scholarly journals Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042124
Author(s):  
Mari Evans ◽  
Mark H Corden ◽  
Caroline Crehan ◽  
Felicity Fitzgerald ◽  
Michelle Heys
Keyword(s):  
Nurse Practitioners ◽  
Low Income ◽  
Delphi Technique ◽  
Clinical Decision ◽  
High Income ◽  
Low Income Countries ◽  
Digital Platform ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Clinical Algorithms

ObjectivesTo determine whether a panel of neonatal experts could address evidence gaps in local and international neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).DesignTwo-round, modified Delphi technique.Setting and participantsParticipants were neonatal experts from high-income and low-income countries (LICs).MethodsThis was a consensus-generating study. In round 1, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus for inclusion (≥80% agreement) were incorporated into the algorithms. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round 2, experts rated items from round 1 that did not reach consensus.ResultsFourteen experts participated in round 1, 10 in round 2. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Per experts’ recommendations, items in line with local and WHO guidelines yet not meeting consensus were still included to encourage consistency for front-line healthcare workers. As a result, the final algorithms included 53 items (62%).ConclusionFour algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to NeoTree will be made in response to these findings. Next steps include clinical validation of the algorithms.

scholarly journals Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

2020 ◽  
Author(s):  
Mari Evans ◽  
Mark H. Corden ◽  
Caroline Crehan ◽  
Felicity Fitzgerald ◽  
Michelle Heys
Keyword(s):  
Expert Opinion ◽  
Low Income ◽  
Delphi Technique ◽  
High Income ◽  
Low Income Countries ◽  
Current Evidence ◽  
Digital Platform ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Clinical Algorithms

ABSTRACTObjectivesTo determine whether a panel of neonatal experts could address evidence gaps in neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).DesignTwo-round, modified Delphi technique.Setting and participantsParticipants were neonatal experts from high-income and low-income countries (LICs).MethodsThis was a consensus-generating study. In round one, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus (≥80% agreement) were included. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round two, experts rated items from round one that did not reach consensus.ResultsFourteen experts participated in round one, ten in round two. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Experts consistently stated that items must be in line with local and WHO guidelines (irrespective of the level of supporting evidence or expert opinion). As a result, the final algorithms included 53 items (62%).ConclusionFour algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to the NeoTree application were made in response to these findings and will be clinically validated in an imminent study.STRENGTHS AND LIMITATIONS OF THIS STUDY➢In this study, a large number of algorithm items were reviewed and evaluated, and half met consensus for inclusion in the management pathways.➢The review was conducted with experts from a broad range of countries and neonatal experience who simultaneously refined the algorithms and highlighted gaps in current evidence, emphasising the need for future research to support international neonatal guidelines.➢Our study method meant that experts were not able to meet in person, which might have promoted dialogue that would have allowed greater clarity in their collective opinion.➢The representation of neonatal experts from LICs was not as robust as from high-income countries, which may have led to an uneven evaluation of the algorithms.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field.MethodsThe authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

Timing of milestone competency acquisition in neurology residency

Neurology ◽  
2018 ◽  
Vol 91 (16) ◽  
pp. 748-754 ◽  
Author(s):  
Lyell K. Jones ◽  
Scott D.Z. Eggers ◽  
David J. Capobianco ◽  
Christopher J. Boes
Keyword(s):  
Delphi Technique ◽  
Educational Expectations ◽  
Residency Programs ◽  
Modified Delphi ◽  
Perceived Importance ◽  
Modified Delphi Technique ◽  
Individual Program ◽  
Participant Characteristics ◽  
The Individual ◽  
The Relationship

ObjectiveTo determine the stage of training at which neurology residents should achieve individual elements of the Accreditation Council for Graduate Medical Education neurology Milestones and to examine the relationship between perceived importance of Milestones and the stage by which they should be achieved.MethodsA modified Delphi technique was used to establish consensus postgraduate year (PGY) expectations for neurology Milestone competencies across 3 geographically and administratively distinct Mayo Clinic neurology residency programs. Timing expectations were examined for relationships to perceived importance of the individual Milestones and effects of participant characteristics.ResultsPGY expectations for neurology Milestone elements ranged from PGY 1.3 to PGY 4.1. Extent of rater educational seniority had no effect on PGY competency expectations. There was a moderate inverse relationship between perceived importance of the Milestone element and the PGY by which it should be achieved (rs = −0.74, p < 0.0001).Conclusions and relevanceExpectations for neurology Milestone competency acquisition can be measured and may help inform individual program design, educational expectations, and future Milestone design.

scholarly journals Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

2018 ◽  
Vol 45 (4) ◽  
pp. E13 ◽  
Author(s):  
Michael C. Dewan ◽  
Ronnie E. Baticulon ◽  
Abbas Rattani ◽  
James M. Johnston ◽  
Benjamin C. Warf ◽  
...  
Keyword(s):  
Low Income ◽  
International Collaboration ◽  
Eastern Mediterranean ◽  
Training Needs ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Workforce ◽  
And Training

OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.

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