Gain Consensus Research Articles

Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group

To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.

S2560 A Rare Case of a Bleeding Duodenal Varix Causing Hemodynamic Instability

Introduction: Variceal bleeding is a life-threatening complication of portal hypertension (PH), affecting 25-35% of patients with cirrhosis. Duodenal varices are uncommon, accounting for 0.4% of variceal bleeds from PH, but are associated with poor outcomes. Presented is a rare case of a bleeding duodenal varix (DV) causing hemodynamic instability in a patient with cirrhosis. Case Description/Methods: A 42-year-old male with polysubstance abuse and alcoholic cirrhosis complicated by PH and esophageal varices (EV) presented via emergency medical services after being found down in the street. The patient was hypotensive, tachycardic to the 140s, and febrile to 40.4 degrees Celsius. Physical exam was remarkable for blood covering his lower extremities and a large blood clot in his rectum. Labs were significant for a hemoglobin of 6.7 g/dl, platelet count of 68 K/MM3, white blood count of 15.6, bilirubin of 4.4 mg/dL, ammonia of 76 umol/L, and lactic acid of 4.2. Triphasic computed tomography of the abdomen and pelvis with intravenous (IV) contrast showed cirrhotic liver morphology and thickening of the ascending colon. Two units of packed red blood cells, IV pantoprazole, and IV octreotide were given. An emergent esophagogastroduodenoscopy demonstrated PH gastropathy, non-bleeding EV, and a 5-millimeter bleeding DV (Figure a). To achieve temporary hemostasis, two clips were placed over the DV with plan for Interventional Radiology (IR) to definitively control bleeding with embolization (Figure b). Abdominal ultrasound with Doppler demonstrated a patent portal venous system. Venogram showed DV fed by inflow from the superior mesenteric venous circulation with outflow via an enlarged right gonadal vein. Retrograde coil embolization resulted in complete resolution of bleeding (Figure c). Discussion: Common sites of variceal bleeding include the esophagus and stomach. Though DVs are rare, it is essential to gain consensus on the optimal approach to treatment as the mortality rate is up to 40% due to origination of DVs in the deep serosal layer and high vascularity of the duodenum. In this case, clips were used to achieve hemostasis followed by embolization for definitive cessation of bleeding. Clips also served as a landmark for IR to target during the venogram and coil embolization. Clips on their own may not be sufficient to control duodenal bleeding as there is risk of inadequate occlusion of vessels or tissue perforation. This multimodal approach offers an effective path to managing bleeding DV.Figure 1.: (a) 5-millimeter bleeding duodenal varix, as indicated by arrow. (b) Duodenal varix after placement of hemostatic clips, as indicated by arrow. (c) Venogram with retrograde coil embolization of the duodenal varix.

New ERAS in liver transplantation - Past, present, and next steps.

There are parallels between the history of Enhanced Recovery after Surgery (ERAS) and liver transplantation. Both have been established and advanced by innovative individuals, often going against perceived wisdom and convention. Liver transplantation has traditionally been considered too complex for ERAS pathways, despite a small number of trials showing them to be both safe and of benefit. To date, there are very few randomized controlled trials and cohort studies publishing outcomes on liver transplant patients enrolled in comprehensive ERAS pathways. To progress our field, the 2022 International Liver Transplantation Society's Consensus Conference has created expert panels to analyze the evidence in 32 domains of the liver transplantation pathway using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to generate expert recommendations. These recommendations will be voted on by the international community to gain consensus using the Danish model, and create the ERAS4OLT.org Enhanced Recovery after Liver Transplantation Pathway.

Stakeholder identified research priorities for early intervention in psychosis.

