Which observed behaviours may reassure physicians that a child is not septic? An international Delphi study

2018 ◽  
Vol 103 (9) ◽  
pp. 864-867 ◽  
Author(s):  
Edward Snelson ◽  
Shammi Ramlakhan
Keyword(s):  
Clinical Features ◽  
Expert Opinion ◽  
Delphi Study ◽  
Electronic Device ◽  
Normal Movement ◽  
Spontaneous Interaction ◽  
Wide Range ◽  
Age Appropriate ◽  
Individual Features ◽  
Rule Out

ObjectiveIn an attempt to improve the diagnosis of sepsis in children, diagnostic aids have concentrated on clinical features that suggest that sepsis is present. Clinicians need to be able to clinically rule out sepsis as well as rule it in. Little is known about which features are consistent with wellness and/or absence of sepsis. Guidelines are therefore likely to improve sensitivity without preserving specificity. We aimed to gather expert opinion on which (if any) features would make clinicians consider a child to be unlikely to have sepsis.DesignWe undertook a modified two-round international Delphi study, where clinicians were asked for features they believed were indicators of wellness in an ill child.ParticipantsOne hundred and ninety-five clinicians (predominantly physicians) who routinely assessed unwell children and had been doing so for most of their careers.ResultsOver 90% of respondents rated age-appropriate verbalisation, playing, smiling and activity as reassuring that a child was unlikely to have sepsis. Eating, spontaneous interaction and normal movement were also agreed to be reassuring by over 70% of participants. Consolability and showing fear of the clinician were not felt to be adequately reassuring. There was wide range of opinion on how reassuring the use of an electronic device was thought to be.ConclusionsThis study confirms that physicians are reassured by specific behaviours in ill children, and provides a framework which may be used to help guide the assessment of the unwell child. Validation of individual features could lead to improved specificity of diagnostic aids for diagnosing sepsis.

Jordanian EFL Teachers' Perceptions of the Appropriateness of Action Pack Textbooks

2006 ◽  
Vol 151 ◽  
pp. 33-56
Author(s):  
Ali Ahmad Al-Barakat ◽  
Ruba Fahmi Bataineh ◽  
Samih Mahmoud Al-Karasneh ◽  
Rula Fahmi Bataineh
Keyword(s):  
Public Schools ◽  
Developmentally Appropriate ◽  
Structured Interview ◽  
Instructional Materials ◽  
Teachers Perceptions ◽  
Textbook Series ◽  
Assessment Tasks ◽  
Wide Range ◽  
Efl Teachers ◽  
Age Appropriate

This study investigates the appropriateness of the Action Pack Textbook Series (APTS) currently taught in the first four primary stage classes in Jordanian public schools. An evaluation checklist, compiled from the literature, and a semi-structured interview were used to evaluate the content, layout, assessment tasks, teacher's book and the availability of supplementary materials. The findings support the following conclusions: Poor ratings were minimal; APTS is adaptable to the needs of both teachers and pupils and provides a broad range of resources that can be selectively integrated into the curriculum; APTS contains modes of instruction that are developmentally appropriate for a wide range of learners; APTS instructional materials are interesting, engaging and effective for the target learners; the format of the teacher's book is easy to follow, the directions for implementing activities are clear, and the teacher's book itself is flexible and allows teachers to choose from a variety of activities to use with their pupils; for the most part, non-text materials are used appropriately to promote learning; and, overall, the materials for the pupils are well written, age-appropriate and compelling in content.

scholarly journals Morphology Dependent Interaction between Co(II)-tetraphenylporphyrin and the MgO(100) surface

2021 ◽  
Author(s):  
Silviya Ninova ◽  
Osman Baris Malcioglu ◽  
Philipp Auburger ◽  
Matthias Franke ◽  
Ole Lytken ◽  
...  
Keyword(s):  
Hybrid Systems ◽  
Electronic Device ◽  
Inorganic Hybrid ◽  
Wide Range ◽  
Device Properties ◽  
Dependent Interaction

Porphyrins are key elements in organic-inorganic hybrid systems for a wide range of applications. Understanding their interaction with the substrate gives a handle on structural and electronic device properties. Here...

Prodromal Dementia With Lewy Bodies: Evolution of Symptoms and Predictors of Dementia Onset

2021 ◽  
pp. 089198872110235
Author(s):  
Kathryn A. Wyman-Chick ◽  
Lauren R. O’Keefe ◽  
Daniel Weintraub ◽  
Melissa J. Armstrong ◽  
Michael Rosenbloom ◽  
...  
Keyword(s):  
Clinical Features ◽  
Dementia With Lewy Bodies ◽  
Clinical Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Data Set ◽  
Wide Range ◽  
Prodromal Dementia ◽  
Dementia Onset

