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1.
JAMA ; 323(1): 70-81, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910284

RESUMO

Importance: Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction. Objective: To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients. Evidence Review: Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes. Findings: The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions). Conclusions and Relevance: This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.


Assuntos
Relações Médico-Paciente , Atenção Primária à Saúde , Medicina Clínica , Comunicação , Técnica Delfos , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Fatores de Tempo
2.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31995677

RESUMO

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Assuntos
Antipsicóticos , Antagonistas Colinérgicos , Programas de Rastreamento/métodos , Conduta do Tratamento Medicamentoso/normas , Exame Neurológico/métodos , Discinesia Tardia , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Consenso , Técnica Delfos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/normas , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco/métodos , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/diagnóstico , Discinesia Tardia/terapia , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores
3.
Anaesthesia ; 75 Suppl 1: e28-e33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31903576

RESUMO

Deaths following surgery are the third largest contributor to deaths globally, and in Africa are twice the global average. There is a need for a peri-operative research agenda to ensure co-ordinated, collaborative research efforts across Africa in order to decrease peri-operative mortality. The objective was to determine the top 10 research priorities for peri-operative research in Africa. A Delphi technique was used to establish consensus on the top research priorities. The top 10 research priorities identified were (1) Develop training standards for peri-operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (2) Develop minimum provision of care standards for peri-operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (3) Early identification and management of mothers at risk from peripartum haemorrhage in the peri-operative period; (4) The role of communication and teamwork between surgical, anaesthetic, nursing and other teams involved in peri-operative care; (5) A facility audit/African World Health Organization situational analysis tool audit to assess emergency and essential surgical care, which includes anaesthetic equipment available and level of training and knowledge of peri-operative healthcare providers (surgeons, anaesthetists and nurses); (6) Establishing evidence-based practice guidelines for peri-operative physicians in Africa; (7) Economic analysis of strategies to finance access to surgery in Africa; (8) Establishment of a minimum dataset surgical registry; (9) A quality improvement programme to improve implementation of the surgical safety checklist; and (10) Peri-operative outcomes associated with emergency surgery. These peri-operative research priorities provide the structure for an intermediate-term research agenda to improve peri-operative outcomes across Africa.


Assuntos
Assistência Perioperatória/métodos , Pesquisa/estatística & dados numéricos , África , Técnica Delfos , Humanos
4.
BJOG ; 127(3): 416-423, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677228

RESUMO

OBJECTIVE: To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings. DESIGN: Modified Delphi process. SETTING: Participants from 34 countries. POPULATION: Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group. METHODS: We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in-person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts. MAIN OUTCOME MEASURE: Consensus on bundle items. RESULTS: Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher-level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym 'FAST-M'. CONCLUSION: A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus. TWEETABLE ABSTRACT: A maternal sepsis bundle for low resource settings has been developed by international consensus.


Assuntos
Pacotes de Assistência ao Paciente/métodos , Administração dos Cuidados ao Paciente , Complicações Infecciosas na Gravidez , Consenso , Técnica Delfos , Feminino , Humanos , Recém-Nascido , Cooperação Internacional , Área Carente de Assistência Médica , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Organização Mundial da Saúde
5.
Int J Paediatr Dent ; 30(1): 96-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31411790

RESUMO

Reporting guidelines can improve the quality of reports of research findings. Some specialities in health care however require guidance on areas that are not captured within the existing guidelines, and this is the case for Paediatric Dentistry where no such standards are available to guide the reporting of different types of study designs. The 'Reporting stAndards for research in PedIatric Dentistry' (RAPID) group aims to address this need by developing guidelines on reporting elements of research of particular relevance to Paediatric Dentistry. The development of RAPID guidelines will involve a five-phase process including a Delphi study, which is an explicit consensus development method designed and implemented in accordance with the Guidance on Conducting and REporting DElphi Studies. The guideline development process will be overseen by an Executive Group. Themes specific to areas in Paediatric Dentistry will be selected, and items to be included under each theme will be identified by members of the Executive Group reviewing at least five reports of experimental and analytical study types using existing reporting guidelines. For the Delphi study, the Executive Group will identify an international multidisciplinary RAPID Delphi Group (RDG) of approximately 60 participants including academics, Paediatric Dentists, parents, and other stakeholders. Each item will be evaluated by RDG on clarity using a dichotomous scale ('well phrased' or 'needs revision') and on suitability for inclusion in the Delphi study using a 9-point Likert scale (1 = 'definitely not include' to 9 = 'definitely include'). The items will then be included in an online Delphi study of up to four rounds, with participants invited from stakeholder groups across Paediatric Dentistry. Items scored 7 or above by at least 80% of respondents will be included in the checklist and further discussed in a face-to-face Delphi consensus meeting. Following this, the Executive Group will finalize the RAPID guidelines. The guidelines will be published in peer-reviewed scientific journals and disseminated at scientific meetings and conferences. All the outputs from this project will be made freely available on the RAPID website: www.rapid-statement.org.


