Co‐Design of a Registry‐Based Tailored Follow‐up Service Intervention for People Living With Stroke: A Multiple Method Consensus Approach

International Association for Hospice and Palliative Care list of essential medicines for palliative care

As an effective treatment for spinal metastasis (SM), ERAS protocol can significantly reduce the length of hospital stay and complications in patients. Establishing an ERAS program for perioperative care after SM surgery is a clinical problem that needs to be addressed urgently. We aimed to develop an Enhanced Recovery After Surgery (ERAS) program and Surgical Safety Checklist (SSC) that conferred clinical benefit to patients with SM and made it relatively easy to manage the condition. We believe that our findings could help establish and promote the continuous improvement of additional ERAS programs for SM. This is a modified Delphi study. We used a two-round process using data acquired from a review of relevant literature and involving a multidisciplinary panel of experts from different hospitals in China. The modified Delphi survey was conducted from February 1, 2024 to April 20, 2024. The experts were invited to evaluate each of the current relevant ERAS recommended topics to determine the appropriateness of inclusion in the ERAS program and SSC with the 5-point Likert scale. Used the results to create specific ERAS and SSC (70% consensus) programs. Close to consensus (65%-69% consensus) findings were considered for the follow-up survey. A multicenter, multidisciplinary group of physicians (n = 75), including clinical workers, researchers, anesthesiologists, nursing specialists, psychologists, nutritionists, and caregivers, with experience in managing patients with SM, were asked to participate. Using the modified Delphi process, we arrived at a consensus for the ERAS program. This included 37 consolidated items in the domains in the following order: preoperative, intraoperative, postoperative, and discharge. The SSC included 37 consolidated items in the domains in the following order: before the induction of anesthesia, before skin incision, and before the patient leaves the operating room. This study, based on the modified Delphi process, helped us develop ERAS and SCC consensus-driven best practice recommendations, including suggestions related to perioperative anesthesia, surgery, and nursing for SM. We hope that this study, in which we integrated both traditional Chinese and Western medical treatment protocols, can provide a basis for a rapid rehabilitation program for surgical interventions in SM.

Despite efforts to provide evidence-based care for people living with kidney disease, health care provider goals and priorities are often misaligned with those of individuals with lived experience of disease. Coupled with competing interests of time, resources, and an abundance of suitable guideline topics, identifying and prioritizing areas of focus for the Canadian nephrology community with a patient-oriented perspective is necessary and important. Similar priority-setting exercises have been undertaken to establish research priorities for kidney disease and to standardize outcomes for kidney disease research and clinical care; however, research priorities are distinct from priorities for guideline development. Inclusion of people living with health conditions in the selection and prioritization of guideline topics is suggested by patient engagement frameworks, though the process to operationalizing this is variable. We propose that the Canadian Society of Nephrology Clinical Practice Guideline Committee (CSN CPGC) takes the opportunity at this juncture to incorporate evidence-based prioritization exercises with involvement of people living with kidney disease and their caregivers to inform future guideline activities. In this protocol, we describe our planned research methods to address this. To establish consensus-based guideline topic priorities for the CSN CPGC using a modified Delphi survey with involvement of multidisciplinary stakeholders, including people living with kidney disease and their caregivers. Protocol for a Modified Delphi Survey. Pilot-tested surveys will be distributed via email and conducted using the online platform SurveyMonkey, in both French and English. We will establish a group of multidisciplinary clinical and research stakeholders (both within and outside CSN membership) from Canada, in addition to people living with kidney disease and/or their caregivers. A comprehensive literature search will be conducted to generate an initial list of guideline topics, which will be organized into three main categories: (1) International nephrology-focused guidelines that may require Canadian commentary, (2) Non-nephrology specific guidelines from Canada that may require CSN commentary, and (3) Novel topics for guideline development. Participants will engage in a multi-round Modified Delphi Survey to prioritize a set of "important guideline topics." Consensus will be reached for an item based on both median score on the Likert-type scale (≥ 7) and the percentage agreement (≥ 75%); the Delphi process will be complete when consensus is reached on each item. Guideline topics will then be given a priority score calculated from the total Likert ratings across participants, adjusted for the number of participants. Potential limitations include participant response rates and compliance to survey completion. We propose to incorporate evidence-based prioritization exercises with the engagement of people living with kidney disease and their caregivers to establish consensus-based guideline topics and inform future guidelines activities of the CSN CPGC.

