scholarly journals Practice recommendations for the use of sedation in routine hospital-based colonoscopy

2020 ◽  
Vol 7 (1) ◽  
pp. e000348 ◽  
Author(s):  
Fahima Dossa ◽  
Catherine Dubé ◽  
Jill Tinmouth ◽  
Anne Sorvari ◽  
Linda Rabeneck ◽  
...  
Keyword(s):  
Deep Sedation ◽  
Consensus Building ◽  
Moderate Sedation ◽  
Practice Recommendations ◽  
Modified Delphi ◽  
Values Assessment ◽  
Strong Consensus ◽  
Multidisciplinary Group ◽  
Assessment Survey ◽  
Trained Nurse

ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

CanVasc consensus recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis: 2020 update

2020 ◽  
pp. jrheum.200721
Author(s):  
Arielle Mendel ◽  
Daniel Ennis ◽  
Ellen Go ◽  
Volodko Bakowsky ◽  
Corisande Baldwin ◽  
...  
Keyword(s):  
Research Network ◽  
Current Evidence ◽  
Supplementary Appendix ◽  
Level Of Evidence ◽  
Modified Delphi ◽  
Delphi Procedure ◽  
Management Guidance ◽  
Explanatory Text ◽  
Assessment Survey ◽  
Needs Assessment Survey

Objective In 2015, the Canadian Vasculitis Research Network (CanVasc) created recommendations for the management of antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) in Canada. The current update aimed to revise existing recommendations and create additional recommendations, as needed, based on a review of new available evidence. Methods A needs assessment survey of CanVasc members informed questions for an updated systematic literature review (publications spanning May 2014-September 2019) using Medline, Embase, and Cochrane. New and revised recommendations were developed and categorized according to the level of evidence and strength of each recommendation. The CanVasc working group used a two-step modified Delphi procedure to reach >80% consensus on the inclusion, wording and grading of each new and revised recommendation. Results Eleven new and 16 revised recommendations were created, and 12 original (2015) recommendations were retained. New and revised recommendations are discussed in detail within this document. Five original recommendations were removed, of which 4 were incorporated into the explanatory text. The supplementary appendix for practical use was revised to reflect the updated recommendations. Conclusion The 2020 updated recommendations provide rheumatologists, nephrologists, and other specialists caring for patients with AAV in Canada with new management guidance, based on current evidence and consensus from Canadian experts.

Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

2020 ◽  
Author(s):  
Sergio Cadoni ◽  
Sauid Ishaq ◽  
Cesare Hassan ◽  
Přemysl Falt ◽  
Lorenzo Fuccio ◽  
...  
Keyword(s):  
Practice Recommendations ◽  
Modified Delphi

scholarly journals Implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training course in a regular endoscopy unit

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. 65-71
Author(s):  
Mauro Manno ◽  
Simona Deiana ◽  
Tommaso Gabbani ◽  
Matteo Gazzi ◽  
Alessandro Pignatti ◽  
...  
Keyword(s):  
Adverse Events ◽  
Training Program ◽  
European Society ◽  
Gastrointestinal Endoscopy ◽  
Deep Sedation ◽  
Safe Procedure ◽  
Moderate Sedation ◽  
Endoscopic Procedures ◽  
Endoscopy Unit ◽  
Electronic Reporting

Abstract Background Several scientific societies have endorsed non-anesthesiologist sedation (NAS) during gastrointestinal endoscopy, considering it a safe procedure when administered by adequately trained personnel. This study aimed to evaluate the occurrence of adverse events after implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training program. Methods From January 2017 to August 2018, data from all consecutive endoscopic procedures in adults (≥ 18 years) performed at our endoscopy unit were collected using an electronic reporting system. Results All staff (physicians and nurses) completed the ESGE-ESGENA sedation course. In total, 12 132 patients underwent endoscopic procedures, 10 755 (88.6 %) of which were performed in a non-anesthesiological setting. Of these, about 20 % used moderate sedation with midazolam + fentanyl and 80 % used deep sedation with additional propofol. No sentinel, 5 (0.05 %) moderate risk, and 18 (0.17 %) minor risk adverse events occurred, all during moderate or deep sedation, and all managed by endoscopy staff without the need for anesthesiologist assistance. Conclusions After completing the ESGE-ESGENA sedation training program, the rate of adverse events was very low in our institution. The findings support implementation of the program in all digestive endoscopy units and inclusion in the curriculum for physicians and nurses to ensure safe endoscopic procedures.

scholarly journals A Consensus Definition of Misophonia: Using a Delphi Process to Reach Expert Agreement

