Personalising care of adults with asthma from Asia: a modified e-Delphi consensus study to inform management tailored to attitude and control profiles

Abstract REALISE Asia—an online questionnaire-based study of Asian asthma patients—identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal–control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal–control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal–control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.

Download Full-text

SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training

British Journal of Surgery ◽

10.1093/bjs/znab361.031 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

A.J. Beamish ◽

M Rabie ◽

M.J. Johnston ◽

D Nally ◽

G Humm ◽

...

Keyword(s):

Surgical Training ◽

Annual Review ◽

Free Text ◽

Delphi Consensus ◽

Online Questionnaire ◽

Consensus Recommendations ◽

Modified Delphi ◽

Surgical Trainees ◽

Training Standards ◽

The Will

Abstract Background The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Methods An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members. Results Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets. Conclusions UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.

Download Full-text

Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

BMC Primary Care ◽

10.1186/s12875-021-01613-7 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Esma Sümeyya Bilgin ◽

Rojda Ülgüt ◽

Nils Schneider ◽

Stephanie Stiel

Keyword(s):

Palliative Care ◽

General Practice ◽

Delphi Study ◽

Health Care Research ◽

Free Text ◽

Delphi Consensus ◽

Intervention Package ◽

Online Questionnaire ◽

Junior Research ◽

Strongly Agree

Abstract Background The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines. Aim A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice. Methods The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions. Results The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints. Conclusion The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide. Trial registration The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

Download Full-text

Autonomy and control in the wish to die in terminally ill patients: A systematic integrative review

Palliative & Supportive Care ◽

10.1017/s1478951521000985 ◽

2021 ◽

pp. 1-8

Author(s):

Andrea Rodríguez-Prat ◽

Donna M. Wilson ◽

Remei Agulles

Keyword(s):

Cultural Context ◽

Personal Autonomy ◽

Empirical Studies ◽

Academic Library ◽

Integrative Review ◽

Free Text ◽

Screening Process ◽

Mesh Terms ◽

Wish To Die ◽

And Control

Abstract Background/Objective Personal autonomy and control are major concepts for people with life-limiting conditions. Patients who express a wish to die (WTD) are often thought of wanting it because of loss of autonomy or control. The research conducted so far has not focused on personal beliefs and perspectives; and little is known about patients’ understanding of autonomy and control in this context. The aim of this review was to analyze what role autonomy and control may play in relation to the WTD expressed by people with life-limiting conditions. Methods A systematic integrative review was conducted. The search strategy used MeSH terms in combination with free-text searching of the EBSCO Discovery Service (which provides access to multiple academic library literature databases, including PubMed and CINAHL), as well as the large PsycINFO, Scopus, and Web of Science library literature databases from their inception until February 2019. The search was updated to January 2021. Results After the screening process, 85 full texts were included for the final analysis. Twenty-seven studies, recording the experiences of 1,824 participants, were identified. The studies were conducted in Australia (n = 5), Canada (n = 5), USA (n = 5), The Netherlands (n = 3), Spain (n = 2), Sweden (n = 2), Switzerland (n = 2), Finland (n = 1), Germany (n = 1), and the UK (n = 1). Three themes were identified: (1) the presence of autonomy for the WTD, (2) the different ways in which autonomy is conceptualized, and (3) the socio-cultural context of research participants. Significance of results Despite the importance given to the concept of autonomy in the WTD discourse, only a few empirical studies have focused on personal interests. Comprehending the context is crucial because personal understandings of autonomy are shaped by socio-cultural–ethical backgrounds and these impact personal WTD attitudes.

