scholarly journals Development and validation of an algorithm to assist in the interpretation of the electrocardiogram

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Pallikadavath ◽  
J Watts ◽  
S Gay ◽  
A Sandilands
Keyword(s):  
Delphi Study ◽  
Online Survey ◽  
Free Text ◽  
Survey Tool ◽  
Modified Delphi ◽  
Funding Sources ◽  
Delphi Exercise ◽  
Predetermined Level ◽  
Time Critical ◽  
Ecg Interpretation

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Interpretation of the electrocardiogram (ECG) is often poorly performed, affecting time critical patient care. There are no reliable methods that consistently bridge the gap between novices and competency. However, the development of a framework allowing a step-wise approach to interpret the ECG based on relevant signals might help. Indeed, in addition to expert teaching, a pilot study of this algorithm significantly improves sustained ECG interpretation in medical students. This study aimed to validate the ECG algorithm tool by confirming the appropriateness of its step-wise components through expert cardiologists. Methods A Modified Delphi Exercise protocol was used. Cardiologists were invited to participate in a questionnaire through an online survey tool. Expert participants evaluated each stage of the ECG algorithm through multiple levels of agreement and explained their decision making with the option of free-text comments. These were collated and analysed by the four authors and changes subsequently made. The process was repeated, with evaluation of the changes from each round until a predetermined level of agreement was achieved. Results This Modified Delphi Exercise produced two rounds. Overall, 55 responses from experts was achieved (first round = 33, round two = 22). The average agreement in round one was 85.8%  with 25 changes from 124 comments. Round two achieved 93.4% agreement with 12 changes from 57 comments. After discussion by four authors, a consensus was reached and a final algorithm was achieved. Figure 1 shows the bradycardia section of the final algorithm (tachycardia and ST/T-wave/ischaemia sections not shown). Conclusions We have validated an ECG algorithm through a rigorous development and review process in a multi-institutional and multi-national Modified Delphi study. The completed expert reviewed algorithm may be a safe, informative tool for novice users to improve ECG interpretation. However, further validation in user groups is now mandated to refine the tool. Abstract Figure 1- Algorithm one of three

scholarly journals The Development of Consensus-Based Descriptors for Low-Acuity Emergency Medical Services Cases for the South African Setting

2021 ◽  
Vol 36 (3) ◽  
pp. 287-294
Author(s):  
Faisal Binks ◽  
Lee Alan Wallis ◽  
Willem Stassen
Keyword(s):  
Emergency Medical Services ◽  
Online Survey ◽  
Medical Services ◽  
Free Text ◽  
Snowball Sampling ◽  
Survey Tool ◽  
Modified Delphi ◽  
Emergency Medical ◽  
High Acuity ◽  
Binary Options

AbstractIntroduction:Emergency Medical Services (EMS) are designed to respond to and manage patients experiencing life-threatening emergencies; however, not all emergency calls are necessarily emergent and of high acuity. Emergency responses to low-acuity patients affect not only EMS, but other areas of the health care system. However, definitions of low-acuity calls are vague and subjective; therefore, it was necessary to provide a clear description of the low-acuity patient in EMS.Aim:The goal of this study was to develop descriptors for “low-acuity EMS patients” through expert consensus within the EMS environment.Methods:A Modified Delphi survey was used to develop call-out categories and descriptors of low acuity through expert opinion of practitioners within EMS. Purposive, snowball sampling was used to recruit 60 participants, of which 29 completed all three rounds. An online survey tool was used and offered both binary and free-text options to participants. Consensus of 75% was accepted on the binary options while free text offered further proposals for consideration during the survey.Results:On completion of round two, consensus was obtained on 45% (70/155) of the descriptors, and a further 30% (46/155) consensus was obtained in round three. Experts felt that respiratory distress, unconsciousness, chest pain, and severe hemorrhage cannot be considered low acuity. For other emergency response categories, specific descriptors were offered to denote a case as low acuity.Conclusion:Descriptors of low acuity in EMS are provided in both medical and trauma cases. These descriptors may not only assist in the reduction of unnecessary response and transport of patients, but also assist in identifying the most appropriate response of EMS resources to call-outs. Further development and validation are required of these descriptors in order to improve accuracy and effectiveness within the EMS dispatch environment.

scholarly journals Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study (Preprint)