Public resources to answer pertinent research questions about the impact of illness and treatment on people with mental health problems are limited. To target funds effectively and efficiently and maximize the health benefits to populations, prioritizing research areas is needed. Research agendas are generally driven by researcher and funder priorities, however, there is growing recognition of the need to include user-defined research priorities to make research more relevant, needs-basedand efficient. To gain consensus on top priorities for research into early intervention in psychosis through a robust, democratic process for prioritization enlisting the views of key stakeholders including users, carersand healthcare professionals. We also sought to determine which user-prioritized questions were supported by scientific evidence. We used a modified nominal group technique to gain consensus on unanswered questions that were obtained by survey and ranked at successive stages by a steering group comprising users, carer representativesand clinicians from relevant disciplines and stakeholder bodies. We checked each question posed in the survey was unanswered in research by reviewing evidence in five databases (Medline, Cinahl, PsychInfo, EMBASEand Cochrane Database). Two hundred and eighty-threequestions were submitted by 207 people. After checking for relevance, reframingand examining for duplicates, 258 questions remained. We gained consensus on 10 priority questions; these largely represented themes around access and engagement, information needs before and after treatment acceptance, and the influence of service-user (SU) priorities and beliefs on treatment choices and effectiveness. A recovery SUtheme identified specific self-management questions and more globally, a need to fully identify factors that impact recovery. Published research findings indicated that the priorities of service users, carersand healthcare professionals were aligned with researchers' and funders' priorities in some areas and misaligned in others providing vital opportunities to develop research agendas that more closely reflect users' needs. Initial results were presented at stakeholder workshops which included service-users, carers, health professionalsand researchers during a consensus workshop to prioritize research questions and allow the opportunity for feedback. Patient and public representatives formed part of the steering group and were consulted regularly during the research process.

Exploring community knowledge, attitudes and perceptions of Alzheimer's Disease/Alzheimer's Disease-Related Dementias and healthy ageing in Asian American, Native Hawaiian and Pacific Islanders.

Alzheimer's disease and related dementias (AD/ADRD) disparities exist in the rapidly growing and extremely heterogeneous Asian American and Native Hawaiian and Pacific Islander (NH/PI) ageing populations in the United States. Limited community-clinical resources supporting culturally competent and timely diagnosis exacerbate barriers to existing care services in these populations. Community-based participatory research or community-engaged research are proven community-academic research approaches that can support the development and implementation of community-focused programmes to maximise community benefit. The NYU Center for the Study of Asian American Health engaged our national and local community partners to gain a deeper understanding of AD/ADRD in this diverse and growing population, to develop a strategic community-engaged research agenda to understand, address and reduce AD/ADRD disparities among Asian American and NH/PI communities. Findings from an initial scoping review identified significant research gaps. We conducted a series of key informant interviews (n= 11) and a modified Delphi survey (n= 14) with Asian American and NH/PI community leaders and older adult service providers followed by a facilitated group discussion of survey findings to gain consensus on key priority research areas identified in the literature and to determine culturally and contextually appropriate approaches to support AD/ADRD prevention, early identification and treatment in Asian American and NH/PI communities. Future research and health education should focus on raising Asian American and NH/PI basic individual- and community-level awareness about AD/ADRD and leveraging existing community assets to integrate effective engagement strategies to access AD/ADRD services within the healthcare system.

International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity.

To gain consensus from physical therapists on pediatric lower limb neurological tests of muscle strength, tactile sensitivity, and reflexes. A Delphi technique was used for 2 sequential questionnaire rounds to gain consensus from a panel of pediatric physical therapists (n = 28). Physical therapists rated their agreement to items from statements on pediatric lower limb neurological tests, their protocols, and interpretation using a 6-point Likert scale. Ninety percent of items gained consensus: 80% on pediatric lower limb neurological tests, 88% on test protocols, and 92% on test interpretation. Fifty-one percent of items had high agreement and high importance. There is variability in pediatric neurological tests used, their protocols, and interpretation. Identification of items with high agreement and importance is the first step to develop a standardized lower limb neurological assessment for pediatric clients of varying ages and diagnoses.

Defining adequacy of staffing in general hospital wards: a Delphi study

ObjectivesTo gain consensus on the items that determine adequacy of shift staffing.DesignThis was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general...