Assuntos
Odontopediatria , Relatório de Pesquisa , Criança , Consenso , Técnica Delfos , Humanos , Projetos de Pesquisa
6.
J Urol ; 203(1): 151-158, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31464563

RESUMO

PURPOSE: Opioids are frequently overprescribed after surgery. The 2018 AUA position statement on opioid use suggests using the lowest dose and potency to achieve pain control but the lack of procedure specific prescribing guidelines contributes to wide variation in prescribing patterns. To address this gap we aimed to develop opioid prescribing recommendations through an expert panel consensus. MATERIALS AND METHODS: The 15-member multidisciplinary expert panel included representatives from 5 stakeholder groups. A 3-step modified Delphi method was used to develop recommendations for postoperative opioid prescribing. Recommendations were made for opioid naïve patients without chronic pain conditions. The panel used oxycodone 5 mg equivalents to define the number of prescribed tablets. RESULTS: Procedure specific recommendations were developed for 16 endourological and minimally invasive urological procedures. The panel agreed that not all patients desire or require opioids and, thus, the minimum recommended number of opioid tablets for all procedures was 0. Consensus ranges were identified to allow prescribed quantities to be aligned with expected needs. The maximum recommended quantity varied by procedure from 0 tablets (3 procedures) to 15 tablets (6 procedures) with a median of 10 tablets. Attending urologists typically voted for higher opioid quantities than nonattending panel members. The panel identified 8 overarching strategies for opioid stewardship, including contextualizing postoperative pain management with patient goals and preferences, and maximizing nonopioid therapies. CONCLUSIONS: Procedure specific guidelines for postoperative opioid prescribing may help align individual urologist prescribing habits with consensus recommendations. These guidelines can aid quality improvement efforts to reduce overprescribing in urology.


Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Urológicos , Técnica Delfos , Humanos , Estados Unidos
7.
J Urol ; 203(1): 164-170, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364922

RESUMO

PURPOSE: Lower urinary tract symptoms are common in men and women. Members of the LURN (Lower Urinary Tract Dysfunction Research Network) sought to create a brief, clinically relevant tool to improve existing measurements of lower urinary tract symptoms in men and women. MATERIALS AND METHODS: Using a modified Delphi methodology during an expert consensus meeting we reduced the LURN CASUS (Comprehensive Assessment of Self-Reported Urinary Symptoms) questionnaire to a brief set of clinically relevant items measuring lower urinary tract symptoms. The sum score of these items was evaluated by comparing it to the AUA SI (American Urological Association Symptom Index), the UDI-6 (Urinary Distress Inventory Short Form) in women only and the CASUS lower urinary tract symptoms screening questions using the Pearson correlation, regression analysis and ROC curves. RESULTS: The LURN SI-10 (10-Item LURN Symptom Index) assesses urinary frequency, nocturia, urgency, incontinence, bladder pain, voiding and post-micturition symptoms (score range 0 to 38). The correlation between LURN SI-10 and AUA SI scores was 0.77 in men and 0.70 in women. The UDI-6 and the LURN SI-10 correlated highly in women (r=0.76). The LURN SI-10 showed good accuracy to predict moderate and severe lower urinary tract symptoms as defined by the AUA SI (ROC AUC range 0.82-0.90). Similar accuracy was shown in predicting different levels of symptom status using the UDI-6 (AUC range 0.84-0.86). CONCLUSIONS: The LURN SI-10 correlates well with the AUA SI and the UDI-6. It includes items related to a broader spectrum of lower urinary tract symptoms, particularly incontinence, bladder pain and post-micturition symptoms, and it applies to men and women.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Consenso , Técnica Delfos , Feminino , Humanos , Masculino , Inquéritos e Questionários
8.
Shanghai Kou Qiang Yi Xue ; 28(4): 388-390, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31792479

