Characterizing spontaneously reported cognitive complaints: the development and reliability of a classification instrument

2012 ◽  
Vol 25 (1) ◽  
pp. 157-166 ◽  
Author(s):  
Daniel Apolinario ◽  
Rafaela Branco Miranda ◽  
Claudia Kimie Suemoto ◽  
Regina Miksian Magaldi ◽  
Alexandre Leopold Busse ◽  
...  
Keyword(s):  
High Reliability ◽  
Phase 1 ◽  
Observer Agreement ◽  
Medical Attention ◽  
Cognitive Complaints ◽  
Cognitive Difficulties ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Practical Tool ◽  
Perceived Cognitive Function

ABSTRACTBackground: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument.Methods: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q).Results: The patients reported 493 spontaneous complaints, with a range of 1–6 complaints per patient and a mean of 2.7 (±1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the κ statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated.Conclusion: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.

Achieving Consensus on Leadership Competencies and Outcome Measures

2005 ◽  
Vol 28 (4) ◽  
pp. 428-446 ◽  
Author(s):  
Julie A. Mcdougal ◽  
C. Michael Brooks ◽  
Mark Albanese
Keyword(s):  
Outcome Measures ◽  
Leadership Training ◽  
Phase 1 ◽  
Nominal Group Technique ◽  
Leadership Competencies ◽  
Nominal Group ◽  
Evaluation Instrument ◽  
Modified Delphi ◽  
Formal Program ◽  
Modified Delphi Technique

Pediatric Pulmonary Centers (PPCs) are federally funded interdisciplinary leadership training programs aiming to improve the health of families and children. This article describes the process PPCs used to efficiently and effectively achieve consensus on leadership training competencies and outcome measures among a large and diverse group of health professionals. Phase 1 used a modified Delphi technique to develop an initial set of competencies and outcome measures. Phase 2 used the nominal group technique and modified focus group strategies to refine and prioritize the competencies and outcomes measures. Participants reported being highly satisfied with the process and outcomes. In Phase 3, a formal program evaluation instrument was implemented, designed to measure the competency and describe the career paths and leadership accomplishments of previous trainees. The consensus process adopted can serve as a model for academic and public health entities seeking to achieve consensus on program goals, strategies, methods, priorities, and outcomes.

scholarly journals P125: Introduction of extracorporeal cardiopulmonary resuscitation (ECPR) into emergency care: a feasibility study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S101-S101
Author(s):  
D. Rollo ◽  
P. Atkinson ◽  
J. Fraser ◽  
J. Mekwan ◽  
J. P. French ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Phase 1 ◽  
Hospital Setting ◽  
Regional Hospital ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Modified Delphi ◽  
Phase Study ◽  
Number Of Patients ◽  
Modified Delphi Technique ◽  
Poor Outcomes

Introduction: Traditionally, out of hospital cardiac arrests (CA) have poor outcomes. Incorporation of extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly to supplement ACLS to provide better outcomes for patients. Current literature suggests potentially improved outcomes, including neurological function. We assessed the feasibility of introduction of ECPR to a regional hospital using a 4-phase study. We report phase-1, an estimation of the number of potential candidates for ECPR in our setting. Methods: Following development and agreement on local criteria for selection of patients for ECPR using a modified Delphi Technique, inclusion and exclusion criteria were applied retrospectively, to a database comprising 4 years of emergency department (ED) cardiac arrests (n=395). This provided estimates of the number of patients who would have qualified for EMS transport for ECPR and initiation of ECPR in the ED. Results: Application of criteria would result in 20.0% (95% CI 16.2-24.3%) of CA being transported to the ED for ECPR (mean 18.5 patients per year). In the ED 4.6% (95% CI 2.83-7.26%) would be eligible to receive ECPR (4.3 patients per year). Incorporating downtime criteria, 3.0% (95% CI 1.6-5.3%) qualify. After considering local in-house cardiac catheterization hours 9.4% (95% CI 6.8-12.9%) and 5.4% (95% CI 3.5-8.2%), without and with EMS rhythm assumptions respectively, would be eligible for transport. For placement on pump, 3.0% (95% CI 1.6-5.3%) and 2.4% (95% CI 1.2-4.6%), without and with use of total downtime respectively, were eligible. Conclusion: If historical patterns of CA were to continue, we believe that an ECPR program may be feasible in our regional hospital setting, with a small number of selected cardiac arrest patients meeting eligibility for transportation and initiation of ECPR. These numbers suggest that an ECPR program would not be resource intensive, yet would be sufficiently busy to maintain adequate team competency.

