eDelphi

eDelphi
  • 文章类型: Journal Article
    背景:在全球范围内,免疫抑制的特征和细分为临床风险组的方式存在明显的不一致.这不利于疾病监测工作的准确性和可比性,这对免疫抑制者的护理及其健康结果具有负面影响。这在COVID-19大流行期间尤其明显;尽管集体动机保护这些患者,相互矛盾的临床定义在这段时间内如何监测和管理免疫抑制患者方面造成了国际分歧.我们建议围绕导致免疫抑制的条件及其与COVID-19有关的严重程度建立国际临床共识。然后可以将这些信息形式化为数字表型,以增强疾病监测,并提供对这些患者进行风险优先排序的急需情报。
    目的:我们的目的是展示电子德尔菲目标,方法论,和统计方法将有助于解决国际上缺乏共识的问题,并为成人免疫抑制提供COVID-19风险分层表型。\"
    方法:利用现有证据证明免疫抑制的成人COVID-19结果不均匀,这项工作将招募50多名世界领先的临床医生,研究,或免疫学或临床风险优先领域的政策专家。经过2轮临床共识构建和1轮总结辩论,这些小组成员将确认应被归类为免疫抑制的医疗状况及其对COVID-19的差异脆弱性。还将提出关于这些风险的时间和剂量依赖性的共识声明。这项工作将迭代进行,小组成员有机会在各轮之间提出澄清问题,并提供持续的反馈以改进问卷项目。统计分析将侧重于答复之间的协议水平。
    结果:该方案概述了一种有效的方法,用于提高对COVID-19成人免疫抑制的定义和有意义的细分的共识。小组成员的招募发生在2024年4月至5月之间;实现了为50多名小组成员设定的目标。该研究于5月底启动,数据收集预计于2024年7月结束。
    结论:本方案,如果全面实施,将提供一个普遍接受的,临床相关,和成人免疫抑制的电子健康记录兼容表型。除了对COVID-19资源优先排序具有立竿见影的价值外,这项研究及其结果对所有不成比例地影响免疫抑制患者的疾病的临床决策具有前瞻性价值.
    PRR1-10.2196/56271。
    BACKGROUND: Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts-which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients.
    OBJECTIVE: We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for \"adult immunosuppression.\"
    METHODS: Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses.
    RESULTS: This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024.
    CONCLUSIONS: This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record-compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed.
    UNASSIGNED: PRR1-10.2196/56271.
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  • 文章类型: Journal Article
    背景:荷兰的研究人员提出了积极健康支柱(PPH)作为广泛涵盖的健康定义,以支持对患有慢性病和其他终身健康状况的人进行更现实和有意义的护理计划。PPH随后被转换为MyPositiveHealth(MPH)蜘蛛网可视化工具。这项研究旨在确定在家庭护理中更多以人为中心的护理计划的机会,使用MPH工具作为将全面评估和基于对话的目标设定联系起来的框架。
    方法:使用改进的eDelphi方法与有目的地采样的专家小组(n=25)进行域映射。小组由研究人员组成,卫生保健提供者,老年人和照顾者。进行了两阶段的eDelphi过程,每个阶段由三轮调查组成。在第一阶段,参与者被要求将interRAI家庭护理(interRAIHC)综合评估工具的201个要素映射到6个MPH领域或"无最佳拟合支柱".第二阶段的重点是确定适应或扩大与MPH领域相关的综合评估的机会。
    结果:在第1阶段,201个元素中的189个在域映射中达成共识。其中包括:身体功能的80个元素,32用于日常功能,32精神健康,24生活质量10参与1是有意义的。确定了十个元素没有最佳匹配的支柱。在第1阶段未达成共识的12个要素构成了第2阶段的基础,在第2阶段,专家小组的参与者提出了“意义和参与”中的4个新评估要素以及6个MPH领域的11个额外描述符。其中,11个描述符中的两个元素和9个达成共识。
    结论:研究结果表明,内部RAIHC的元素朝向物理,功能,和心理健康领域。因此,可能需要补充评估元素和/或工具来支持对以人为本的家庭和社区护理中的“有意义”和“参与”的全面评估。还可能需要附加的描述符来帮助关于MPH域的理解和应用的通信。
    BACKGROUND: Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting.
    METHODS: A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or \"No pillar of best fit\". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains.
    RESULTS: In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus.
    CONCLUSIONS: Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of \'Meaningfulness\' and \'Participation\' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.
