Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content

2021 ◽  
pp. bmjspcare-2021-003013
Author(s):  
Felicity Dewhurst ◽  
Barbara Hanratty ◽  
Katherine Frew ◽  
Paul Paes ◽  
Richard Walker ◽  
...  
Keyword(s):  
Learning Outcomes ◽  
Delphi Study ◽  
Palliative Medicine ◽  
Care Home ◽  
Geriatric Medicine ◽  
Future Research ◽  
Delphi Panel ◽  
Specialist Training ◽  
Training Requirements ◽  
National Training

ObjectivesFrailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty.MethodsLiterature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected.ResultsThe meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes.ConclusionsThis frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.

66. Innovation in the academic half-day CanMEDS medical expert competency for residency educations

2007 ◽  
Vol 30 (4) ◽  
pp. 65
Author(s):  
H. R. Rajani ◽  
C. Good
Keyword(s):  
Core Competency ◽  
Core Knowledge ◽  
Specialist Training ◽  
Medical Expert ◽  
Learning Session ◽  
Training Requirements ◽  
The Core ◽  
Case Based Learning ◽  
Contact Hours ◽  
Didactic Presentation

Over the past decade we have attempted various iterations of the academic half-day, but recurring trainee complaints of only didactic sessions, a parallel resident-directed “Nelsons” rounds, and low attendance necessitated a reconsideration of the approach. After discussion with the postgraduate trainees we divided the academic year into two blocks. An initial 8 week “summer program” with 24 student contact hours, focuses on the introduction to and review of common, critical care and emergency pediatric issues. The following 40 weeks has 120 student contact hours. Two thirds of the time is directed at the CanMEDS Medical Expert Core Competency. The postgraduate trainees have developed a three year core knowledge curriculum. The 200 “core” topics are mapped onto four international curricula; the RCPSC’s Objectives of Training and Specialty Training Requirements in Pediatrics using the Systems-Based Educational Objectives in the Core Program in Pediatrics, the American Board of Pediatrics – General Pediatrics Outline, and the Royal College of Pediatrics & Child Health (RCPCH) Framework of Competencies for Basic Specialist Training, and Core Higher Specialist Training in Paediatrics. The two hour Medical Expert session is divided equally into a postgraduate trainee didactic presentation, and a collaborator case-based learning session. Six weeks prior to the scheduled session the trainee and the assigned faculty collaborator receive the core Medical Expert topic mapped to the four international curricula. The pediatric trainee develops a didactic presentation along with a two page summary. The collaborator, a resource for the trainee’s didactic presentation, develops three clinical cases that emphasize core knowledge, and attends as a Medical Expert resource person. We are currently surveying the postgraduate trainees and faculty about this international-based core medical expert program of study.

scholarly journals Is area deprivation associated with greater impacts of COVID-19 in care homes across England? A preliminary analysis of COVID-19 outbreaks and deaths

2021 ◽  
pp. jech-2020-215039 ◽  
Author(s):  
Anders Malthe Bach-Mortensen ◽  
Michelle Degli Esposti
Keyword(s):  
Negative Binomial ◽  
Care Home ◽  
Negative Binomial Regression ◽  
Population Characteristics ◽  
Care Homes ◽  
Future Research ◽  
Area Deprivation ◽  
Binomial Regression ◽  
Index Of Multiple Deprivation

