Defining adverse events during trauma resuscitation: a modified RAND Delphi study

BackgroundThe majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these AEs that limits performance comparisons between hospitals and trauma systems. The objective of this study was to create a taxonomy of AEs that occur during trauma resuscitation and a corresponding classification system to assign a degree of harm.MethodsThis study used a modified RAND Delphi methodology to establish a taxonomy of AEs in trauma and a degree of harm classification system. A systematic review informed the preliminary list of AEs. An interdisciplinary panel of 22 trauma experts rated these AEs through two rounds of online surveys and a final consensus meeting. Consensus was defined as 80% for each AE and the final checklist.ResultsThe Delphi panel consisted of 22 multidisciplinary trauma experts. A list of 57 evidence-informed AEs was revised and expanded during the modified Delphi process into a finalized list of 67 AEs. Each AE was classified based on degree of harm on a scale from I (no harm) to V (death).DiscussionThis study developed a taxonomy of 67 AEs that occur during the initial phases of a trauma resuscitation with a corresponding degree of harm classification. This taxonomy serves to support a standardized evaluation of trauma care between centers and regions.Level of evidenceLevel 5.

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Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study

Annals of Pharmacotherapy ◽

10.1177/1060028019897371 ◽

2020 ◽

Vol 54 (7) ◽

pp. 625-632 ◽

Cited By ~ 2

Author(s):

Leena Taji ◽

Marisa Battistella ◽

Allan K. Grill ◽

Jessie Cunningham ◽

Brenda L. Hemmelgarn ◽

...

Keyword(s):

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Delphi Study ◽

Dose Adjustment ◽

Sglt2 Inhibitor ◽

Primary Care Providers ◽

Delphi Panel ◽

Care Providers ◽

Modified Delphi

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.

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Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study

International Journal of Mental Health Systems ◽

10.1186/s13033-020-00374-7 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Wendy Shoesmith ◽

Sze Hung Chua ◽

Beena Giridharan ◽

Dawn Forman ◽

Sue Fyfe

Keyword(s):

Delphi Study ◽

Collaborative Practice ◽

Consensus Recommendations ◽

Modified Delphi ◽

System A

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Adoption and evaluation of the Doha Agreement Classification system of groin pain in athletes (part 1): a modified Delphi study among the founding expert group v1 (protocols.io.8m7hu9n)

protocols.io ◽

10.17504/protocols.io.8m7hu9n ◽

2019 ◽

Author(s):

Willem Heijboer ◽

Adam Weir ◽

Eamonn Delahunt ◽

Per H ◽

Anthony G ◽

...

Keyword(s):

Classification System ◽

Delphi Study ◽

Groin Pain ◽

Expert Group ◽

Modified Delphi

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LO61: A modified Delphi study to identify trauma care modifiers for older adults

CJEM ◽

10.1017/cem.2020.116 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S29-S30

Author(s):

K. Yadav ◽

V. Boucher ◽

N. Le Sage ◽

C. Malo ◽

E. Mercier ◽

...

Keyword(s):

Older Adults ◽

Trauma Care ◽

Delphi Study ◽

Major Trauma ◽

Expert Panel ◽

Trauma Team ◽

Trauma Centre ◽

Trauma Patients ◽

Median Score ◽

Modified Delphi

Introduction: Older (age >=65 years) trauma patients suffer increased morbidity and mortality. This is due to under-triage of older trauma victims, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. There are currently no Canadian guidelines for the management of older trauma patients. The objective of this study was to identify modifiers to the prehospital and emergency department (ED) phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study to assess senior-friendly major trauma care modifiers based on national expert consensus. The panel consisted of 24 trauma care providers across Canada, including medical directors, paramedics, emergency physicians, emergency nurses, trauma surgeons and trauma administrators. Following a literature review, we developed an online Delphi survey consisting of 16 trauma care modifiers. Three online survey rounds were distributed and panelists were asked to score items on a 9-point Likert scale. The following predetermined thresholds were used: appropriate (median score 7–9, without disagreement); inappropriate (median score 1–3; without disagreement), and uncertain (any median score with disagreement). The disagreement index (DI) is a method for measuring consensus within groups. Agreement was defined a priori as a DI score <1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panelists. Of 19 trauma care modifiers, the expert panel achieved consensus agreement for 17 items. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate <10 or >20 breaths/minute or needing ventilatory support (DI = 0.24). The ED modifier with the strongest level of agreement was obtaining a 12-lead electrocardiogram following the primary and secondary survey for all older adults (DI = 0.01). Two trauma care modifiers failed to reach consensus agreement: transporting older patients with ground level falls to a trauma centre and activating the trauma team based solely on an age >=65 years. Conclusion: Using a modified Delphi process, an expert panel agreed upon 17 trauma care modifiers for older adults in the prehospital and ED phases of care. These modifiers may improve the delivery of senior-friendly trauma care and should be considered when developing local and national trauma guidelines.