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  • 文章类型: Journal Article
    慢性肾脏病(CKD)是猫发病和死亡的重要原因。目前尚未就CKD治疗试验中哪些结果最重要,以协助循证决策达成一致。核心结果集(COSs)起源于人类医疗保健,是一套商定的结果,在与特定疾病有关的任何试验中,作为最低限度进行测量和报告。为了建立猫科动物CKD的COS,本研究使用了系统综述和两种共识方法(电子德尔菲(eDelphi),和面对面的共识会议),与一个由主要利益相关者组成的国际小组。系统审查确定了104个独特的已发布参数,在eDelphi的第1轮中由小组成员进行评级。小组成员还被要求提出其他参数。在第2轮中,对这些另外的参数进行评级,并且在第1轮中>10%的小组成员不理解的任何参数被重新定义和重新评级。在第1轮和第2轮中达成共识的参数已从第3轮中删除,所有其余参数均由小组成员重新评估,他们可以查看自己的先前评级以及整个小组的中位数评级。为了纳入COS,超过80%的小组成员必须以1-9的Likert量表将参数评为8或9(其中1不重要,9非常重要)。在协商一致的会议上,小组成员讨论并重新评估了边界参数,并简化了最终的COS。边界线参数是那些最接近的,但没有实现,纳入的80%门槛。eDelphi面板(n=73)评估了24/104个参数,足以包含在内,并提出了另外20个参数,其中3个达到了纳入阈值。这总共有27个参数供列入。共识会议小组(n=16)对额外的6/20边界线参数进行了评估,足以包含在内。在精简过程中,4个参数被删除,因为一个被认为不是结果,还有三个已经被其他参数解决了。其余的COS共有29个参数。这些被分为9个核心主题:临床检查,生活质量,血清生物化学,全血细胞计数,尿液分析,吃的食物总量,CKD进展,生存时间和死亡原因。这是第一个用于猫科动物药物的COS。在未来的治疗效果试验中,COS将加强这种情况的证据基础,通过更容易地比较研究之间的结果,减少研究浪费。
    Chronic Kidney Disease (CKD) is an important cause of feline morbidity and mortality. There is currently no agreement on which outcomes are most important in CKD treatment trials to assist evidence-based decision making. Core Outcome Sets (COSs) originated in human healthcare and are an agreed set of outcomes to be measured and reported as a minimum in any trial conducted relating to a particular disease. To establish a COS for feline CKD, this study used a systematic review and two consensus methodologies (an electronic Delphi (eDelphi), and an in-person consensus meeting), with an international panel of key stakeholders. The systematic review identified 104 unique published parameters, which were rated by panellists in round 1 of the eDelphi. Panellists were also asked to suggest additional parameters. In round 2 these additional parameters were rated and any parameters not understood by >10 % of panellists in round 1 were redefined and re-rated. Parameters reaching consensus in rounds 1 and 2 were removed from round 3, when all remaining parameters were re-rated by panellists who could view their own previous rating alongside the median rating of the whole panel. To reach inclusion in the COS, parameters had to be rated 8 or 9 on a Likert scale of 1-9 (where 1 was not important and 9 was very important) by more than 80 % of panellists. In the consensus meeting, panellists discussed and re-rated borderline parameters and streamlined the final COS. Borderline parameters were those that had been closest to, but not achieved, the 80 % threshold for inclusion. The eDelphi panel (n = 73) rated 24/104 parameters highly enough for inclusion and proposed an additional 20 parameters, of which 3 reached the inclusion threshold. This totalled 27 parameters for inclusion. The consensus meeting panel (n = 16) rated an additional 6/20 borderline parameters highly enough for inclusion. During the streamlining process, 4 parameters were removed as one was considered not an outcome, and three were already addressed by other parameters. The remaining COS totalled 29 parameters. These were grouped into 9 core themes: clinical examination, quality of life, serum biochemistry, complete blood count, urinalysis, total amount of food eaten, CKD progression, survival time and cause of death. This is the first COS for feline medicine. In future treatment efficacy trials the COS will strengthen the evidence-base for this condition, by facilitating easier comparison of results between studies, and reduce research waste.
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  • 文章类型: Journal Article
    As patients are increasingly searching for information about their medical condition on the internet, there is a need for health professionals to be able to guide patients toward reliable and suitable information sources on the internet.
    The aim of the study was to develop a clinical tool for health care professionals to assess the usability and quality of the content of websites containing medical information that could be recommended to patients.
    A 3-round modified electronic Delphi (eDelphi) study was conducted with 20 health care professionals.
