tomada de Decisão Clínica , Consenso , Contraindicações de Procedimentos , Técnica Delfos , Medicina Baseada em Evidências , Humanos , Neoplasias Hepáticas/patologia , Seleção de Pacientes , Fatores de Risco
11.
BMC Med Inform Decis Mak ; 20(1): 210, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887609

RESUMO

BACKGROUND: Clinical analytics is a rapidly developing area of informatics and knowledge mobilisation which has huge potential to improve healthcare in the future. It is widely acknowledged to be a powerful mediator of clinical decision making, patient-centred care and organisational learning. As a result, healthcare systems require a strategic foundation for clinical analytics that is sufficiently directional to support meaningful change while flexible enough to allow for iteration and responsiveness to context as change occurs. METHODS: In New South Wales, the most populous state in Australia, the Clinical Analytics Working Group was charged with developing a five-year vision for the public health system. A modified Delphi process was undertaken to elicit expert views and to reach a consensus. The process included a combination of face-to-face workshops, traditional Delphi voting via email, and innovative, real-time iteration between text re-formulation and voting until consensus was reached. The six stage process engaged 35 experts - practising clinicians, patients and consumers, managers, policymakers, data scientists and academics. RESULTS: The process resulted in the production of 135 ideas that were subsequently synthesised into 23 agreed statements and encapsulated in a single page (456 word) narrative. CONCLUSION: The visioning process highlighted three key perspectives (clinicians, patients and managers) and the need for synchronous (during the clinical encounter) and asynchronous (outside the clinical encounter) clinical decision support and reflective practice tools; the use of new and multiple data sources and communication formats; and the role of research and education.


Assuntos
Tomada de Decisão Clínica , Assistência à Saúde/normas , Assistência Centrada no Paciente , Pesquisa em Sistemas de Saúde Pública , Indicadores de Qualidade em Assistência à Saúde/normas , Austrália , Comunicação , Consenso , Técnica Delfos , Humanos , New South Wales
12.
Br J Sports Med ; 54(22): 1314-1320, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32912847

RESUMO

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Medicina Militar/educação , Medicina Esportiva/educação , Atletas/educação , Técnica Delfos , Humanos , Medicina Militar/organização & administração , Militares/educação , Medicina Esportiva/organização & administração , Participação dos Interessados , Estados Unidos , Universidades
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1324-1327, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32867444

RESUMO

Objective: To analyze the predictive ability of HIV infection risk assessment tool for men who have sex with men (MSM). Sentinel surveillance data of MSM in Taizhou prefecture of Zhejiang province was used. Methods: MSM involved in AIDS sentinel surveillance program in Taizhou from 2013 to 2017 were included in the study and items listed in the HIV infection risk assessment tool for MSM was revised. Related data on questions and options involved in sentinel surveillance was collected and individual risk scores were calculated. We determined the predictive ability of this tool by comprehensive analyzing the HIV infection status and individual risk scores. Results: A total of 1 944 MSM were included in the study, with an average age of (35.04±13.28)years old. Most of them were recruited from the venues (55.7%) and 48.2% were never married. Among these MSM, HIV infection rate was 12.6%(245/1 944) with the median of risk score as 23.99, versus 20.36 from the HIV negative ones. Significant differences appeared on the risk scores between the target populations that with different HIV status (Mann-Whitney test, P=0.007). According to the principle of decision tree, MSM were divided into two groups according to risk scores: ≤18.66 and >18.66. It appeared that the risk scores were in parallel with the rates of HIV infection (χ(2)=13.102, P<0.001). Results from the multivariate analysis showed that MSM with higher risk score were more likely to be infected with HIV (>18.66 vs. ≤18.66: aOR=1.72, 95%CI: 1.27-2.32, P<0.001). Area under the ROC curve (AUC) for HIV infection was 0.553 (95%CI: 0.516-0.590, P=0.007). At the point of risk score 19.01, Youden's index appeared the maximum, with sensitivity as 0.69 and specificity as 0.43, of this tool. Conclusions: The HIV infection risk assessment tool for MSM developed based on Delphi method can predict the risk of HIV infection in MSM to some extent. MSM with higher risk score seemed likely to be infected with HIV. Items of this tool need to be adjusted for the verification of the tool through cohort studies in the near future.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Medição de Risco/métodos , Vigilância de Evento Sentinela , Adulto , China/epidemiologia , Técnica Delfos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
14.
J Nurs Adm ; 50(10): 539-545, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32925665

RESUMO

OBJECTIVE: The purpose of this study was to explore perspectives of nurse leaders regarding strategies to mitigate the job demands of 12-hour shift work and learn their views regarding the role of breaks in offsetting the cognitive and physical demands of acute care nurses working 12-hour shifts. BACKGROUND: The strain of long shifts can result in adverse outcomes for nurses, organizations, and patients. METHODS: A modified, 3-round, e-Delphi solicited input from nurse leaders. First, qualitative information about support and resources to mitigate the adverse effects of 12-hour shifts was collected, and then 2 subsequent rounds used consensus identification and item ranking to develop recommendations. RESULTS: Findings reinforce that job demands of 12-hour shifts can be mitigated via staffing practices, quiet break spaces, and the opportunity to work with familiar patients. CONCLUSIONS: Recommendations from this work may enhance patient safety, positive organizational outcomes, and a resilient and sustainable nursing workforce.