2021 ◽  
Author(s):  
Amish Acharya ◽  
Gaby Judah ◽  
Hutan Ashrafian ◽  
Viknesh Sounderajah ◽  
Nick Johnstone-Waddell ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Delphi Study ◽  
Evidence Synthesis ◽  
Population Screening ◽  
Free Text ◽  
Screening Programs ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Screening Services

BACKGROUND The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. OBJECTIVE The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. METHODS This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. RESULTS The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. CONCLUSIONS The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/32660

scholarly journals Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study

10.2196/32660 ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. e32660
Author(s):  
Amish Acharya ◽  
Gaby Judah ◽  
Hutan Ashrafian ◽  
Viknesh Sounderajah ◽  
Nick Johnstone-Waddell ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Delphi Study ◽  
Evidence Synthesis ◽  
Population Screening ◽  
Free Text ◽  
Screening Programs ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Screening Services

Background The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID) PRR1-10.2196/32660

scholarly journals Barriers and Facilitators Perceived by Spanish Experts Concerning Nursing Research: A Delphi Study

2020 ◽  
Vol 17 (9) ◽  
pp. 3224
Author(s):  
Alberto González-García ◽  
Ana Díez-Fernández ◽  
Noelia Martín-Espinosa ◽  
Diana P. Pozuelo-Carrascosa ◽  
Rubén Mirón-González ◽  
...  
Keyword(s):  
Delphi Study ◽  
Online Survey ◽  
Research Work ◽  
Research Priorities ◽  
Barriers And Facilitators ◽  
Nursing Research ◽  
Continuous Training ◽  
Survey Tool ◽  
Management Positions ◽  
Two Phases

The identification of research priorities in line with current health needs and nursing competencies is a priority. Nevertheless, barriers and facilitators perceived by nurses to performing nursing research have scarcely been investigated. The main aim of this study was to explore the situation in nursing research in Spain, as perceived by Spanish experts. A Delphi study technique in two phases was applied using an online survey tool. A panel of 20 nursing experts in nursing, teaching and management positions participated. The strengths highlighted were the possibility of reaching the PhD level, the possibility of receiving continuous training in research methodology, and access to scientific knowledge through the Internet. The weaknesses identified were the lack of Spanish nursing journals in which to publish the research results, the lack of funding in nursing care research, and the lack of connection between the healthcare institutions and the university. According to the experts, elements that could enhance leadership in research are the creation of nursing research units in hospitals, the economic recognition of nurses with PhDs, and considering research work as part of their daily tasks in clinical settings. The idea of being subordinated to physicians still remains in nurses’ ways of thinking.

Identification and operationalisation of indicators to monitor successful uptake of advance care planning policies: a modified Delphi study

2021 ◽  
pp. bmjspcare-2020-002780
Author(s):  
Konrad Fassbender ◽  
Patricia Biondo ◽  
Jayna Holroyd-Leduc ◽  
Alexei Potapov ◽  
Tracy Lynn Wityk Martin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Advance Care Planning ◽  
Delphi Study ◽  
Online Survey ◽  
Practice Change ◽  
Public Healthcare ◽  
Care Planning ◽  
Face To Face ◽  
Modified Delphi ◽  
Advance Care

BackgroundIn 2014, the province of Alberta, Canada implemented a province-wide policy and procedures for advance care planning (ACP) and goals of care designation (GCD) across its complex, integrated public healthcare system. This study was conducted to identify and operationalise performance indicators for ACP/GCD to monitor policy implementation success and sustainment of ACP/GCD practice change.MethodsA systematic review and environmental scan was conducted to identify potential indicators of ACP/GCD uptake (n=132). A purposive sample of ACP/GCD stakeholders was invited to participate in a modified Delphi study to evaluate, reduce and refine these indicators through a combination of face-to-face meetings and online surveys.ResultsAn evidence-informed Donabedian by Institute of Medicine (IOM) framework was adopted as an organising matrix for the indicators in an initial face-to-face meeting. Three online survey rounds reduced and refined the 132 indicators to 18. A final face-to-face meeting operationalised the indicators into a measurable format. Nine indicators, covering 11 of the 18 Donabedian×IOM domains, were operationalised.ConclusionsNine ACP/GCD evidence-informed indicators mapping to 11 of 18 Donabedian×IOM domains were endorsed, and have been operationalised into an online ACP/GCD dashboard. The indicators provide a characterisation of ACP/GCD uptake that could be generalised to other healthcare settings, measuring aspects related to ACP/GCD documentation, patient satisfaction and agreement between medical orders and care received. The final nine indicators reflect the stakeholders’ expressed intent to strike a balance between comprehensiveness and feasibility within a large provincial healthcare system.