IntroductionThe COVID-19 pandemic has disproportionately impacted care homes and vulnerable populations, exacerbating existing health inequalities. However, the role of area deprivation in shaping the impacts of COVID-19 in care homes is poorly understood. We examine whether area deprivation is linked to higher rates of COVID-19 outbreaks and deaths among care home residents across upper tier local authorities in England (n=149).MethodsWe constructed a novel dataset from publicly available data. Using negative binomial regression models, we analysed the associations between area deprivation (Income Deprivation Affecting Older People Index (IDAOPI) and Index of Multiple Deprivation (IMD) extent) as the exposure and COVID-19 outbreaks, COVID-19-related deaths and all-cause deaths among care home residents as three separate outcomes—adjusting for population characteristics (size, age composition, ethnicity).ResultsCOVID-19 outbreaks in care homes did not vary by area deprivation. However, COVID-19-related deaths were more common in the most deprived quartiles of IDAOPI (incidence rate ratio (IRR): 1.23, 95% CI 1.04 to 1.47) and IMD extent (IRR: 1.16, 95% CI 1.00 to 1.34), compared with the least deprived quartiles.DiscussionThese findings suggest that area deprivation is a key risk factor in COVID-19 deaths among care home residents. Future research should look to replicate these results when more complete data become available.

scholarly journals Music Connects Us: Development of a Music-Based Group Activity Intervention to Engage People Living with Dementia and Address Loneliness

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 570
Author(s):  
Hannah M. O’Rourke ◽  
Tammy Hopper ◽  
Lee Bartel ◽  
Mandy Archibald ◽  
Matthias Hoben ◽  
...  
Keyword(s):  
Social Interactions ◽  
Social Connectedness ◽  
Care Home ◽  
Intervention Mapping ◽  
Group Activity ◽  
Relationship Building ◽  
Care Staff ◽  
Future Research ◽  
Engaged Scholarship ◽  
Severe Dementia

There is a need for intervention research to understand how music-based group activities foster engagement in social interactions and relationship-building among care home residents living with moderate to severe dementia. The purpose of this conceptual paper is to describe the design of ‘Music Connects Us’, a music-based group activity intervention. Music Connects Us primarily aims to promote social connectedness and quality of life among care home residents living with moderate to severe dementia through engagement in music-making, supporting positive social interactions to develop intimate connections with others. To develop Music Connects Us, we adapted the ‘Music for Life’ program offered by Wigmore Hall in the United Kingdom, applying an intervention mapping framework and principles of engaged scholarship. This paper describes in detail the Music Connects Us program, our adaptation approach, and key adaptations made, which included: framing the project to focus on the engagement of the person living with dementia to ameliorate loneliness; inclusion of student and other community-based musicians; reduced requirements for care staff participation; and the development of a detailed musician training approach to prepare musicians to deliver the program in Canada. Description of the development, features, and rationale for Music Connects Us will support its replication in future research aimed to tests its effects and its use in clinical practice.

How Might We Screen for Psychological Factors in People With Pelvic Pain? An e-Delphi Study

2021 ◽  
Author(s):  
Angela Pontifex ◽  
Caris Savin ◽  
Caitlin Park ◽  
Alina Filipe Nunes ◽  
K Jane Chalmers ◽  
...  
Keyword(s):  
Focus Group ◽  
Pelvic Pain ◽  
Delphi Method ◽  
Delphi Study ◽  
Psychological Factors ◽  
Clinical Utility ◽  
Delphi Process ◽  
Future Research ◽  
Exclusion Criteria ◽  
Group Design

Abstract Objective Persistent pelvic pain is a complex condition often influenced by psychological factors that can alter treatment outcomes. These factors are potentially modifiable; however, currently there is no instrument to screen for them in these individuals. The purpose of this study was to determine (1) which psychological factors should be screened in individuals with persistent pelvic pain and (2) the most appropriate statements to represent these psychological factors. Methods The study used a focus group design followed by an electronic-Delphi (e-Delphi) process. A focus group consisting of 8 experts was conducted to determine the relevant psychological factors to screen. These results informed round 1 of the e-Delphi process, consisting of a panel of 14 pain/pelvic pain experts. The e-Delphi process consisted of 3 rounds of online surveys and 2 teleconference discussions to establish consensus on the most appropriate statement to screen for each of the psychological factors. Results The focus group identified 13 relevant psychological factors. During the e-Delphi process, relevant screening statements were assessed using a 100-point allocation system. Experts could reword and suggest new statements. Statements were assessed for consensus and stability and were eliminated as the rounds progressed if they met the exclusion criteria. At the termination of round 3, there were 15 statements remaining. Conclusions The final list of 15 statements will assist clinicians in screening for psychological factors and is an important step for clinicians in providing psychologically informed care to people with persistent pelvic pain. Future research should determine the psychometric properties of the statements to determine their clinical utility as a questionnaire. Impact This study has refined a list of statements to help screen for psychological factors in individuals with persistent pelvic pain. Developed robustly using an e-Delphi method, this list is an important first step forward for clinicians to provide psychologically informed care to these individuals.