RESUMO

PURPOSE: To evaluate the dental quality comprehensively by data model of efficacy coefficient based on the principle of multi-objective programming. METHODS: The correlation index of dental medical quality was selected by Delphi method, while the index weight was determined by the scale of the analytic hierarchy process. Then efficacy coefficient method was used to evaluate the dental quality of Shanghai Stomatological Hospital in a certain period. RESULTS: During the period of 2016-2017, the D value of the efficiency coefficient was 84.92, 83.41, 86.99 and 81.98, respectively, which demonstrated that the overall quality of the hospital was in good condition. CONCLUSIONS: The efficiency coefficient method can objectively reflect the comprehensive level of medical quality, which can provide a strong support for comprehensive evaluation and control of the quality of dental hospital.


Assuntos
Assistência Odontológica , Qualidade da Assistência à Saúde , China , Técnica Delfos
9.
Public Health ; 176: 133-141, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31796166

RESUMO

OBJECTIVE: The objective of this study was to identify priority social factors contributing to indigenous cardiometabolic diseases. STUDY DESIGN: A three-round Delphi process was used to consolidate and compare the opinions of 60 experts in indigenous cardiometabolic health from Australia, New Zealand and the United States. METHODS: Round one: three open-ended questions: (i) historical, (ii) economic and (iii) sociocultural factor contributors to cardiometabolic disease risk. Round two: a structured questionnaire based on the results from the first round; items were ranked according to perceived importance. Final round: the items were reranked after receiving the summary feedback. RESULTS: Several key findings were identified: (i) an important historical factor is marginalisation and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that the socio-economic status and educational inequalities are important; and (iii) while consensus was not reached, economic and educational factors were also perceived to be historically influential. CONCLUSION: These findings support the need for multilevel health promotion policy. For example, tackling financial barriers that limit the access to health-promoting resources, combined with improving literacy skills to permit understanding of health education.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Metabólicas/prevenção & controle , Grupos Populacionais , Determinantes Sociais da Saúde , Austrália , Consenso , Consultores , Técnica Delfos , Humanos , Nova Zelândia , Inquéritos e Questionários , Estados Unidos
10.
Metas enferm ; 22(10): 5-13, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185326

RESUMO

Objetivo: identificar las competencias necesarias para desempeñar el rol de gestora enfermera en España en cada uno de los niveles funcionales. Metodología: partiendo de la realización de una revisión bibliográfica de la literatura especializada se diseñó un estudio Delphi estructurado en cuatro rondas para consensuar las competencias necesarias para la gestora enfermera. Resultados: se obtuvo el consenso de 51 competencias, distribuidas en seis dominios. El nivel de experto se alcanza mediante estudios de máster y doctorado. La gestora enfermera tiene que desarrollar sus competencias al nivel de competente, muy competente y experto. El 96% de los integrantes del panel manifestó que para alcanzar el nivel de experto es necesario desarrollar estudios de máster o doctorado. El 60,78% de las competencias de la gestora enfermera de alta dirección debe ser desarrollada al nivel de experto mediante el desarrollo de estudios de máster, experto universitario y especialización universitaria, frente al 9,8% de la dirección logística y al 21,57% de las competencias requeridas para la dirección operativa. Para el nivel de competente serán necesarios estudios de experto, especialista universitario y formación continuada. Conclusiones: el modelo de competencias para la gestora enfermera en España se compone de 51 competencias, de las cuales ocho son básicas. De los resultados se evidencia el grado de desarrollo para cada competencia, y la formación requerida para alcanzar este grado


