Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy—an expert consensus based on a modified Delphi process

2021 ◽  
Author(s):  
Isabel Bartella ◽  
Laura F C Fransen ◽  
Christian A Gutschow ◽  
Christiane J Bruns ◽  
Mark L van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Standard Of Care ◽  
Tube Formation ◽  
Delphi Process ◽  
International Consensus ◽  
Intrathoracic Anastomosis ◽  
Modified Delphi ◽  
Double Stapling ◽  
Gastric Tube Reconstruction

Summary Background: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of IL reconstruction using Delphi methodology. Methods: The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed. Results: Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice. Conclusion: This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.

Association between Level of Anastomosis and Reflux Esophagitis following Esophagectomy with Gastric Tube Reconstruction

2017 ◽  
Vol 68 (2) ◽  
pp. 143-145
Author(s):  
M. Sakai ◽  
R. Muranushi ◽  
H. Saito ◽  
K. Kuriyama ◽  
T. Yoshida ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
Gastric Tube ◽  
Gastric Tube Reconstruction

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Identifying the capabilities most important for veterinary employability using a modified Delphi process

2021 ◽  
Author(s):  
Melinda A. Bell ◽  
Martin A. Cake ◽  
Laura T. King ◽  
Caroline F. Mansfield
Keyword(s):  
Delphi Process ◽  
Modified Delphi

scholarly journals Development of an explicit tool assessing potentially inappropriate medication use in Hong Kong elder patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu Zhang ◽  
Eliza LY Wong ◽  
Eng-kiong Yeoh ◽  
Bosco HM Ma
Keyword(s):  
Hong Kong ◽  
Inappropriate Medication ◽  
Delphi Process ◽  
Potentially Inappropriate Medication ◽  
Medical Conditions ◽  
Modified Delphi ◽  
Adverse Health Outcomes ◽  
Elder Patients ◽  
Prescribing Quality ◽  
Prescribing Practice

Abstract Background Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. Methods A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn’t reach consensus on were excluded from the final Hong Kong-specific PIM list. Results After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. Conclusions The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.

scholarly journals Proximal gastrectomy with gastric tube reconstruction or jejunal interposition reconstruction in upper-third gastric cancer: which offers better short-term surgical outcomes?

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiguo Li ◽  
Yan Ma ◽  
Guiting Liu ◽  
Ming Fang ◽  
Yingwei Xue
Keyword(s):  
Gastric Cancer ◽  
Reflux Esophagitis ◽  
Surgical Outcomes ◽  
Gastric Tube ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Short Term ◽  
Jejunal Interposition Reconstruction ◽  
Upper Third ◽  
Gastric Tube Reconstruction

Abstract Objective Proximal gastrectomy acts as a function-preserving operation for upper-third gastric cancer. The aim of this study was to compare the short-term surgical outcomes between proximal gastrectomy with gastric tube reconstruction and proximal gastrectomy with jejunal interposition reconstruction in upper-third gastric cancer. Methods A retrospective review of 301 patients who underwent proximal gastrectomy with jejunal interposition (JI) or gastric tube (GT) at Harbin Medical University Cancer Hospital between June 2007 and December 2016 was performed. The Gastrointestinal Symptom Rating Scale (GSRS) and Visick grade were used to evaluate postgastrectomy syndromes. Gastrointestinal fiberoscopy was used to evaluate the prevalence and severity of reflux esophagitis based on the Los Angeles (LA) classification system. Results The JI group had a longer operation time than the GT group (220 ± 52 vs 182 ± 50 min), but no significant difference in blood loss was noted. Compared to the GT group, the Visick grade and GSRS score were significantly higher. Reflux esophagitis was significantly increased in the GT group compared with the JI group. Conclusion Proximal gastrectomy is well tolerated with excellent short-term outcomes in patients with upper-third gastric cancer. Compared with GT construction, JI construction has clear functional advantages and may provide better quality of life for patients with upper-third gastric cancer.

scholarly journals Development of an international standard set of patient-centred outcome measures for overall paediatric health: a consensus process

2020 ◽  
pp. archdischild-2020-320345
Author(s):  
Beatrix Algurén ◽  
Jessily P Ramirez ◽  
Matthew Salt ◽  
Nick Sillett ◽  
Stacie N Myers ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Healthcare Delivery ◽  
Well Being ◽  
Delphi Process ◽  
Global Perspective ◽  
Modified Delphi ◽  
Starting Point ◽  
Patient Reported ◽  
Standard Set ◽  
Paediatric Health

ObjectiveTo develop an Overall Pediatric Health Standard Set (OPH-SS) of outcome measures that captures what matters to young people and their families and recognising the biopsychosocial aspects of health for all children and adolescents regardless of health condition.DesignA modified Delphi process.SettingThe International Consortium for Health Outcomes Measurement convened an international Working Group (WG) comprised of 23 international experts from 12 countries in the field of paediatrics, family medicine, psychometrics as well as patient advisors. The WG participated in 11 video-conferences, through a modified Delphi process and 9 surveys between March 2018 and January 2020 consensus was reached on a final recommended health outcome standard set. By a literature review conducted in March 2018, 1136 articles were screened for clinician and patient-reported or proxy-reported outcomes. Further, 4315 clinical trials and 12 paediatric health surveys were scanned. Between November 2019 and January 2020, the final standard set was endorsed by a patient validation (n=270) and a health professional (n=51) survey.ResultsFrom a total of 63 identified outcomes, consensus was formed on a standard set of outcome measures that comprises 10 patient-reported outcomes, 5 clinician-reported measures, and 6 case-mix variables. The four developmental age-specific packages (ie, 0–5, 6–12, 13–17, 18–24 years) include either five or six measures with an average time for completion of 20 min.ConclusionsThe OPH-SS is a starting point to drive value-based paediatric healthcare delivery from a global perspective for enhancing child and adolescent physical health and psychosocial well-being.

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