Case study on the novel permitting and authorization of PacWave South, a US grid-connected wave energy test facility: Development, challenges, and insights

Marine energy (i.e., energy from waves, tides, currents) in the United States is a nascent industry. In particular, permitting processes—an uncertainty for industry advancement that can be costly and time consuming to navigate—have rarely been tested and used for marine energy. The novelty of the marine energy industry and utilization of open ocean permitting processes that were not originally developed for marine energy have led to extensive efforts to gain consensus amongst state and federal regulatory agencies to authorize marine energy projects. In 2021, Oregon State University successfully completed permitting of a wave energy test facility, called PacWave South, off the coast of Oregon, which is designed to advance wave energy research and development. This article documents the multi-year process that Oregon State University used to receive federal and state authorization for a pre-permitted commercial-scale grid-connected facility by detailing the development of the test facility, management of uncertainty and challenges, and key decisions. The PacWave South case study provides insights for the larger marine energy community as the industry advances towards commercialization.

TQM model based on Deming prize for schools

PurposeThis paper aims to develop a total quality management (TQM) model based on the Deming prize criteria extracted from the Deming Prize. The proposed model is aligned with the school education context and deployed with the goal of achieving school excellence.Design/methodology/approachThe model is developed based on a literature review in which key concepts for formulating the criteria and sub-criteria were identified. A qualitative research approach is applied to validate the model’s effectiveness. Interviews and feedback from an international school in Japan which adopted the model are used to determine its impact.FindingsThe model emphasises the achievement of school objectives (A) by implementing TQM activities (B) and assessing their impact (C). Its implementation offers enhanced organisational ability and the achievement of society-oriented school objectives. The findings show that the model gives clarity to TQM application and offers benefits for schools’ future sustainability.Originality/valueThis research proposes the adoption of a TQM model for educational institutions based on Deming criteria. Based on a comparison with prescriptive models such as Malcolm Baldrige National Quality Award and ISO 9001, this study shows how the developed model ensures organisational ability in current practice and future growth towards school excellence. Through the formulation of society-oriented school objectives and their linkage with results, it enables schools to create a balanced recognition of important stakeholders and gain consensus in realising the school’s objectives.

What patient assessment skills do pharmacist independent prescribers require to prescribe immunomodulators in myeloma?

To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing immunomodulators in myeloma across National Health Service Scotland. This was a two-phase study which used nominal group technique to gain local consensus followed by a two-round eDelphi questionnaire to gain national consensus across all cancer networks. This project was conducted across the three cancer networks within NHS Scotland: South East Scotland Cancer Network; West of Scotland Cancer Network and North Cancer Alliance. Participants were invited from each cancer network (South East Scotland Cancer Network, West of Scotland Cancer Network and North Cancer Alliance) and included haematology consultants, haematology specialist registrars, haematology advanced nurse practitioners and haematology pharmacists. There were five participants in the nominal group technique. Twenty-two out of 31 patient assessment skills gained local consensus, seven patient assessment skills did not gain consensus and two patient assessment skills were deemed irrelevant. There were 12 and 14 participants in round one and two of the eDelphi questionnaire, respectively. Twenty-nine patient assessment skills were included in the first-round questionnaire and 21 gained consensus. The remaining eight patient assessment skills were included in round two where seven did not achieve consensus and one achieved disagreement consensus. This research outlines 21 patient assessment skills required for pharmacist independent prescribers to prescribe immunomodulators for myeloma patients according to haematology specialists in Scotland. Discussion on patient assessment skills without consensus showed that the pharmacist independent prescribers would have a shared responsibility with the consultant. This work should inform the development of a competency framework to allow training of pharmacist independent prescribers in Scotland. Some patient assessment skills could be transferrable for pharmacist independent prescribers prescribing systemic anti-cancer therapy for other haematological malignancies.