Objective: to identify the skills needed to play the role of Nurse Manager in Spain at each function level. Methodology: based on a bibliographic review conducted in specialized literature, a Delphi study was designed, structured into four rounds, in order to reach a consensus about the skills needed by the Nurse Manager. Results: a consensus was reached about 51 skills, classified into six domains. The level expert is achieved through master and doctorate courses. Nurse Managers must develop their skills at the following levels: Competent, Very Competent and Expert. Out of the panel members, 96% declared that in order to reach the expert level it is necessary to acquire master or doctorate degrees; 60.78% of the skills of the High Management Nurse Manager must be developed at Expert level, through Master, University Expert and University Specialty degrees, vs. 9.8% of logistical management and 21.57% of skills required for operational management. The Competent level requires Expert, University Specialist and Continuous Education degrees. Conclusions: the competency model for the Nurse Manager in Spain consists of 51 skills, including eight basic skills. The level of development for each skill is shown in results, as well as the training required to achieve said degree


Assuntos
Humanos , Papel do Profissional de Enfermagem , Enfermeiras Administradoras , Educação Continuada em Enfermagem/tendências , Supervisão de Enfermagem , Técnica Delfos , Consenso , Administração Sanitária
12.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(10): 830-840, dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185605

RESUMO

Introducción: La exposición solar en la infancia es el principal factor de riesgo para el desarrollo de cáncer de piel en la vida adulta. Las intervenciones basadas en programas y políticas de fotoprotección escolar han demostrado ser las estrategias más eficaces y coste-efectivas para la prevención del cáncer de piel. Objetivos: Elaborar un modelo de certificación que permita identificar de forma objetiva aquellos centros escolares que promueven activamente la fotoprotección. Métodos: Se empleó metodología de consenso basada en panel de expertos, recurriendo al método Delphi en 2 rondas. Se analizaron las medianas de las valoraciones de la importancia y factibilidad de cada una de las recomendaciones, y el porcentaje de respuestas positivas para los niveles de cada una de ellas. Resultados: Se obtuvo un modelo integrado por 14 recomendaciones junto a sus criterios de evaluación, relativas a 7 dimensiones: 1) liderazgo organizacional (5 recomendaciones), 2) comunicación efectiva (2 recomendaciones), 3) elementos estructurales (2 recomendaciones), 4) formación de profesionales (una recomendación), 5) currículum escolar (una recomendación), 6) modelos de conducta (2 recomendaciones) y 7) hábitos del alumnado (una recomendación). Todas las recomendaciones mostraron un alto nivel de acuerdo, tanto en la valoración de la importancia y factibilidad como en la categorización de los niveles de complejidad. Conclusión: Se trata del primer distintivo de fotoprotección escolar que se desarrolla en nuestro país. Se necesitan estudios que evalúen el grado de aceptación de la estrategia y su impacto en los hábitos de fotoprotección de los escolares


Introduction: Sun exposure during childhood is the main risk factor for skin cancer in later life. School-based sun protection policies and practices have proven to be the most effective and cost-effective strategies for preventing skin cancer. Objective: To develop a sun protection accreditation program known as «Soludable» (a play on the Spanish words sol [sun] and saludable [healthy]) to objectively identify schools that actively promote sun protection behaviors among students. Methods: The consensus method used was a 2-round Delphi technique with input from a panel of experts. We then calculated the median scores for the importance and feasibility of each of the recommendations proposed and the level of complexity assigned to each recommendation by counting the percentage of experts who chose each difficulty category. Results: The resulting accreditation model consists of 14 recommendations with corresponding evaluation criteria divided into 7 domains: 1) organizational leadership (5 recommendations), 2) effective communication (2 recommendations), 3) structural elements (2 recommendations), 4) training of professionals (1 recommendation), 5) school curriculum (1 recommendation), 6) behavioral models (2 recommendations), and 7) student habits (1 recommendation). A high level of agreement among experts was observed for all recommendations, in terms of both their perceived importance and feasibility and their categorization by levels of complexity. Conclusions: This is the first sun protection accreditation program developed for Spanish schools. Studies are needed to evaluate how this program is received and how it affects students' sun protection behaviors


Assuntos
Humanos , Queimadura Solar/prevenção & controle , Política de Saúde , Instituições Acadêmicas , Exposição Ambiental/prevenção & controle , Consenso , Técnica Delfos , Liderança , Estilo de Vida Saudável
13.
Rev Med Chil ; 147(5): 589-601, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859891

RESUMO

BACKGROUND: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. AIM: To develop a tool to conduct family studies, devised by experts in Primary Health Care. MATERIAL AND METHODS: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. RESULTS: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. CONCLUSIONS: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.