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A Delphi study to identify prehospital and emergency department trauma care modifiers for older adults

Canadian Journal of Surgery ◽

10.1503/cjs.021519 ◽

2021 ◽

Vol 64 (3) ◽

pp. E339-E345

Author(s):

Krishan Yadav ◽

Valérie Boucher ◽

Natalie Le Sage ◽

Christian Malo ◽

Éric Mercier ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Trauma Care ◽

Delphi Study ◽

Older Patients ◽

Major Trauma ◽

Trauma Centre ◽

Expert Consensus ◽

Consensus Methods ◽

Modified Delphi

Background: Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehospital and emergency department phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study between May and September 2019 to identify major trauma care modifiers for older adults based on national expert consensus. The panel consisted of 24 trauma care professionals from across Canada from the prehospital and emergency department phases of care. The survey consisted of 16 trauma care modifiers. Three online survey rounds were distributed. Consensus was defined a priori as a disagreement index score less than 1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panellists. The panel achieved consensus agreement for 17 of the 19 trauma care modifiers. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate less than 10 or greater than 20 breaths/min or need for ventilatory support. The emergency department modifier with the strongest level of agreement was obtaining 12-lead electrocardiography following the primary and secondary survey. Conclusion: Using a modified Delphi process, an expert panel agreed on 17 trauma care modifiers for older adults in the prehospital and emergency department settings. These modifiers may improve the delivery of trauma care for older adults and should be considered when developing local and national trauma guidelines.

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Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Hypertension Research ◽

10.1038/s41440-021-00839-3 ◽

2022 ◽

Author(s):

Biggie Baffour-Awuah ◽

Melissa J. Pearson ◽

Neil A. Smart ◽

Gudrun Dieberg

Keyword(s):

Blood Pressure ◽

Resistance Training ◽

Delphi Study ◽

Consensus Meeting ◽

Expert Consensus ◽

Uncontrolled Hypertension ◽

Delphi Panel ◽

Modified Delphi ◽

Study Team ◽

Final Item

AbstractUncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts’ consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.

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Polydactyly of the thumb: a modification of the Wassel-Flatt classification

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420981541 ◽

2021 ◽

pp. 175319342098154

Author(s):

Jae Kwang Kim ◽

Bassmh Abdullah A Al-Dhafer ◽

Young Ho Shin ◽

Hyun Seok Joo

Keyword(s):

Classification System ◽

Kappa Coefficient ◽

Classification Systems ◽

Level Of Evidence ◽

Observer Reliability ◽

System A ◽

Surgical Methods ◽

Definition Of ◽

Triphalangeal Thumb ◽

Original Classification

Although the Wassel-Flatt classification system has been widely used for radial polydactyly, it has some limitations. We modified the classification system by introducing the hypoplastic types and refining the definition of triphalangeal thumb without changing the main structure of the original classification system. A total of 200 consecutive duplicated thumbs of 183 patients treated surgically from June 2016 to June 2018 were included. We evaluated intra-observer and inter-observer reliability using the kappa coefficient in the modified and original Wassel-Flatt classification systems (three examiners evaluated each case twice, with an interval of 4 weeks). We also evaluated the surgical methods according to the types of deformity in the modified and original Wassel-Flatt classification systems. The modified Wassel-Flatt classification system had good inter-observer reliability and provides useful information for determining the surgical plan according to the types of radial polydactyly. Level of evidence: IV

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Patterns of Success for Urban 4-H Youth Development in the Near Future

Journal of Youth Development ◽

10.5195/jyd.2007.347 ◽

2007 ◽

Vol 2 (2) ◽

pp. 74-90

Author(s):

W. Jack Kerrigan, Jr.

Keyword(s):

Best Practices ◽

Youth Development ◽

Delphi Study ◽

Qualitative Data ◽

Delphi Process ◽

Delphi Panel ◽

Target Populations ◽

Modified Delphi ◽

Development Programming ◽

Near Future

A Modified Delphi study identified patterns of success for urban Extension 4-H programming in the next five years. The Delphi panel of 20 experts represented all regions, program areas, organizational levels as well as two external friends of Extension. The Delphi process provided both quantitative and qualitative data on the topics of collaboration, target populations, and programming. Fifteen patterns of success were identified for urban 4-H youth development. These patterns should serve as best practices for Extension youth development programming in urban counties for “making the best better!” in the near future.

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