Background: Research criteria for prodromal dementia with Lewy bodies (DLB) were published in 2020, but little is known regarding prodromal DLB in clinical settings. Methods: We identified non-demented participants without neurodegenerative disease from the National Alzheimer’s Coordinating Center Uniform Data Set who converted to DLB at a subsequent visit. Prevalence of neuropsychiatric and motor symptoms were examined up to 5 years prior to DLB diagnosis. Results: The sample included 116 participants clinically diagnosed with DLB and 348 age and sex-matched (1:3) Healthy Controls. Motor slowing was present in approximately 70% of participants 3 years prior to DLB diagnosis. In the prodromal phase, 50% of DLB participants demonstrated gait disorder, 70% had rigidity, 20% endorsed visual hallucinations, and over 50% of participants endorsed REM sleep behavior disorder. Apathy, depression, and anxiety were common prodromal neuropsychiatric symptoms. The presence of 1+ core clinical features of DLB in combination with apathy, depression, or anxiety resulted in the greatest AUC (0.815; 95% CI: 0.767, 0.865) for distinguishing HC from prodromal DLB 1 year prior to diagnosis. The presence of 2+ core clinical features was also accurate in differentiating between groups (AUC = 0.806; 95% CI: 0.756, 0.855). Conclusion: A wide range of motor, neuropsychiatric and other core clinical symptoms are common in prodromal DLB. A combination of core clinical features, neuropsychiatric symptoms and cognitive impairment can accurately differentiate DLB from normal aging prior to dementia onset.

scholarly journals Oculogyric Crisis – Atypical Presentation in Patient with Dengue Fever

2021 ◽  
pp. 19-23
Author(s):  
Saurabh Rajkumar Jain ◽  
Jitendra D. Lakhani ◽  
Pramod R. Jha
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Neurological Complications ◽  
Oculogyric Crisis ◽  
Co Morbidity ◽  
Wide Range ◽  
Chief Complaints ◽  
Plasma Leakage ◽  
Multi Organ Dysfunction Syndrome ◽  
Rule Out

Here we are presenting a case of dengue fever presented with an atypical symptom of “oculogyric crisis” with features of multi organ dysfunction syndrome. Increased vascular permeability, plasma leakage, haemorrhagic manifestations, and thrombocytopenia are charecteristics of dengue fever.  A 19 year old male patient, with no co-morbidity came to Dhiraj hospital with chief complaints of  fever which was high grade & intermittent, it is associated with chills & rigours for 5 days. Also complain of abdominal pain over epigastric region, dull aching non radiating associated with decreased appetite since 5 days. Dengue infection has a wide range of clinical features. Neurological complications can occur in any spectrum of dengue infection.  The diagnosis of oculogyric crisis is majorly clinical and it requires a focused detailed history and detailed physical examination to find out possible triggers for the crisis and to rule out other reasons for abnormal eye movements.

scholarly journals Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

2020 ◽  
Vol 9 (7) ◽  
pp. 2237
Author(s):  
Nicola Galea ◽  
Francesco Bandera ◽  
Chiara Lauri ◽  
Camillo Autore ◽  
Andrea Laghi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Electronic Device ◽  
Multimodality Imaging ◽  
Nuclear Imaging ◽  
Clinical Decision ◽  
Cardiac Device ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios ◽  
Wide Range

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

scholarly journals Diagnosis and management of bile acid diarrhoea: a survey of UK expert opinion and practice

2019 ◽  
Vol 11 (5) ◽  
pp. 358-363 ◽  
Author(s):  
Julian R F Walters ◽  
Ramesh Arasaradnam ◽  
H Jervoise N Andreyev ◽  
Keyword(s):  
Bile Acid ◽  
Expert Opinion ◽  
Best Practice ◽  
Online Survey ◽  
Design Method ◽  
Diagnosis And Management ◽  
Bile Acid Malabsorption ◽  
Presenting Symptoms ◽  
Wide Range ◽  
The Uk

ObjectiveBile acid diarrhoea (BAD), which includes bile acid malabsorption, causes a variety of digestive symptoms. Diagnostic rates and management vary considerably. We conducted a survey of current practice to review expert opinion and provide guidance on diagnosis and management.Design/methodAn online survey was conducted of clinical members of the UK Bile Acid Related Diarrhoea Network, who had all published research on BAD (n=21). Most were National Health Service consultants who had diagnosed over 50 patients with the condition.ResultsThe preferred terminology was to use BAD, with primary and secondary to classify causes. A wide range of presenting symptoms and associated conditions were recognised. SeHCAT (tauroselcholic acid) was the preferred diagnostic test, and 50% of respondents thought general practitioners should have access to this. Patients who met the Rome IV diagnostic criteria for functional diarrhoea, irritable bowel syndrome (IBS) with predominant diarrhoea or postcholecystectomy diarrhoea were usually investigated by SeHCAT, which was used sometimes in other types of IBS. Treatment with a bile acid sequestrant was offered to patients with low SeHCAT values, with expected response rates >70% in the most severe. Colestyramine was the usual sequestrant, starting between 2 g and 8 g daily; colesevelam was an alternative. In patients who had an incomplete response, increasing the dose, changing to an alternative sequestrant, use of loperamide and a low fat diet were suggested. Recommendations for follow-up and to improve the overall patient experience were made.ConclusionThis expert survey indicates current best practice in the diagnosis and management of BAD.