scholarly journals What is meant by “frailty” in undergraduate medical education? A national survey of UK medical schools

2021 ◽  
Vol 12 (2) ◽  
pp. 355-362
Author(s):  
Rebecca Winter ◽  
Muna Al-Jawad ◽  
Juliet Wright ◽  
Duncan Shrewsbury ◽  
Harm Van Marwijk ◽  
...  
Keyword(s):  
Medical Education ◽  
Learning Outcomes ◽  
Undergraduate Medical Education ◽  
Geriatric Medicine ◽  
Treatment Decision ◽  
Medical Schools ◽  
Educational Strategies ◽  
Treatment Decision Making ◽  
Negative Perceptions ◽  
Common Learning

Abstract Purpose All UK medical schools are required to include frailty in their curriculum. The term is open to interpretation and associated with negative perceptions. Understanding and recognising frailty is a prerequisite for consideration of frailty in the treatment decision-making process across clinical specialities. The aim of this survey was to describe how frailty has been interpreted and approached in UK undergraduate medical education and provide examples of educational strategies employed. Methods All UK medical schools were invited to complete an electronic survey. Schools described educational strategies used to teach and assess frailty and provided frailty-related learning outcomes. Learning Outcomes were grouped into categories and mapped to the domains of Outcomes for Graduates (knowledge, skills and values). Results 25/34 Medical schools (74%) participated. The interpretation of what frailty is vary widely and the diversity of teaching strategies reflect this. The most common Learning outcomes included as “Frailty” are about the concept of frailty, Comprehensive Geriatric Assessments and Roles of the MDT. Frailty teaching is predominantly opportunistic and occurred within geriatric medicine rotations in all medical schools. Assessments focus on frailty syndromes such as falls and delirium. Conclusion There is variation regarding how frailty has been interpreted and approached by medical schools. Frailty is represented in an array of teaching and assessment methods, with a lack of constructive alignment to related learning outcomes. Consensus should be agreed as to what frailty means in medical education. Further research is required to explore which frailty-specific educational strategies in undergraduate medical education enhance learning.

Primary Addiction Medicine Skills for Hospice and Palliative Medicine Physicians: A Modified Delphi Study

2021 ◽  
Author(s):  
Isaac S. Chua ◽  
Ellie Fratt ◽  
J. Janet Ho ◽  
Claudia S. Roldan ◽  
Daniel A. Gundersen ◽  
...  
Keyword(s):  
Delphi Study ◽  
Palliative Medicine ◽  
Addiction Medicine ◽  
Modified Delphi

scholarly journals Insights of project managers into the problems in project management

2016 ◽  
Vol 16 (1) ◽  
pp. 90-103 ◽  
Author(s):  
Peter Vincent Livesey
Keyword(s):  
Project Management ◽  
Delphi Study ◽  
Soft Skills ◽  
Project Managers ◽  
Delphi Panel ◽  
Relative Importance ◽  
Team Management ◽  
Management Skills ◽  
Hard Skills ◽  
Importance Index

A Delphi study using project managers who had managed projects in excess of $500 million was used to confirm the significance and frequency of problems resulting from the nature of projects. Using the results obtained from the Delphi study a ranking of the problems experienced in these projects was obtained by calculating a Relative Importance Index. Additionally, the Delphi panel members were asked their views concerning the need for traditional project management skills (hard skills) and team management skills (soft skills) as project size increased from below $50 million to over $500 million. A substantial increase in the need for both skills was indicated with the increase in the need for soft skills being the most significant.