The Hospice Farewell: Ideological Perspectives of its Professional Practitioners

1990 ◽  
Vol 21 (4) ◽  
pp. 283-300 ◽  
Author(s):  
Anoel Rinaldi ◽  
Michael C. Kearl
Keyword(s):  
Hospice Care ◽  
National Sample ◽  
High Rate ◽  
Older Individuals ◽  
Modified Delphi ◽  
Death Denial ◽  
Cultural Climate ◽  
Quality Of Death ◽  
Modified Delphi Technique ◽  
Professional Practitioners

This research examines a social service devoted to “good deaths” in our country: hospice. Using a modified Delphi technique, a national sample of hospice experts ( n = 48) was questioned in order to elicit group judgments about hospice ideology, the issue of control over one's own death trajectory, and hospice's relevance for older individuals. The respondents generally concurred that hospice, influenced by the work of Kübler-Ross, represents a radical departure in how we die, a reaction to the quality of death within a cultural climate of death denial, and, in some sense, a demodernization movement. While a high rate of consensus was obtained on many of the issues that evolved, little evidence of a coherent ideology could be detected linking notions of hospice origins, issues of patient control, and suitability of hospice care for older individuals.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field.MethodsThe authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document

2017 ◽  
Vol 21 (6) ◽  
pp. 513-524 ◽  
Author(s):  
Afsaneh Alavi ◽  
Charles Lynde ◽  
Raed Alhusayen ◽  
Marc Bourcier ◽  
Isabelle Delorme ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Hidradenitis Suppurativa ◽  
Expert Panel ◽  
Scientific Evidence ◽  
Treatment Modalities ◽  
Modified Delphi ◽  
Consensus Document ◽  
Expert Opinions ◽  
Modified Delphi Technique ◽  
Necrosis Factor

Background: Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. Objectives: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. Methods: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. Results: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. Conclusions: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti–tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.

FEMORAL NECK FRACTURES AND CLASSIFICATIONS RELIABILITY: ARE WE USING REPRODUCIBLE SYSTEMS?

2021 ◽  
pp. 2150015
Author(s):  
Emilio Enrietti ◽  
Marco Bechis ◽  
Giulia Nicolaci ◽  
Domenico Messina ◽  
Michele Reboli ◽  
...  
Keyword(s):  
Femoral Neck ◽  
High Reliability ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Observer Agreement ◽  
Type I ◽  
X Rays ◽  
Correct Treatment ◽  
Femur Fractures ◽  
Pauwels Classification

Introduction: Classification systems for femoral neck fractures are very helpful for surgeons in order to choose the correct treatment. The purpose of this study was to verify the reliability and reproducibility in the most used classifications for proximal medial femoral fracture: Garden and Pauwels classifications. Materials and methods: Five surgeons independently classified 82 intra-capsular femur fractures treated with 3 cannulated screws using Pauwels and Garden classifications measured on pre- and post-operatively X-Rays. Inter-observer agreement was calculated for both classifications using the multi-rater Fleiss’ kappa; intra-observer agreement from pre-operative to post-operative XRs for Pauwels classification was also calculated with the same method. Results: Only six cases of AVN were registered. The inter-observers agreement based on pre-operative X-rays was moderate for Pauwels classification ([Formula: see text] 0.528) and slightly lower for Garden classification ([Formula: see text] 0.448); but in the simplified Garden classification (type I and II not displaced vs type III and IV displaced) the agreement measured was almost perfect ([Formula: see text] 0.908). The intra-observer agreement for Pauwels classification was moderate ([Formula: see text] 0.456). All the results were statistically significant. Conclusions: This is the first study evaluating the Pauwels angle on both preoperative and postoperative X-rays to assess their reproducibility. Garden classification has a really high reliability and reproducibility in evaluating displaced and not displaced fractures and consequently can be helpful in choosing the correct treatment. Pauwels classification has a lower inter and intra-observer agreement.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

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