scholarly journals A Delphi Study to Detect Deficiencies and Propose Actions in Real Life Treatment of Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Alfredo García-Layana ◽  
Luis Arias ◽  
Marta S. Figueroa ◽  
Javier Araiz ◽  
José María Ruiz-Moreno ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Delphi Study ◽  
Online Survey ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Modified Delphi ◽  
Age Related ◽  
Consensus Statements ◽  
High Level ◽  
Level Of Agreement

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD).Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations.Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics.Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

scholarly journals Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anna M. Anderson ◽  
Christine Comer ◽  
Toby O. Smith ◽  
Benjamin T. Drew ◽  
Hemant Pandit ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Delphi Study ◽  
Functional Limitations ◽  
Rapid Review ◽  
Free Text ◽  
Definitive Evidence ◽  
Modified Delphi ◽  
Importance Ratings ◽  
Total Knee

Abstract Background Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation. Methods A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists’ importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as ‘Important’ or ‘Very important’ by at least 70% of all respondents in Round 3 were included in the final set of recommendations. Results Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments. Conclusions This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.

scholarly journals Expert opinion on the UK standard of care for haemophilia patients with inhibitors: a modified Delphi consensus study

2021 ◽  
Vol 12 ◽  
pp. 204062072110070
Author(s):  
Kate Khair ◽  
Elizabeth Chalmers ◽  
Thuvia Flannery ◽  
Annabel Griffiths ◽  
Felicity Rowley ◽  
...  
Keyword(s):  
Delphi Study ◽  
Online Survey ◽  
Treatment Options ◽  
Tolerance Induction ◽  
Standard Of Care ◽  
Steering Committee ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Bypassing Agents ◽  
The Uk

Background and Aims: Despite advances in haemophilia care, inhibitor development remains a significant complication. Although viable treatment options exist, there is some divergence of opinion in the appropriate standard approach to care and goals of treatment. The aim of this study was to assess consensus on United Kingdom (UK) standard of care for child and adult haemophilia patients with inhibitors. Methods: A modified Delphi study was conducted using a two-round online survey. A haemophilia expert steering committee and published literature informed the Round 1 questionnaire. Invited participants included haematologists, haemophilia nurses and physiotherapists who had treated at least one haemophilia patient with inhibitors in the past 5 years. Consensus for 6-point Likert scale questions was pre-defined as ⩾70% participants selecting 1–2 (disagreement) or 5–6 (agreement). Results: In all, 46.7% and 35.9% questions achieved consensus in Rounds 1 ( n = 41) and 2 ( n = 34), respectively. Consensus was reached on the importance of improving quality of life (QoL) and reaching clinical goals such as bleed prevention, eradication of inhibitors and pain management. There was agreement on criteria constituting adequate/inadequate responses to immune tolerance induction (ITI) and the appropriate factor VIII dose to address suboptimal ITI response. Opinions varied on treatment aims for adults and children/adolescents, when to offer prophylaxis with bypassing agents and expectations of prophylaxis. Consensus was also lacking on appropriate treatment for mild/moderate patients with inhibitors. Conclusion: UK healthcare professionals appear to be aligned on the clinical goals and role of ITI when managing haemophilia patients with inhibitors, although novel treatment developments may require reassessment of these goals. Lack of consensus on prophylaxis with bypassing agents and management of mild/moderate cases identifies a need for further research to establish more comprehensive, evidence-based treatment guidance, particularly for those patients who are unable/prefer not to receive non-factor therapies.

scholarly journals Motivations to Adopt Plant-Based Diets: Data from the Adhering to Dietary Approaches for Personal Taste (ADAPT) Study (P16-024-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Akari Miki ◽  
Micaela Karlsen ◽  
Kara Livingston ◽  
Gail Rogers ◽  
Sara Folta ◽  
...  
Keyword(s):  
Disease Prevention ◽  
Animal Welfare ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Online Survey ◽  
Health Concern ◽  
Free Text ◽  
Personal Taste ◽  
Funding Sources ◽  
And Gender