Which Depressed Patients will Respond to Electroconvulsive Therapy?

1989 ◽  
Vol 154 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Allan I. F. Scott
Keyword(s):  
Effective Treatment ◽  
Clinical Features ◽  
Electroconvulsive Therapy ◽  
Physiological Responses ◽  
Depressive Illness ◽  
Seizure Threshold ◽  
Posterior Pituitary ◽  
Clinical Predictors ◽  
Depressed Patients ◽  
Wide Range

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Fake news and brand management: a Delphi study of impact, vulnerability and mitigation

2019 ◽  
Vol 29 (2) ◽  
pp. 246-254 ◽  
Author(s):  
Andrew Flostrand ◽  
Leyland Pitt ◽  
Jan Kietzmann
Keyword(s):  
Expert Opinion ◽  
Delphi Study ◽  
Social Life ◽  
Brand Management ◽  
Mitigation Strategies ◽  
Fake News ◽  
Content Type ◽  
Management Domain ◽  
International Panel ◽  
The Impact

Purpose Fake news is presently one of the most discussed phenomena in politics, social life and the world of business. This paper aims to report the aggregated opinions of 42 brand management academics on the level of threat to, the involvement of, and the available actions of brand managers resulting from fake news. Design/methodology/approach A Delphi study of 42 academics with peer-reviewed publications in the brand management domain. Findings The study found that on some dimensions (e.g. the culpability of brand managers for incentivizing fake news by sponsoring its sources), expert opinion varied greatly. Other dimensions (e.g. whether the impact of fake news on brand management is increasing) reached a high level of consensus. The general findings indicate that fake news is an increasing phenomenon. Service brands are most at risk, but brand management generally is need of improving or implementing, fake news mitigation strategies. Research limitations/implications Widely diverse opinions revealed the need for conclusive research on the questions of: whether brands suffer damage from sponsoring fake news, whether fake news production is supported by advertising and whether more extensive use of internet facilitated direct interactions with the public through crowdsourcing increased vulnerability. Practical implications Experts agreed that practitioners must become more adept with contemporary tools such as fake news site blacklists, and much more aware of identifying and mitigating the brand vulnerabilities to fake news. Social implications A noteworthy breadth of expert opinion was revealed as to whether embellished or fabricated brand narratives can be read as fake news, inviting the question as to whether brands now be held to higher standards of communication integrity. Originality/value This paper provides a broad-shallow exploratory overview of the professional opinions of a large international panel of brand management academics on how the recent arrival of industrial fake news does, and will, impact this field.

scholarly journals ICON 2019—International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients

2019 ◽  
Vol 54 (8) ◽  
pp. 444-451 ◽  
Author(s):  
Bill Vicenzino ◽  
Robert-Jan de Vos ◽  
Hakan Alfredson ◽  
Roald Bahr ◽  
Jill L Cook ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Delphi Study ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Sensory Modality ◽  
Consensus Meeting ◽  
Response Options ◽  
Patient Rating ◽  
Wide Range ◽  
Health Related

BackgroundThe absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busily. We aimed to determine options for, and then define, core health-related domains for tendinopathy.MethodsWe conducted a Delphi study of healthcare professionals (HCP) and patients in a three-stage process. In stage 1, we extracted candidate domains from clinical trial reports and developed an online survey. Survey items took the form: ‘The ‘candidate domain’ is important enough to be included as a core health-related domain of tendinopathy’; response options were: agree, disagree, or unsure. In stage 2, we administered the online survey and reported the findings. Stage 3 consisted of discussions of the findings of the survey at the ICON (International Scientific Tendinopathy Symposium Consensus) meeting. We set 70% participant agreement as the level required for a domain to be considered ‘core’; similarly, 70% agreement was required for a domain to be relegated to ‘not core’ (see Results next).ResultsTwenty-eight HCP (92% of whom had >10 years of tendinopathy experience, 71% consulted >10 cases per month) and 32 patients completed the online survey. Fifteen HCP and two patients attended the consensus meeting. Of an original set of 24 candidate domains, the ICON group deemed nine domains to be core. These were: (1) patient rating of condition, (2) participation in life activities (day to day, work, sport), (3) pain on activity/loading, (4) function, (5) psychological factors, (6) physical function capacity, (7) disability, (8) quality of life and (9) pain over a specified time. Two of these (2, 6) were an amalgamation of five candidate domains. We agreed that seven other candidate domains were not core domains: range of motion, pain on clinician applied test, clinical examination, palpation, drop out, sensory modality pain and pain without other specification. We were undecided on the other five candidate domains of physical activity, structure, medication use, adverse effects and economic impact.ConclusionNine core domains for tendon research should guide reporting of outcomes in clinical trials. Further research should determine the best outcome measures for each specific tendinopathy (ie, core outcome sets).

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