远程营养不良应用程序(R-MAPP)是在COVID-19大流行期间开发的,旨在为在社区工作的医疗保健专业人员(HCP)提供支持,以完成远程营养评估,并为营养保健提供实际指导。这项研究的目的是将R-MAPP修改为适合儿童的版本,儿科远程营养不良应用(Pedi-R-MAPP),并提供一种结构化的方法来完成以营养为重点的评估,作为技术支持护理服务(TECS)咨询的一部分。
完成了十步过程:1)修改成人R-MAPP的权限,2)文献检索告知Pedi-R-MAPP内容,3)Pedi-R-MAPP草案,4)使用TECS对HCP实践的国际调查,5)邀请营养专家参与改良的Delphi过程,6)第一次利益相关者会议,以商定工具的目的/草案,7)第一轮在线调查,8)从调查中删除共识的声明,9)针对未达成共识的声明的第二轮在线调查,以及10)第二次利益相关者会议,最终确定了Pedi-R-MAPP营养意识工具。
由463个HCP完成的国际调查,55%的儿科医生,38%的营养师,7%的护士/其他人。当HCP被要求回顾过去12个月时,营养师(n=110)报告说,每10个预约中有5.7±10.6个是亲自完成的;相比之下,儿科医生(n=182)报告每10个预约中有7.5±7.0个是亲自完成的(p<0.0001),其余的作为TECS咨询完成。总的来说,确定并使用了74篇文章来开发Pedi-R-MAPP,其中包括使用交通信号灯系统的颜色编码建议;绿色,琥珀色,红色和紫色。18名参与者同意参加Delphi共识,并完成了两轮修改后的Delphi调查。在第一次会议上就拟议工具的目的和草案各节达成了协议。在第一轮在线调查中,86%(n=89/104)的声明达成共识,而在第二轮中,12.5%(n=13/104)的陈述没有达成共识。在第二次专家会议上,对有争议的陈述进行讨论,直到达成协议并最终确定Pedi-R-MAPP。
使用改良的德尔菲共识开发了Pedi-R-MAPP营养意识工具。该工具旨在通过提供一种结构化的方法来完成以营养为重点的远程评估,从而支持COVID-19大流行快速跟踪的技术转型,以及确定随访的频率以及可能需要亲自评估的儿童。
The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation.
A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no
consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool.
The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi
consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached
consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no
consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised.
The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi
consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.