Assuntos
Técnica Delfos , Saúde da Família/normas , Atenção Primária à Saúde/normas , Inquéritos e Questionários/normas , Adulto , Chile , Continuidade da Assistência ao Paciente/normas , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes , Fatores Socioeconômicos
14.
Environ Monit Assess ; 191(12): 741, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31713051

RESUMO

The developments in information technologies have changed the values shared in the urban society and the urban dwellers' profile over time. The projects and applications that will enable the cities to reach the standards of the modern world cities have been compulsory. The concept of urban transformation has been put forward in order to solve the problems that arise in the cities and to increase the quality of life of the urban dwellers. The quality of the social and physical structure determines the quality of life in urban areas. Urban natural and cultural landscape value concepts have a broad context which includes many tangible and intangible components of the cities. Urban landscape values are the strongest factors in determining and influencing the quality of urban life due to their scope. In this study, urban landscape values of today's cities on the basis of changing social, ecological, economic, and cultural norms have been determined by gathering the opinion of 13 experts through Delphi technique. In addition, the possible effects of urban renewal applications on urban landscape values were also determined by the data gathered. At the end of the study, 15 natural and 20 cultural urban landscape values were determined and it was concluded that the urban renewal applications have a direct impact on the natural and cultural landscape values of an urban area. As a result of the study, we identified the perception of natural and cultural urban landscape values in the cities under the influence of globalization in accordance with the purpose of the study and discussed the possible effects of urban transformation practices on natural and cultural urban landscape values ​in cities with a dynamic structure and in constant interaction with the living society. In addition to creating resources for subsequent similar studies, the present study also presents the urban parameters which must be taken into account in all processes including design, implementation, and monitoring stages together starting from the planning stage of urban transformation practices.


Assuntos
Conservação dos Recursos Naturais , Técnica Delfos , Monitoramento Ambiental/métodos , Cidades , Humanos , Qualidade de Vida , Reforma Urbana
15.
Isr Med Assoc J ; 21(11): 710-715, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713356

RESUMO

BACKGROUND: The policies and practices related to medical cannabis are currently in flux. These changes have been associated with many controversies, and there is a lack of consensus within the medical community regarding medical cannabis practices. OBJECTIVES: To validate clinical vignettes that can be used to examine and improve medical cannabis practices. METHODS: Ten physicians participated in a Delphi survey of two consequent rounds in which they quantified the eligibility of medical cannabis therapy for six clinical vignettes describing both chronic pain and cancer patients. RESULTS: Higher consensus was achieved for the vignettes of cancer patients, which were additionally rated as more eligible for medical cannabis therapy. The highest level of consent (4.3 out of 5) was achieved regarding a vignette of a metastatic cancer patient. While in some cases physicians consolidated their ratings toward the group's average, in other cases they remained stable in their responses. CONCLUSIONS: While controversies related to medical cannabis are expected to remain rampant, the validated vignettes may facilitate assessment of clinical practices, which is essential for a successful implementation of medical cannabis policies. These vignettes may additionally be used in medical training for appropriate patient selection for medical cannabis authorization.


Assuntos
Dor do Câncer/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Tomada de Decisão Clínica , Maconha Medicinal , Neoplasias/tratamento farmacológico , Técnica Delfos , Humanos , Israel
16.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 752-758, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185567

RESUMO

Antecedentes y objetivo: La formulación de calcipotriol y dipropionato de betametasona (Cal/BD) en espuma para el tratamiento de la psoriasis vulgar presenta una alternativa galénica y una mayor eficacia respecto a presentaciones anteriores. El objetivo de este estudio fue evaluar la satisfacción de pacientes y médicos con este tratamiento para la psoriasis corporal. Material y métodos: Estudio observacional retrospectivo en el que se incluyeron 446 pacientes con psoriasis en placas con una superficie de afectación máxima del 30% tratados con Cal/BD en espuma durante las 4 semanas previas. Los pacientes valoraron la satisfacción con el tratamiento mediante el cuestionario TSQM-9 (Treatment Satisfaction Questionnaire for Medication) y los médicos mediante una escala Likert de 5 puntos. Resultados: En la evaluación de la eficacia de la medicación, los pacientes mostraron una alta satisfacción con la capacidad de Cal/BD en espuma en el tratamiento de su psoriasis (84%), alivio de síntomas (84,4%) y rapidez de acción (82,8%). Respecto a la comodidad en usar la medicación, el 91,8% de los pacientes valoraron positivamente la facilidad de uso, el 93,9% la facilidad en la planificación y el 89,9% la facilidad en el seguimiento de la posología. Globalmente, el 85% de los pacientes se mostraron satisfechos/sumamente satisfechos con el tratamiento. Respecto a la satisfacción con el tratamiento por parte de los médicos, el 85,7% se mostraron muy/bastante satisfechos. Conclusión: Cal/BD en espuma mostró altas tasas de satisfacción por parte de pacientes y médicos en el tratamiento de la psoriasis vulgar en el cuerpo