Download Full-text

Brain–Computer Interface (BCI) Control of a Virtual Assistant in a Smartphone to Manage Messaging Applications

Sensors ◽

10.3390/s21113716 ◽

2021 ◽

Vol 21 (11) ◽

pp. 3716

Author(s):

Francisco Velasco-Álvarez ◽

Álvaro Fernández-Rodríguez ◽

Francisco-Javier Vizcaíno-Martín ◽

Antonio Díaz-Estrella ◽

Ricardo Ron-Angevin

Keyword(s):

Free Text ◽

Short Message ◽

Negative Consequences ◽

Computer Interfaces ◽

Brain Signals ◽

Message Service ◽

Performance Results ◽

And Control ◽

E Mail ◽

Visual P300

Brain–computer interfaces (BCI) are a type of assistive technology that uses the brain signals of users to establish a communication and control channel between them and an external device. BCI systems may be a suitable tool to restore communication skills in severely motor-disabled patients, as BCI do not rely on muscular control. The loss of communication is one of the most negative consequences reported by such patients. This paper presents a BCI system focused on the control of four mainstream messaging applications running in a smartphone: WhatsApp, Telegram, e-mail and short message service (SMS). The control of the BCI is achieved through the well-known visual P300 row-column paradigm (RCP), allowing the user to select control commands as well as spelling characters. For the control of the smartphone, the system sends synthesized voice commands that are interpreted by a virtual assistant running in the smartphone. Four tasks related to the four mentioned messaging services were tested with 15 healthy volunteers, most of whom were able to accomplish the tasks, which included sending free text e-mails to an address proposed by the subjects themselves. The online performance results obtained, as well as the results of subjective questionnaires, support the viability of the proposed system.

Download Full-text

Knowledge, Performance, and Attitude Towards Mask Use to Prevent and Control COVID-19 Outbreak Among a Group of Iranian People: A Cross-sectional Study

Shiraz E-Medical Journal ◽

10.5812/semj.111491 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Abdolhamid Tajvar ◽

Teamur Aghamolaei ◽

Shokrollah Mohseni ◽

Anahita Fakherpour ◽

Zabihollah Damiri ◽

...

Keyword(s):

Cross Sectional Study ◽

Online Questionnaire ◽

Cross Sectional ◽

Educational Levels ◽

Final Score ◽

Knowledge And Attitude ◽

And Performance ◽

And Control ◽

Do So ◽

Good Attitude

Background: Due to the pandemic, COVID-19 cases and deaths are increasing unexpectedly and precipitately. More importantly, asymptomatic carriers could infect healthy people through sneezing, coughing, and talking. Therefore, mask usage is required to prevent and control COVID-19. Objectives: This study was aimed at examining the knowledge, attitude, and performance levels (KAP) of the Iranian population regarding mask usage to prevent and control the COVID-19 outbreak during a one-month period from early April to early May 2020. Methods: A researcher-made, validated, and reliable questionnaire consisting of 30 questions on knowledge, attitude, and performance regarding mask usage was utilized. Data collection was performed through the online method. To do so, the online questionnaire link was provided for the participants via social networks. The correct and wrong answers were scored 1 and 0 points, respectively. The final score of each dimension was calculated and classified as 0 - 50% (low), 51 - 75% (moderate), and 75% > (good). Results: A total of 1581 participants took part in the study. Although the participants had good attitude (74%) and performance (70.80%), but only 13.70% of them had good knowledge regarding mask usage. Also, significant differences were found between the participants’ knowledge and higher educational levels (P < 0.001). There were significant associations between the participants’ age, gender, educational level, and job and their knowledge and attitude levels (P < 0.05). Besides, female participants had higher performance scores than did male participants (P < 0.001). The participants with governmental jobs had significantly higher performance than unemployed ones (P < 0.001). Conclusions: The participants obtained low KAP scores; therefore, it is required to train and inform the society and enhance their KAP levels via social media regarding the importance of mask usage, including proper donning, doffing, cleaning, disinfection, and safely and hygienic disposal procedures of masks to prevent and control COVID-19.

Download Full-text

A Cross-Sectional Survey of Personal Hygiene Positive Behavior Related to COVID-19 Prevention and Control among Indonesian Communities

Sustainability ◽

10.3390/su14010169 ◽

2021 ◽

Vol 14 (1) ◽

pp. 169

Author(s):

Fatma Lestari ◽

Abdul Kadir ◽

Muhammad Idham ◽

Fahrul Azwar ◽

Ganis Ramadhany ◽

...