Abstract Objectives To examine the differences in key motivations to adopt a dietary pattern (1) between self-reported plant-based diet followers and omnivores, and (2) among three types of plant-based diet followers: whole food, plant-based (WFPB), vegan, and vegetarian+pescatarian. Methods Adhering to Dietary Approaches for Personal Taste (ADAPT) is an online survey that recruits followers of popular diets. Of the 2010 enrolled participants, 1227 participants described their diet as plant-based, either WFPB (n = 705), vegan (n = 388), vegetarian (n = 103), or pescatarian (n = 31). The remaining 783 participants were categorized as omnivores. A multiple choice question with a free text option prompted participants to indicate their reasons for adhering to their self-identified dietary pattern, and a follow-up question asked them to rank their key motivations for adherence. The percentage of participants who chose each response as one of their top 2 key motivators was tabulated within each dietary pattern. Logistic regression, adjusted for age and gender, was used to compare the prevalence of top reasons among dietary patterns. The results were considered significant if <P = 0.05 after Bonferroni correction. Results The majority of both plant-based diet followers (79%) and of omnivores (83%) identified disease prevention and overall wellness as top motivations for following their dietary patterns. Significantly more plant-based diet followers, versus omnivores, chose helping the environment (17% vs. 4%) and supporting animal welfare (28% vs. 1%). Significantly more omnivores chose enjoyment (39% vs. 26%) and the need to address a specific health concern (44% vs. 29%). Significantly more WFPB followers (87%) chose disease prevention and overall wellness compared to vegans (71%) and vegetarians+pescatarians (66%). Significantly more vegans (47%) and vegetarians+pescatarians (33%) chose animal welfare than WFPB followers (15%). Conclusions The dietary motivations of plant-based diet followers are more diverse compared to those of omnivores. Among plant-based diet followers, WFPB followers often chose health motivations, and vegans, vegetarians, and pescatarians often chose ethical motivations. Funding Sources The Lisa Wendel Memorial Foundation, Tufts Collaborates Seed Grant, Tufts Summer Scholars Grant, and USDA ARS agreement No. 58-1950-4-003.

scholarly journals Identifying priorities for cancer caregiver interventions: protocol for a three-round modified Delphi study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024725 ◽  
Author(s):  
Sarah-May Blaschke ◽  
Sylvie D Lambert ◽  
Patricia M Livingston ◽  
Sanchia Aranda ◽  
Anna Boltong ◽  
...  
Keyword(s):  
Delphi Study ◽  
Advisory Group ◽  
Free Text ◽  
Relative Importance ◽  
Illness Trajectory ◽  
Modified Delphi ◽  
Outcome Framework ◽  
Human Ethics ◽  
Cancer Caregiver ◽  
Caregiver Interventions

IntroductionCancer is often considered a chronic disease, and most people with cancer have a caregiver, often a family member or friend who provides a significant amount of care during the illness trajectory. Caregivers are frequently in need of support, and a range of interventions have been trialled to improve outcomes. Consensus for optimal ways to support caregivers is not known. The aim of this protocol paper is to describe procedures for a modified Delphi study to explore expert consensus about important factors when developing caregiver interventions.Methods and analysisOnline modified Delphi methodology will be used to establish consensus for important caregiver intervention factors incorporating the Patient problem, Intervention, Comparison and Outcome framework. Round 1 will comprise a free-text questionnaire and invite the panel to contribute factors they deem important in the development and evaluation of caregiver interventions. Round 2 is designed to determine preliminary consensus of the importance of factors generated in round 1. The panel will be asked to rate each factor using a 4-point Likert-type scale. The option for panellists to state reasoning for their rating will be provided. Descriptive statistics (median scores and IQR) will be calculated to determine each item’s relative importance. Levels of consensus will be assessed based on a predefined consensus rating matrix. In round 3, factors will be recirculated including aggregate group responses (statistics and comment summaries) and panellists’ own round 2 scores. Panellists will be invited to reconsider their judgements and resubmit ratings using the same rating system as in round 2. This will result in priority lists based on the panel’s total rating scores.Ethics and disseminationEthics for this study has been gained from the Deakin University Human Ethics Advisory Group. It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums.

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