2021 ◽  
Author(s):  
Susan Swedo ◽  
David M. Baguley ◽  
Damiaan Denys ◽  
Laura J. Dixon ◽  
Mercede Erfanian ◽  
...  
Keyword(s):  
Delphi Method ◽  
Clinical Evidence ◽  
Consensus Building ◽  
Expert Committee ◽  
Consensus Definition ◽  
Modified Delphi ◽  
Building Process ◽  
Definition Of ◽  
Common Understanding ◽  
Iterative Voting

AbstractMisophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, a project was conducted to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society

Neurosurgery ◽  
2020 ◽  
Vol 87 (4) ◽  
pp. 647-654 ◽  
Author(s):  
Gregory D Schroeder ◽  
Jose A Canseco ◽  
Parthik D Patel ◽  
Alan S Hilibrand ◽  
Christopher K Kepler ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Research Society ◽  
Return To Play ◽  
Spine Injury ◽  
Injury Management ◽  
Modified Delphi ◽  
Strong Consensus ◽  
Signal Changes ◽  
Spine Research

Abstract BACKGROUND Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies. OBJECTIVE To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations. METHODS Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes. RESULTS Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter >10 mm (90.5%), as well as those with resolved MRI signal changes and diameter >13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of cervical spine injury (78.9%). CONCLUSION This study provides modified Delphi process consensus statements regarding cervical spine injury management in collision sport athletes from leading experts in spine surgery, sports injuries, and cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.

Development of best practice recommendations for the safe use of pulmonary hypertension pharmacotherapies using a modified Delphi method

2019 ◽  
Vol 76 (3) ◽  
pp. 153-165 ◽  
Author(s):  
Zachary R Smith ◽  
Krishna Rangarajan ◽  
Jennifer Barrow ◽  
Danielle Carter ◽  
James C Coons ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Delphi Method ◽  
Best Practice ◽  
Modified Delphi Method ◽  
Practice Recommendations ◽  
Modified Delphi

scholarly journals Creation of an Australian Osteotomy Knee Registry Datasheet Instrument using a Modified Delphi Method

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0018 ◽  
Author(s):  
Christopher J. Vertullo
Keyword(s):  
Mechanical Axis ◽  
Consensus Building ◽  
Flexion Deformity ◽  
Delphi Consensus ◽  
Knee Oa ◽  
Modified Delphi ◽  
Group Members ◽  
Final Instrument ◽  
Fixed Flexion Deformity ◽  
Correction Calculation

Background: In 2015, the Australian Knee Society(AKS) agreed to initiate and fund an Australian Knee Osteotomy Registry (AKOR) in 2015 in conjunction with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). A concise and robust dataset was required to proceed to AKOR preliminary site trialing. Study Design: Modified Delphi consensus building. Methods: Seven participants who were orthopaedic surgeons, AKS members and AKOR working group members performed a four round modified Delphi consensus building electronic non-blinded questionnaires using Google Sheets, a cloud-based spreadsheet. Round 1 involved the attribute rating using 0-10 of surgeon assessed utility of 41 initial datasheet instrument questions with 168 stem options. Surgeons could comment on each question or stem, giving comments on their rating and or proposing new variations or additions. Round 1 questions were based on the Swedish HTO Registry dataset with additional questions from surgeon interview. Questions and or stems with a mean utility rating of less than 2 were excluded. Questions and or stems with a mean utility raking of 8 or greater were accepted. Questions and or stem with a mean utility ranking of between 8 and 2 were included in subsequent rounds. Surgeons comments and votes were non-blinded. New or alternative questions or stems could be proposed by any surgeon during the process and voted on in the next round. This process was repeated until dataset consensus was achieved. Results: A final dataset of 32 questions was created after 4 rounds. Consensus was reached on the following items; patients demographics, hospital, state, surgeon’s code, date, primary or re-operation, diagnosis at primary procedure, diagnosis at re-operation, type of primary osteotomy, type of re-operation, form of fixation, bone graft, coincidental surgery, approach to correction calculation, pre-operative status of ACL, pre-operative status of PCL, previous knee surgery, preoperative mechanical axis, planned post-operative mechanical axis, preoperative fixed flexion deformity, pre-operative Ahlbäck grading of knee OA. Questions that had a final utility rating less than 10 included; coincidental surgery, approach to correction calculation, pre-operative Ahlbäck grading of knee OA, planned post-operative mechanical axis and preoperative fixed flexion deformity. Conclusion: The final AKOR dataset requires pragmatic validation prior to nation-wide implementation. Questions with low final attribute rating may not be included in the final instrument after validatation.

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