Purpose : The purpose of this study is to derive basic information for constructing a systematic clinical practice manual by comparing and analyzing clinical practice manuals conducted by each university in optometry and other fields. Methods : In this study, clinical practice manuals of optometry conducted by each university were compared and analyzed with manuals in other fields. Clinical practice manuals of optometry were reviewed in four categories such as procedure and application, operation standards, accreditation standards, and operation subject while manuals in other fields were reviewed through four categories such as introduction of clinical practice, understanding of clinical practice, clinical practice operation method and evaluation. Results : As a result of comparing the clinical training manuals in each university, it was found that the procedure and utilization, accreditation standards, and subjects were not unified, and there was a limit to the importance of clinical training in the curriculum. On the other hand, the on-site training manuals of the four occupational groups (radiologist technologist, physical therapist, nurse assistant and emergency medical technician) are generally well equipped with evaluation elements and show a unified operation method. Conclusion : An integrated and systematic clinical training manual to redeem the expertise of prospective optometric students is insufficient. In order to accumulate more experience, it is necessary to develop and implement a standard manual for clinical practice that allows students to experience the job of an optometrist and improve their job skills evenly.

Creating a Clinical Care Pathway for Depressive Symptoms and Disorders in Long-Term Care: A Modified Delphi Process.

Stakeholder perspectives on the reduction of opioid exposure in ICU: A modified Delphi survey.

To develop core competencies for learning health system (LHS) researchers to guide the development of training programs. Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings. The competencies were developed from August to December 2016 using qualitative methods. The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n=19 members) consensus development meetings produced the final set of competencies. The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field. The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs.

Postmortem magnetic resonance imaging (PMMRI) following fetal and perinatal demise is increasingly used in clinical practice as a non-invasive adjunct or alternative to autopsy. Imaging protocols vary widely between centers and there is currently no consensus. From expert consensus, we aimed to develop two PMMRI protocols for pragmatic clinical perinatal imaging: first, a standardized "minimal" PMMRI clinical protocol (with the minimum essential sequences needed per body part), and second, an "ideal" PMMRI clinical protocol with the ideal full protocol, time allowing. A modified Delphi survey was conducted, between July and November 2024, among members of the European Society of Paediatric Radiology (ESPR) postmortem (PM) Task Force, of the PM imaging committee of the Society for Pediatric Radiology (SPR) and the Australian and New Zealand Society for Paediatric Radiology (ANZSPR). The survey was based on two pre-existing published PMMRI protocols and consisted of two multiple-choice tables which included all the MRI sequences in different planes according to each body part with an additional 10 PMMRI organizational questions (three of which were free text, seven multiple choice). An email containing the link to the survey was sent to 22 members of the different international PM imaging taskforces, recruited on a voluntary basis, given their clinical interest and experience in practicing perinatal PM imaging. The results were collected and analyzed in a descriptive manner, and a point-of-care PMMRI clinical protocol was established based on the recommendations of our expert panelists. Nineteen PM imaging specialists from 17 centers worldwide (Europe, the USA, Canada, Australia, and New Zealand) completed the survey and formed our expert panel. By consensus (defined as > 60% agreement), the final "minimal" PMMRI clinical protocol includes three-dimensional (3-D) isovolumetric T2- and T1-weighted sequences of brain (72.2% and 77.8% respectively) and chest-abdomen-pelvis (83.3% and 77.8% respectively). The "ideal" PMMRI clinical protocol includes 3-D isovolumetric T2- and T1-weighted sequences of the whole body (66.7-100%; 61.1 - 91.7% respectively) with axial susceptibility-weighted imaging (SWI) (81.3%) and diffusion-weighted imaging (DWI) (68.8%) of the brain. Additional sequence if time allows is axial T2 turbo spin echo (TSE) (56.3%) of the brain. As a minimum, 3-D isovolumetric T1- and T2-weighted sequences of the brain and body, acquired together in a single station, should be performed as part of a perinatal clinical PMMRI protocol. We hope these recommendations will facilitate the standardization and globalization of perinatal PMMRI in clinical practice.