Overcoming Challenges to Inclusive User-based Testing of Health Information Technology with Vulnerable Older Adults: Recommendations from a Human Factors Engineering Expert Inquiry

Involving representative users in usability testing of health information technology (HIT) is central to user-centered design. However, (vulnerable) older adults as representative users have unique requirements. Aging processes may affect physical capabilities and cognitive skills, which can hamper testing with this demographic and may require special attention and revised protocols. This study was performed to provide expert-based recommendations for HIT user-testing with (vulnerable) older adults to support inclusive HIT design and evaluation. First, we conducted a structured workshop with ten experts in HIT implementation and research, recruited through purposeful sampling, to generate insights into how characteristics of older adults may influence user-testing. Next, five Human Factor researchers experienced in HIT user-testing with (vulnerable) older adults validated the results and provided additional textual insights to gain consensus on the most important recommendations. A thematic analysis was performed on the resulting inquiries. Applied codes were based on the User-Centered Design framework. The analysis resulted in nine recommendations for user-testing of HIT with older adults, divided into three main themes: (1) empathetic approach and trust-building, (2) new requirements for testing and study design, and (3) adjustments to usability evaluation methods. For each theme a checklist of relevant items to follow-up on the recommendation is provided. The recommendations generated through expert inquiry contribute to more effective usability testing of HIT with older adults. This provides an important step towards improved accessibility of HIT amongst older adults through inclusive user-centered design.

Staying Current: Developing Just-in-time Evidence-Based Learning Objectives for a Maternal Cardiac Arrest Simulation Curriculum

Background:Our objective was to review the latest evidence on resuscitation care for maternal cardiac arrest (MCA) and gain expert consensus on best practices to inform an evidence-based curriculum.Methods:We convened a multidisciplinary panel of stakeholders in MCA to develop an evidence-based simulation training, Obstetric Life Support™ (OBLS). To inform the learning objectives, we used a novel three-step process to achieve consensus on best practices for maternal resuscitation. First, we reaffirmed the evidence process on an existing MCA guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II). Next, via systematic review, we evaluated the latest evidence on MCA and identified emerging topics since the publication of the MCA guideline. Finally, we applied a modified Research and Development (RAND) technique to gain consensus on emerging topics to include as additional just-in-time best practices.Results:The AGREE II survey results demonstrated unanimous consensus on reaffirmation of the 2015 American Heart Association (AHA) MCA guideline for inclusion into the OBLS curriculum. A systematic review with deduplication resulted in 11,871 articles for review. After categorizing and synthesizing the relevant literature, we presented twelve additional best practices to the expert panel using a modified RAND technique. Upon completion, the 2015 AHA statement and nine additional just-in-time best practices were affirmed to inform the OBLS curriculum.Conclusions:A novel three-step process including reaffirmation of evidence process, systematic review, and a modified RAND technique resulted in unanimous consensus from experts in MCA resuscitation on existing and new just-in-time best practices to inform the learning objectives for an evidence-based curriculum.

Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic.

BackgroundHealthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor to the spread of the 2020 pandemic. Timely review of HCA cases is essential to identify learning to inform infection prevention and control (IPC) policies and organisational response.AimTo identify key areas for improvement through rapid investigation of HCA SARS-CoV-2 cases and to implement change.MethodsCases were identified based on date of first positive SARS-CoV-2 PCR sample in relation to date of hospital admission. Cases were reviewed using a structured gap analysis tool to identify key learning points. These were discussed in weekly multidisciplinary meetings to gain consensus on learning outcomes, level of harm incurred by the patient and required actions. Learning was then promptly fed back to individual teams and the organisation.FindingsOf the 489 SARS-CoV-2 cases admitted between 10th March and 23rd June 2020, 114 suspected HCA cases (23.3%) were reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were identified: individual patient vulnerability, communication, IPC implementation, policy issues and organisational response. Adaptations to policies based on these reviews were completed within the course of the initial phase of the pandemic.ConclusionThis approach enabled timely learning and implementation of control measures and policy development.