    In round one of the eDelphi study, of the 68 items initially created, 41 items (29 on usability and 12 on content) were rated as important or very important by more than half of the panel and thus selected for further evaluation in round two. In round two, of the 41 items chosen from round 1, 19 were selected (9 on usability and 10 on content) as important or very important by more than half of the panel for further evaluation. As a result of round three, 2 items were combined as a single item, leaving the instrument with 18 items in total (8 on usability and 10 on content). The tool is freely accessible online.
    The CUE-tool can be used to (1) evaluate the usability and reliability of the content of websites before recommending them to patients as a good information source; (2) identify websites that do not have reliable content or may be difficult for patients to use; (3) develop quality websites by using the criteria in the CUE-tool; and (4) identify different qualities between different websites.
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  • 文章类型: Journal Article
    尽管有不利影响,抗精神病药物经常用于治疗痴呆的行为和心理症状。定期监测抗精神病药处方已被证明可以提高处方的适当性。然而,目前还没有就这种监测工具的组成部分达成共识。
    这项研究的目的是使用专家共识程序来确定抗精神病药重复处方工具的关键组成部分,该工具适用于一般实践中的痴呆症患者。
    采用了改进的eDelphi技术。我们邀请了痴呆症患者抗精神病药处方的多学科专家参加。这些专家包括全科医生(GP),老年医生和老年精神病医生。第一轮的发言清单是通过审查现有监测工具和国际最佳做法准则制定的。在德尔福的第二轮中,任何在第一轮中未达成共识的声明都被提交重新评级,对小组和个人的具体陈述的回应进行个性化反馈。最后一轮由面对面的专家会议组成,以解决第二轮的任何不确定性。
    在两次eDelphi回合和一次面对面共识会议上,总共对23个项目进行了评级,总共产生了18个认可项目和5个拒绝项目。认可的声明告知了一个结构化的发展,在初级保健中监测痴呆症患者抗精神病药物的重复处方工具。
    重复处方工具的开发为全科医生提供了当前指南中缺乏的实用建议,并将通过提供结构化格式来支持全科医生,以在审查痴呆症患者的抗精神病药物处方时使用。最终改善患者护理。现在需要在临床实践中评估该工具的可行性和可接受性。
    UNASSIGNED: Despite their adverse effects, antipsychotics are frequently used to manage behavioral and psychological symptoms of dementia. Regular monitoring of antipsychotic prescribing has been shown to improve the appropriateness of prescribing. However, there is currently no consensus on what the components of such a monitoring tool would be.
    UNASSIGNED: The aim of this study was to use an expert consensus process to identify the key components of an antipsychotic repeat prescribing tool for use with people with dementia in a general practice setting.
    UNASSIGNED: A modified eDelphi technique was employed. We invited multidisciplinary experts in antipsychotic prescribing to people with dementia to participate. These experts included general practitioners (GPs), geriatricians and old age psychiatrists. The list of statements for round 1 was developed through a review of existing monitoring tools and international best practice guidelines. In the second round of the Delphi, any statement that had not reached consensus in the first round was presented for re-rating, with personalized feedback on the group and the individual\'s response to the specific statement. The final round consisted of a face-to-face expert meeting to resolve any uncertainties from round 2.
    UNASSIGNED: A total of 23 items were rated over two eDelphi rounds and one face-to-face consensus meeting to yield a total of 18 endorsed items and five rejected items. The endorsed statements informed the development of a structured, repeat prescribing tool for monitoring antipsychotics in people with dementia in primary care.
    UNASSIGNED: The development of repeat prescribing tool provides GPs with practical advice that is lacking in current guidelines and will help to support GPs by providing a structured format to use when reviewing antipsychotic prescriptions for people with dementia, ultimately improving patient care. The feasibility and acceptability of the tool now need to be evaluated in clinical practice.