<h3>Objectives</h3> To develop a minimum dataset to be routinely collected across a heterogenous population within a subacute rehabilitation service to guide best care and outcomes for patients, and value for...

ObjectivesTo develop a minimum dataset to be routinely collected across a heterogenous population within a subacute rehabilitation service to guide best care and outcomes for patients, and value for the...

Interactive technology and games provide promising methods for wheelchair skills training. This paper introduces RollAbility, a rehabilitative game for powered wheelchair skills training aimed at children and teenagers with complex movement disorders. The game combines clinical best practices and standardized training protocols with player experience goals. Developed through an iterative process with rehabilitation experts and game designers, RollAbility utilizes the Wheelchair Skills Training Program [Kirby et al. '23] and integrates key insights from Aufheimer's [CHI '23] motivation studies in physical therapy to ensure both therapeutic and engaging gameplay. Evaluated through exploratory sessions with children, therapists, and clinical experts, results show that RollAbility effectively merges clinical protocols with an engaging game format. However, balancing player autonomy and therapist guidance remains a critical consideration. This work offers a blueprint for designing therapeutic games that align clinical protocols with engaging player experiences.

ObjectivesClinicians, patients, and policy makers rely on published results from clinical trials to help inform evidence-based decision-making. To be able to critically evaluate and use the results of trials, readers...

ObjectivesClinicians, patients, and policy makers rely on published results from clinical trials to help inform evidence-based decision-making. To be able to critically evaluate and use the results of trials, readers...

BackgroundComparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research. The objective in this study was to develop a core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy.MethodsFirstly, eligible outcomes were identified through a systematic review of trials of medication review in older patients (≥65 years) and interviews with 15 older patients. Secondly, an international three-round Delphi survey in four countries involving patients, healthcare professionals, and experts was conducted to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results.ResultsOf the 164 participants invited to take part in the Delphi survey, 150 completed Round 1, including 55 patients or family caregivers, 55 healthcare professionals, and 40 experts. A total of 129 participants completed all three rounds. Sixty-four eligible outcomes were extracted from 47 articles, 32 clinical trial protocols, and patient interviews. Thirty outcomes were removed and one added after Round 1, 18 outcomes were removed after Round 2, and seven after Round 3. Results were discussed during consensus meetings. Consensus was reached on seven outcomes, which constitute the core outcome set: drug-related hospital admissions; drug overuse; drug underuse; potentially inappropriate medications; clinically significant drug-drug interactions; health-related quality of life; pain relief.ConclusionsWe developed a core outcome set of seven outcomes which should be used in future trials of medication review in multi-morbid older patients with polypharmacy.

This study aimed to develop a cosmesis scale to evaluate the cosmetic appearance of hemodialysis (HD) arteriovenous (AV) accesses from the perspective of the patient and clinician, which could be incorporated into clinical trials. Using a modified Delphi process, two AV access cosmesis scale (AVACS) components were developed in a four-round Delphi panel consisting of two surveys and two consensus meetings with two rounds of patient consultation. The Delphi panel consisted of 15 voting members including five interventional or general nephrologists, five vascular surgeons, three interventional radiologists, and two vascular access nurse coordinators. Four patients experienced with vascular access were involved in patient question development. For a component to be included in the AVACS, it had to meet the prespecified panel consensus agreement of ⩾70%. The clinician component of the AVACS includes nine questions on the following AV access features: scarring, skin discoloration, aneurysm/pseudoaneurysms and megafistula appearance. The patient component includes six questions about future vascular access decisions, interference with work or leisure activities, clothing choices, self-consciousness or attractiveness, emotional impact, and overall appearance. Delphi panel methods are subjective by design, but with expert clinical opinion are used to develop classification systems and outcome measures. The developed scale requires further validation testing but is available for clinical trial use. While safety and efficacy are the primary concerns when evaluating AV access for HD, cosmesis is an important component of the ESKD patient experience. The AVACS has been designed to assess this important domain; it can be used to facilitate patient care and education about vascular access choice and maintenance. AVACS can also be used to inform future research on developing new techniques for AV access creation and maintenance, particularly as relates to AV access cosmesis.