Background and objective: Calcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body. Material and methods: Retrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale. Results: Patients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment. Conclusion: Both patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Beclometasona/uso terapêutico , Psoríase/tratamento farmacológico , Resultado do Tratamento , Satisfação do Paciente , Calcitriol/uso terapêutico , Estudos Retrospectivos , Inquéritos e Questionários/normas , Técnica Delfos , Aerossóis/uso terapêutico
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 91, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623634

RESUMO

BACKGROUND: The Basic-Trauma Management (BTM) course has been taught to third-year medical students in small groups for many years without substantial changes. With the introduction of a new curriculum for Swiss medical students, it was necessary to revise the BTM content and re-align it. Our aim was to identify core competencies for the revised BTM course. METHODS: We applied a three-round step-wise Delphi consensus. First, we asked open-ended questions on what were the most important competencies to be taught for BTM; the second round used Likert scales to ensure agreement on the competencies; and the final round reached out for consensus on these BTM competencies. Stakeholders were selected based on their long-standing experience in teaching BTM and in managing trauma patients. RESULTS: Consensus was found on 29 competencies out of an initial 130 proposals. "Human Factors", which had not been taught previously, scored relatively high, at 22%. The sole specific trauma skill agreed upon was the use of tourniquets. CONCLUSIONS: This is an example of curricular revision of a clinical skills course after the introduction of a regulatory framework for undergraduate medical education. The revised course curriculum tailors the concepts and skills in trauma that fulfill stakeholder needs, and are in agreement with the new Swiss learning outcomes.


Assuntos
Educação Baseada em Competências , Currículo , Educação de Graduação em Medicina , Traumatologia/educação , Competência Clínica , Técnica Delfos , Humanos , Estudantes de Medicina , Suíça , Ensino
18.
Int J Gynaecol Obstet ; 147(2): 134-139, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31571233

RESUMO

OBJECTIVE: To develop a Core Outcome Set (COS) for pregnancy nutrition research that is relevant to varied stakeholders and resource settings. METHODS: This study has three distinct phases. The first phase involves generating a list of outcomes for consideration for the COS. This includes a systematic review of studies evaluating nutrition during pregnancy where all outcomes reported in relevant literature will be extracted. Qualitative interviews with currently or previously pregnant women will also be conducted. This step will supplement the findings of the systematic review by identifying additional outcomes of importance to this stakeholder group. In the second phase of the study, healthcare professionals, researchers, and mothers from various international resource settings will be invited to participate in a two-round modified Delphi survey. The aim of the survey is to gain consensus on which outcomes are most important to include in the COS. Finally, a face-face consensus meeting will be held with a select group of participants to finalize the COS. CONCLUSION: This COS will support standardization of outcome reporting in pregnancy nutrition research and ensure that selected outcomes are considered important by a variety of stakeholders. This will enhance the evidence behind nutrition interventions in pregnancy to improve outcomes for pregnant women.


Assuntos
Consenso , Fenômenos Fisiológicos da Nutrição Pré-Natal , Técnica Delfos , Feminino , Humanos , Gravidez , Resultado da Gravidez , Pesquisa Qualitativa , Revisão Sistemática como Assunto , Adulto Jovem
19.
J Shoulder Elbow Surg ; 28(11): 2061-2071, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542325

RESUMO

BACKGROUND: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies. METHODS: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least two-thirds agreement. RESULTS: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue). CONCLUSION: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed.


Assuntos
Artroplastia do Ombro/efeitos adversos , Atitude do Pessoal de Saúde , Consenso , Técnica Delfos , Humanos , Inquéritos e Questionários
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