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  • 文章类型: Journal Article
    背景:本文介绍了“VEctorboRneDiseAses范围审查”(VERDAS)联盟针对Vectors发出的呼吁所采取的总体方法,世界卫生组织主办的热带病研究和培训特别方案环境与社会股。该项目的目的是进行广泛的知识综合,并确定在城市环境中控制和预防媒介传播疾病的知识差距。
    方法:该联盟由14名研究人员组成,13名研究助理,还有一名来自加拿大七个不同机构的研究协调员,哥伦比亚,巴西,法国,西班牙,布基纳法索。为财团进行的范围审查制定了六步协议,基于Arksey和O\'Malley开发并由Levac等人改进的框架。第一步,通过国际eDelphi咨询确定了六个主题。在接下来的四个步骤中,进行了范围审查。第六步是2017年3月在哥伦比亚举行的VERDAS研讨会。
    结论:在本文中,我们讨论了遇到的几个方法论问题,并分享了我们对这项工作的思考。我们认为,该协议提供了一个详尽而严格的过程的强有力的例子,可以对任何给定的主题进行广泛的知识综合,并且应在未来的研究计划和多个领域的捐助者议程中予以考虑,以科学地强调研究需求。
    BACKGROUND: This paper presents the overall approach undertaken by the \"VEctor boRne DiseAses Scoping reviews\" (VERDAS) consortium in response to a call issued by the Vectors, Environment and Society unit of the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization. The aim of the project was to undertake a broad knowledge synthesis and identify knowledge gaps regarding the control and prevention of vector-borne diseases in urban settings.
    METHODS: The consortium consists of 14 researchers, 13 research assistants, and one research coordinator from seven different institutions in Canada, Colombia, Brazil, France, Spain, and Burkina Faso. A six-step protocol was developed for the scoping reviews undertaken by the consortium, based on the framework developed by Arksey and O\'Malley and improved by Levac et al. In the first step, six topics were identified through an international eDelphi consultation. In the next four steps, the scoping reviews were conducted. The sixth step was the VERDAS workshop held in Colombia in March 2017.
    CONCLUSIONS: In this article, we discuss several methodological issues encountered and share our reflections on this work. We believe this protocol provides a strong example of an exhaustive and rigorous process for performing broad knowledge synthesis for any given topic and should be considered for future research initiatives and donor agendas in multiple fields to highlight research needs scientifically.
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  • 文章类型: Journal Article
    在精神卫生服务中,在国际边界上司空见惯的是,为了防止好斗的患者伤害自己,其他患者或工作人员,强制措施,最重要的是,需要采取暴力管理策略。没有协议,来自欧盟的建议或指示,在欧盟各国应采取哪些强制措施,没有一个整体的最佳实践方法。
    这个项目是通过一个专家组构思的,欧洲精神病学研究小组(EViPRG)。该研究旨在纳入欧盟和多学科的回应,以确定17个欧洲国家的暴力管理做法以及相关的研究和教育优先事项。从EVIPRG成员,每个国家的一名成员同意担任其国家的国家项目协调员。鉴于受访者的国际传播,本研究设计和数据收集采用eDelphi调查方法。开发了一种调查仪器,通过EVIPRG成员同意和验证。
    结果包括来自17个国家的2809名受访者,其中999名受访者自我选择参加第2轮eDelphi。大多数受访者从事急性精神病学工作,54%(n=1511);门诊部,10.5%(n=295);和法医,9.3%(n=262)。受访者的其他工作领域包括康复,初级保健和急诊。令人关切的是,19.5%的受访者没有接受过暴力管理培训。在暴力患者的管理中最常用的干预措施是身体约束,隐居和药物。教育和研究的最高优先事项包括:预防暴力;环境和工作人员对暴力程度的影响;管理暴力的最佳做法;风险评估以及暴力和侵略的病因和触发因素。
    在许多欧洲国家,在精神卫生服务中与暴力管理有关的程序和政策问题上缺乏明确性。欧洲的暴力管理实践似乎支离破碎,没有明确的意识形态立场或合作教育和研究。在欧洲,语言差异是现实,可能会导致孤立的思维,然而,它绝不能被视为分享最佳实践的障碍。
    In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach.
    The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG.
    The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression.
    In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice.
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  • 文章类型: Journal Article
    BACKGROUND: The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards.
    METHODS: The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided.
    UNASSIGNED: For each round, the SurveyMonkey\'s email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds.
    CONCLUSIONS: An online survey provided numerous advantages over traditional survey approaches including high quality data collection, ease and speed of survey administration, direct communication with the panel and rapid collation of feedback allowing data collection to be undertaken in 12 weeks. Only minor challenges were experienced using the technology. Ethical issues, specific to using the Internet to conduct research and external hosting of web-based software, lacked formal guidance.
    CONCLUSIONS: High response rates and an increased level of data quality were achieved in this study using web-survey software and the process was efficient and user-friendly. However, when considering online survey software, it is important to match the research design with the computer capabilities of participants and recognize that ethical review guidelines and processes have not yet kept pace with online research practices.
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