Keyword(s):

Prevention And Control ◽

Online Survey ◽

Cross Sectional Study ◽

Positive Behavior ◽

Personal Hygiene ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Health Council ◽

And Control

People’s behaviors can affect the spread of the COVID-19 virus. Public behaviors, including proper personal hygiene and healthy life practices, the use of appropriate masks, and the application of good disinfectants, have an important role in human health and protection towards prevention and control of COVID-19 spread. This study aims to perform a survey of public behavior and best practices related to COVID-19 prevention and control among Indonesian communities. A cross-sectional study was designed to collect information using an online survey. Respondents were gathered from 34 provinces in Indonesia through the Indonesia National Safety and Health Council network and Universities network. Respondents voluntarily submitted their response to a predesigned online questionnaire. The collected data was then analyzed using SPSS 24.0. A total of 771 respondent subjects (male 386; female 385) were recruited. The results show that 96% of participants implement positive behavior of personal hygiene, including wearing a mask when going outside their house, and almost 67.3% of respondents sprayed a disinfectant in their house. The majority of participants hold a door handle (37.2%) and desk (28.1%) at a frequency of more than six times a day. There were 8.2% of participants implementing good personal hygiene, including hand-washing at least once a day and maximum of more than six times after going to the toilet. At-risk behaviors were conducted by respondents in which they touched part of their face at a frequency of once during an hour. It was identified that males are less likely to perform better hand hygiene as opposed to females. In conclusion, the study showed that positive behavior of personal hygiene related to COVID-19 has been implemented among Indonesian communities. This result suggests that positive behavior based on community-based prevention and control needs to be continually maintained in order to prevent and control COVID-19 spread.

Download Full-text

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210044 ◽

2021 ◽

pp. 1-9

Author(s):

Robert M. Kay ◽

Kristan Pierz ◽

James McCarthy ◽

H. Kerr Graham ◽

Henry Chambers ◽

...

Keyword(s):

Cerebral Palsy ◽

Rectus Femoris ◽

Delphi Consensus ◽

Level Of Evidence ◽

Modified Delphi ◽

International Panel ◽

Children With Cerebral Palsy ◽

Stiff Knee ◽

Paediatric Orthopaedic ◽

Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

Download Full-text

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

10.2196/preprints.33588 ◽

2021 ◽

Author(s):

Edmond Li ◽

Rosy Tsopra ◽

Geronimo Jimenez ◽

Alice Serafini ◽

Gustavo Gusso ◽

...

Keyword(s):

Primary Care ◽

Care Delivery ◽

Lessons Learned ◽

Survey Study ◽

Free Text ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Face To Face ◽

Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

Download Full-text

Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

European Respiratory Review ◽

10.1183/16000617.0147-2019 ◽

2020 ◽

Vol 29 (155) ◽

pp. 190147 ◽

Cited By ~ 1

Author(s):

Franck F. Rahaghi ◽

Nadera J. Sweiss ◽

Lesley Ann Saketkoo ◽

Mary Beth Scholand ◽

Joseph B. Barney ◽

...

Keyword(s):

Adverse Events ◽

Delphi Study ◽

Severe Disease ◽

Pulmonary Sarcoidosis ◽

Event Management ◽

Delphi Consensus ◽

Consensus Recommendations ◽

Modified Delphi ◽

Immunosuppressive Medications ◽

Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

Download Full-text

Text Mining and Big Data Analytics for Retrospective Analysis of Clinical Texts from Outpatient Care

Cybernetics and Information Technologies ◽

10.1515/cait-2015-0055 ◽

2015 ◽

Vol 15 (4) ◽

pp. 58-77 ◽

Cited By ~ 4

Author(s):

Svetla Boytcheva ◽

Galia Angelova ◽

Zhivko Angelov ◽

Dimitar Tcharaktchiev

Keyword(s):

Blood Pressure ◽

Big Data ◽

Text Mining ◽

Retrospective Analysis ◽

Outpatient Care ◽

Data Analytics ◽

Big Data Analytics ◽

Free Text ◽

Arterial Blood ◽

And Control

Abstract This paper presents the results of an on-going research project for knowledge extraction from large corpora of clinical narratives in Bulgarian language, approximately 100 million of outpatient care notes. Entities with numerical values are mined in the free text and the extracted information is stored in a structured format. The Algorithms for retrospective analyses and big data analytics are applied for studying the treatment and evaluating the diabetes compensation and control of arterial blood pressure.

Download Full-text