International consensus on diagnosis and management of Dravet syndrome.

ObjectiveThis study was undertaken to gain consensus from experienced physicians and caregivers regarding optimal diagnosis and management of Dravet syndrome (DS), in the context of recently approved, DS‐specific therapies and emerging disease‐modifying treatments.MethodsA core working group was convened consisting of six physicians with recognized expertise in DS and two representatives of the Dravet Syndrome Foundation. This core group summarized the current literature (focused on clinical presentation, comorbidities, maintenance and rescue therapies, and evolving disease‐modifying therapies) and nominated the 31‐member expert panel (ensuring international representation), which participated in two rounds of a Delphi process to gain consensus on diagnosis and management of DS.ResultsThere was strong consensus that infants 2–15 months old, presenting with either a first prolonged hemiclonic seizure or first convulsive status epilepticus with fever or following vaccination, in the absence of another cause, should undergo genetic testing for DS. Panelists agreed on evolution of specific comorbidities with time, but less agreement was achieved on optimal management. There was also agreement on appropriate first‐ to third‐line maintenance therapies, which included the newly approved agents. Whereas there was agreement for recommendation of disease‐modifying therapies, if they are proven safe and efficacious for seizures and/or reduction of comorbidities, there was less consensus for when these should be started, with caregivers being more conservative than physicians.SignificanceThis International DS Consensus, informed by both experienced global caregiver and physician voices, provides a strong overview of the impact of DS, therapeutic goals and optimal management strategies incorporating the recent therapeutic advances in DS, and evolving disease‐modifying therapies.

V02-01 DESIGN AND VALIDATION OF A NON-BIOHAZARDOUS SIMULATION MODEL FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 May 2022V02-01 DESIGN AND VALIDATION OF A NON-BIOHAZARDOUS SIMULATION MODEL FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Ahmed Ghazi, Rachel Melnyk, John Melnyk, Rajat Jain, Scott Quarrier, Amy Krambeck, Nicole Miller, Narang Gopal, and Mitchell Humphreys Ahmed GhaziAhmed Ghazi More articles by this author , Rachel MelnykRachel Melnyk More articles by this author , John MelnykJohn Melnyk More articles by this author , Rajat JainRajat Jain More articles by this author , Scott QuarrierScott Quarrier More articles by this author , Amy KrambeckAmy Krambeck More articles by this author , Nicole MillerNicole Miller More articles by this author , Narang GopalNarang Gopal More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: HoLEP is a an underutilized, minimally invasive approach for the management of benign prostatic hyperplasia. Its steep learning curve and lack of realistic simulation platforms with incorporated objective metrics has hindered the adoption of this technique. Our aim is to demonstrate the design and validation of a high-fidelity non-biohazardous hydrogel platform fabricated to specifications attained through expert consensus. METHODS: Validation was completed in 3 phases: Phase 1, Delphi methodology to gain consensus from an expert panel of endourologists. Consensus (>80% agreement) over 3 rounds defined 81 essential elements. Phase 2, Prototype development: these essential items were incorporated into prototypes fabricated using a combination of hydrogel molding and 3D printing. Phase 3: Validation comparing 6 experts and 6 novices performance from 4 centers using the consensus based objective and subjective metrics. RESULTS: The model contained all 9 anatomic components (ex. bladder, ureteric orifices, lateral and median lobes, capsule, urethra), 7 objective evaluation metrics (ex. injury of ureteric orifices or bladder neck, perforation of the bladder or prostate capsule), and 5 procedural steps except for hemostasis and morcellation. Categorically overall utility, anatomical and procedural components, tissue fidelity, and assessment of performance received an 82%, 78%, 73% and 82% satisfaction score by experts respectively. Laser and instrument tissue interactions achieved highest (>85%) satisfaction. Experts outperformed novices in enucleation time (15.1 vs 47.5 min p=0.001), weight of adenoma resected (75.5 vs 49 g p=0.04) and developed global evaluation too (27 vs 15.8 p=0.001). All experts agreed the model could provide a safe training alternative, be used to evaluate trainee performance, and trial new approaches in a risk-free environment. CONCLUSIONS: This is the first consensus-based approach to design and provide initial validation of a non-biohazardous HoLEP simulation with incorporated evaluation metrics capable of supplementing HoLEP training. Further validation studies are required to establish its effectiveness as a training platform. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e111 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ghazi More articles by this author Rachel Melnyk More articles by this author John Melnyk More articles by this author Rajat Jain More articles by this author Scott Quarrier More articles by this author Amy Krambeck More articles by this author Nicole Miller More articles by this author Narang Gopal More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement PDF DownloadLoading ...