The Effect of Concealed Handgun Carry Deregulation in Arizona on Crime in Tucson

2018 ◽  
Vol 30 (8) ◽  
pp. 1186-1203 ◽  
Author(s):  
Michael R. Smith ◽  
Matthew Petrocelli
Keyword(s):  
El Paso ◽  
Future Research ◽  
Multiple Time ◽  
Multiple Time Series ◽  
Training Requirements ◽  
State Adoption ◽  
Concealed Carry ◽  
And Control ◽  
The Impact ◽  
And Training

In 2010, the Arizona legislature effectively deregulated concealed handgun carry in the state by passing Senate Bill (SB) 1108, which eliminated licensing and training requirements for concealed carry. Although researchers have extensively examined the impact of state adoption of concealed carry laws, almost nothing is known about the effects of deregulating concealed carry altogether. This study contributes to the more guns, less crime debate by examining the impact of Arizona’s decision to deregulate concealed carry. Using a multiple time-series research design with an experimental (Tucson) and control city (El Paso), the present study examines the impact of deregulation on handgun-related violent crime and gun larcenies in Arizona’s second largest city—Tucson. We find that the passage of SB 1108 had no impact on handgun-related offenses that could be expected to change following deregulation. The implications of these findings for policy making and future research are discussed.

scholarly journals Improving the understanding of how patients with non-dystrophic myotonia are selected for myotonia treatment with mexiletine (NaMuscla): outcomes of treatment impact using a European Delphi panel

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ann-Marie Chapman ◽  
Marieke Schurer ◽  
Laure Weijers ◽  
Amer Omar ◽  
Hiba Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Natural History ◽  
Negative Impact ◽  
Phase Iii ◽  
Future Research ◽  
Delphi Panel ◽  
Economic Modelling ◽  
Patient Access ◽  
History Of

Abstract Background Non-dystrophic myotonias (NDMs) comprise muscle chloride and sodium channelopathies due to genetic defects of the CLCN1- and SCN4A-channels. No licensed antimyotonic treatment has been available until approval of mexiletine (NaMuscla®) for adult patients by the EMA in December 2018. This Delphi panel aimed to understand how outcomes of the pivotal phase III Mexiletine study (MYOMEX) translate to real world practice and investigate health resource use, quality of life and the natural history of NDM to support economic modelling and facilitate patient access. Methods Nine clinical experts in treating NDM took part in a two-round Delphi panel. Their knowledge of NDM and previous use of mexiletine as an off-label treatment prior to NaMuscla’s approval ensured they could provide both qualitative context and quantitative estimates to support economic modelling comparing mexiletine (NaMuscla) to best supportive care. Consensus in four key areas was sought: healthcare resource utilization (HRU), treatment with mexiletine (NaMuscla), patient quality of life (QoL), and the natural history of disease. Concept questions were also asked, considering perceptions on the feasibility of mapping the validated Individualized Neuromuscular Quality of Life (INQoL) instrument to the generic EQ-5D™, and the potential impact on caregiver QoL. Results Consensus was achieved for key questions including the average long-term dosage of mexiletine (NaMuscla) in practice, the criteria for eligibility of myotonia treatment, the clinical importance of QoL outcomes in MYOMEX, the higher proportion of patients with increased QoL, and the reduction in the need for mental health resources for patients receiving mexiletine (NaMuscla). While consensus was not achieved for other questions, the results demonstrated that most experts felt mexiletine (NaMuscla) reduced the need for HRU and was expected to improve QoL. The QoL mapping exercise suggested that it is feasible to map domains of INQoL to EQ-5D. Points of interest for future research were identified, including that mexiletine (NaMuscla) may slow the annual decrease in QoL of patients over their lifetime, and a significant negative impact on QoL for some caregivers. Conclusions This project successfully provided data from an informed group of clinical experts, complementing the currently available clinical trial data for mexiletine (NaMuscla) to support patient access decisions.

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