Assuntos
Liderança , Recursos Humanos de Enfermagem no Hospital , Admissão e Escalonamento de Pessoal , Tolerância ao Trabalho Programado , Técnica Delfos , Humanos , Estados Unidos
15.
Medwave ; 20(8): e8012, 2020 Sep 07.
Artigo em Espanhol | MEDLINE | ID: mdl-32956343

RESUMO

Objective: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. Methods: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. Results: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. Conclusions: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Radioterapia (Especialidade)/estatística & dados numéricos , Carga de Trabalho , Infecções por Coronavirus/prevenção & controle , Técnica Delfos , Desinfecção/métodos , Física Sanitária , Humanos , Higiene/normas , Neoplasias/radioterapia , Doenças Profissionais/prevenção & controle , Doenças Profissionais/veterinária , Cuidados Paliativos/organização & administração , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Radioterapia (Especialidade)/organização & administração , Distância Social , Triagem/organização & administração
16.
Rev Bras Enferm ; 73(suppl 2): e20200260, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965401

RESUMO

OBJECTIVE: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. METHOD: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem). RESULTS: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. FINAL CONSIDERATIONS: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Instituição de Longa Permanência para Idosos , Avaliação em Enfermagem/métodos , Casas de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Brasil/epidemiologia , Comunicação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/transmissão , Técnica Delfos , Desinfecção/métodos , Desinfecção/normas , Família , Feminino , Enfermagem Geriátrica , Educação em Saúde , Humanos , Masculino , Eliminação de Resíduos de Serviços de Saúde/métodos , Pessoa de Meia-Idade , Práticas Mortuárias/métodos , Avaliação em Enfermagem/organização & administração , Avaliação em Enfermagem/normas , Saúde do Trabalhador , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Pneumonia Viral/transmissão
17.
Am J Orthod Dentofacial Orthop ; 158(5): 650-660, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32950336

RESUMO

INTRODUCTION: A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups. METHODS: A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16 years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set. RESULTS: After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures. CONCLUSIONS: A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.


Assuntos
Ensaios Clínicos como Assunto , Estética Dentária , Ortodontia , Projetos de Pesquisa , Adolescente , Criança , Consenso , Técnica Delfos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento
18.
PLoS One ; 15(9): e0239179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941481

RESUMO

Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. "Human resources interventions," "professional education and training," "medication management/reconciliation protocols," "pay-for performance (P4P) schemes and financing for safety," "digital technology solutions to improve safety," and "hand hygiene initiatives" were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (ß = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.


Assuntos
Prova Pericial , Política de Saúde , Prioridades em Saúde/normas , Segurança do Paciente/normas , Análise Custo-Benefício , Técnica Delfos , Prioridades em Saúde/economia , Prioridades em Saúde/legislação & jurisprudência , Japão , Segurança do Paciente/economia , Segurança do Paciente/legislação & jurisprudência
19.
Artigo em Inglês | MEDLINE | ID: mdl-32961660

RESUMO

Leveraging the community of practice recently established through the U.S. National Institute of Environmental Health Sciences (NIEHS) Disaster Research Response (DR2) working group, we used a modified Delphi method to identify and prioritize environmental health sciences Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and associated Coronavirus Disease 2019 (COVID-19) research questions. Twenty-six individuals with broad expertise across a variety of environmental health sciences subdisciplines were selected to participate among 45 self-nominees. In Round 1, panelists submitted research questions and brief justifications. In Round 2, panelists rated the priority of each question on a nine-point Likert scale. Responses were trichotomized into priority categories (low priority; medium priority; and high priority). A research question was determined to meet consensus if at least 69.2% of panelists rated it within the same priority category. Research needs that did not meet consensus in round 2 were redistributed for re-rating. Fourteen questions met consensus as high priority in round 2, and an additional 14 questions met consensus as high priority in round 3. We discuss the impact and limitations of using this approach to identify and prioritize research questions in the context of a disaster response.


Assuntos
Infecções por Coronavirus , Coronavirus , Saúde Ambiental , Pandemias/prevenção & controle , Pneumonia Viral , Pesquisa , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Técnica Delfos , Surtos de Doenças , Humanos , National Institute of Environmental Health Sciences (U.S.) , Pneumonia Viral/epidemiologia , Estados Unidos
20.
BMJ ; 370: m3164, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32909959

RESUMO

The CONSORT 2010 (Consolidated Standards of Reporting Trials) statement provides minimum guidelines for reporting randomised trials. Its widespread use has been instrumental in ensuring transparency when evaluating new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate impact on health outcomes.The CONSORT-AI extension is a new reporting guideline for clinical trials evaluating interventions with an AI component. It was developed in parallel with its companion statement for clinical trial protocols: SPIRIT-AI. Both guidelines were developed through a staged consensus process, involving a literature review and expert consultation to generate 29 candidate items, which were assessed by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed on in a two-day consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants).The CONSORT-AI extension includes 14 new items, which were considered sufficiently important for AI interventions, that they should be routinely reported in addition to the core CONSORT 2010 items. CONSORT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention is integrated, the handling of inputs and outputs of the AI intervention, the human-AI interaction and providing analysis of error cases.CONSORT-AI will help promote transparency and completeness in reporting clinical trials for AI interventions. It will assist editors and peer-reviewers, as well as the general readership, to understand, interpret and critically appraise the quality of clinical trial design and risk of bias in the reported outcomes.


Assuntos
Inteligência Artificial , Projetos de Pesquisa , Lista de Checagem , Protocolos Clínicos , Ensaios Clínicos como Assunto , Consenso , Técnica Delfos , Humanos
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