517 Understanding Distinctions in the Implementation of Learning Health System (LHS)

OBJECTIVES/GOALS: The LHS concept has been promoted as a means for health systems to improve quality, safety, efficiency and equity. NAMs definition has been widely adopted, but is broad and has led to variation in how LHS is operationalized. Drawing on a taxonomy developed through a review of literature, we developed a tool that shows how LHSs are implemented in practice. METHODS/STUDY POPULATION: The LHS Implementation Assessment Tool (LHS-IAT) will indicate which forms of work are being carried out by a health system that purports to operate a LHS. LHS-IAT is based on the LHS Consolidated Framework (LHS-CF); which was developed through a qualitative analysis of LHS literature. LHS-CF contains 38 primary elements’ and 56 secondary elements’ that have been associated with the LHS construct. These elements are organized into 5 bodies of work• (e.g.; translating evidence into practice) and 4 enabling conditions• (e.g.; supportive culture). LHS-IAT assesses whether a health system operating as an LHS is implementing each of the key elements in LHS-CF. The usefulness of LHS-IAT will be demonstrated by applying the tool to 5 LHSs that have been described in the literature. RESULTS/ANTICIPATED RESULTS: LHS-IAT produces a quantitative profile for any given health system operating as a LHS; each LHS element is assessed as either emphasized; otherwise present; or absent. With this information, we create profiles for each implementation of LHS, using spider graphs. Systems that emphasize different elements will have different shapes for their spider graphs. Based on our initial coding of publications, we expect at least 4 distinct profiles within our sample, reflecting differences in emphasis on factors such as: continuous improvement practices, adoption of internally and externally tested interventions, research conducted to address patient care issues prioritized by institutional leaders, investigator-initiated research, clinician-engaged research, and engagement of patients and families. DISCUSSION/SIGNIFICANCE: The LHS-IAT will show differences in how health systems are translating the LHS concept into practice. This will allow for a shared language for those studying and/or implementing LHS. With the ability to map out an approach, health system leaders will have a tool to clarify intent and gain consensus as to which LHS model they want to implement and invest in.

An e-Delphi study to obtain expert consensus on the level of risk associated with preventable e-prescribing events.

AimsWe aim to seek expert opinion and gain consensus on the risks associated with a range of prescribing scenarios, preventable using e‐prescribing systems, to inform the development of a simulation tool to evaluate the risk and safety of e‐prescribing systems (ePRaSE).MethodsWe conducted a two‐round e‐Delphi survey where expert participants were asked to score pre‐designed prescribing scenarios using a five‐point Likert scale to ascertain the likelihood of occurrence of the prescribing event, likelihood of occurrence of harm and the severity of the harm.ResultsTwenty‐four experts consented to participate with 15 pand 13 participants completing rounds 1 and 2, respectively. Experts agreed on the level of risk associated with 136 out of 178 clinical scenarios with 131 scenarios categorised as high or extreme risk.ConclusionWe identified 131 extreme or high‐risk prescribing scenarios that may be prevented using e‐prescribing clinical decision support. The prescribing scenarios represent a variety of categories, with drug–disease contraindications being the most frequent, representing 37 (27%) scenarios, and antimicrobial agents being the most common drug class, representing 28 (21%) of the scenarios. Our e‐Delphi study has achieved expert consensus on the risk associated with a range of clinical scenarios with most of the scenarios categorised as extreme or high risk. These prescribing scenarios represent the breadth of preventable prescribing error categories involving both basic and advanced clinical decision support. We will use the findings of this study to inform the development of the e‐prescribing risk and safety evaluation tool.

Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique

BackgroundTransitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions.MethodsA modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors’: i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis.ResultsTwenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors.ConclusionsPriority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs.

A Delphi Study to Establish Research Priorities for Neuroscience Nursing.

BACKGROUND: Establishing research priorities is essential not only to support evidence-based nursing practice but also to direct research agendas for nursing organizations such as the American Association of Neuroscience Nursing. METHODS: A 6-member Research Agenda Task Force selected potential research priorities based on a literature search of neuroscience nursing research. Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 neuroscience nursing experts to gain consensus on the research priorities for neuroscience nursing. Survey data included demographics, agreement with selected gaps in neuroscience nursing research, and impact of selected neuroscience nursing research topics on the field. RESULTS: Twenty-six of 53 experts (49% response rate) participated in round 1, and 30 of 53 experts (57% response rate) participated in round 2. In round 1, the Research Agenda Task Force members revised the list of gaps in neuroscience nursing research to include only the top 39 ranked topics with greater than or equal to 73% agreement, created a new category "Professional Practice Issues," and added 1 additional topic. In round 2, 14 topics were ranked greater than or equal to 70% impactful and identified as the top neuroscience nursing research priorities. CONCLUSION: The results of this study served as an effort for creating research priorities and enhancing research collaboration that focuses on neuroscience nursing. Focusing on gaps in the literature and setting research priorities can ultimately improve patient outcomes. Neuroscience nursing research priorities can be used to inform, guide, and aid nurse scientists, educators, and providers, and to inform agencies that provide research and program funding.

First Nations Australians\u2019 self-determination in health and alcohol policy development: a Delphi study

BackgroundRecognition of the role of structural, cultural, political and social determinants of health is increasing. A key principle of each of these is self-determination, and according to the United Nations (2007), this is a right of Indigenous Peoples. For First Nations Australians, opportunities to exercise this right appear to be limited. This paper explores First Nations Australian communities’ responses to reducing alcohol-related harms and improving the health and well-being of their communities, with a focus on understanding perceptions and experiences of their self-determination. It is noted that while including First Nations Australians in policies is not in and of itself self-determination, recognition of this right in the processes of developing health and alcohol policies is a critical element. This study aims to identify expert opinion on what is needed for First Nations Australians’ self-determination in the development of health- and alcohol-related policy.MethodsThis study used the Delphi technique to translate an expert panel’s opinions into group consensus. Perspectives were sought from First Nations Australians (n = 9) and non-Indigenous Peoples (n = 11) with experience in developing, evaluating and/or advocating for alcohol interventions led by First Nations Australians. Using a web-based survey, this study employed three survey rounds to identify and then gain consensus regarding the elements required for First Nations Australians’ self-determination in policy development.ResultsTwenty panellists (n = 9 First Nations Australian) participated in at least one of the three surveys. Following the qualitative round 1 survey, six main themes, 60 subthemes and six examples of policy were identified for ranking in round 2. In round 2, consensus was reached with 67% of elements (n = 40/60). Elements that did not reach consensus were repeated in round 3, with additional elements (n = 5). Overall, consensus was reached on two thirds of elements (66%, n = 43/65).ConclusionsSelf-determination is complex, with different meaning in each context. Despite some evidence of self-determination, systemic change in many areas is needed, including in government. This study has identified a starting point, with the identification of elements and structural changes necessary to facilitate First Nations Australian community-led policy development approaches, which are vital to ensuring self-determination.