scholarly journals Schizophrenia and “unmet needs”: From diagnosis to care in Italy

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Silvana Galderisi ◽  
Marco A. Riva ◽  
Paolo Girardi ◽  
Mario Amore ◽  
Bernardo Carpiniello ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Delphi Study ◽  
Unmet Needs ◽  
Early Recognition ◽  
Accurate Identification ◽  
Integration Of Care ◽  
Delphi Approach ◽  
Essential Components ◽  
Strong Consensus ◽  
Barriers And Challenges

Abstract Background. Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery. Methods. A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry. Results. A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice. Conclusions. The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS.

The development and critique of validated assessment tools for pre-hospital resuscitation skills

2019 ◽  
Vol 8 (1) ◽  
pp. 50-63
Author(s):  
Amy Seymour-Walsh
Keyword(s):  
Clinical Education ◽  
Delphi Study ◽  
Life Support ◽  
Advanced Life Support ◽  
Needle Insertion ◽  
Assessment Tools ◽  
Emergency Setting ◽  
Content Type ◽  
Delphi Approach ◽  
Essential Components

Purpose The purpose of this paper is to describe the development of clinically credible skill practice and assessment guides for intraosseous (IO) needle insertion and laryngeal mask airway (LMA) insertion as two essential components of advanced life support (ALS) training. Design/methodology/approach A modified Delphi approach was used to determine expert consensus in the application of IO and LMA devices for the pre-hospital and emergency setting. Nine pre-hospital clinical specialists were recruited to participate in this Delphi study to determine consensus of clinical expert practice. Findings Two rounds were required to obtain a performance and assessment checklist for each skill. Both lists were then further modified to maximise their useability. However, the development of a “validated” checklist using a pre-determined process such as a Delphi approach is challenged. Rather, the implementation of these tools in a stated context, and analysis of the data they generate, is an essential aspect of validation which the Delphi approach does not address. Research limitations/implications Participant feedback regarding the rationale for their scores was limited in this study in order to minimise participant input and maximise completion of all rounds of the study. Further, devices used in the study may no longer be first-line choices with the advent of more modern devices including semi-automatic IO devices and LMAs which do not have inflatable cuffs. The refined checklists are able to be adapted to these newer devices. Practical implications Pre-hospital education contexts which may not have access to expert assessors who are skilled in providing global judgements now have access to clinically relevant skill-specific assessment tools for IO and LMA insertion. Originality/value Worldwide, ALS accreditation and competence is demanded of countless health professionals, and to date, validated practice and assessment guides specifically developed for the emergency setting for which they are used, are not available in the published literature. This paper proposes to fill that gap, in addition to guiding clinical education researchers in strategies to develop valid assessment tools through rigorous critique.

scholarly journals Prevention and management of major complications in percutaneous endoscopic gastrostomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000628
Author(s):  
Kurt Boeykens ◽  
Ivo Duysburgh
Keyword(s):  
Clinical Practice ◽  
Abdominal Wall ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Early Recognition ◽  
Endoscopic Technique ◽  
Abdominal Wound ◽  
Review Of The Literature ◽  
Endoscopic Gastrostomy ◽  
Major Complications ◽  
Life Threatening

BackgroundPercutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only few major complications. Nevertheless these complicationscan be sometimes life-threatening or generate serious morbidity.MethodAnarrative review of the literature of major complications in percutaneousendoscopic gastrostomy.ResultsThis review was written from a clinical viewpoint focussing on prevention andmanagement of major complications and documentedscientific evidence with real cases from more than 20 years of clinical practice.ConclusionsMajorcomplications are rare but prevention, early recognition and popper management areimportant.

scholarly journals Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks

2021 ◽  
Vol 46 (7) ◽  
pp. 571-580
Author(s):  
Kariem El-Boghdadly ◽  
Morné Wolmarans ◽  
Angela D Stengel ◽  
Eric Albrecht ◽  
Ki Jinn Chin ◽  
...  
Keyword(s):  
Education Research ◽  
Clinical Practice ◽  
Abdominal Wall ◽  
Chest Wall ◽  
Round Table Discussion ◽  
Anesthetic Techniques ◽  
Delphi Consensus ◽  
International Consensus ◽  
Strong Consensus ◽  
Regional Anesthetic

BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.

scholarly journals A consensus approach toward the standardization of spinal stiffness measurement using a loaded rolling wheel device: results of a Delphi study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maliheh Hadizadeh ◽  
Greg Kawchuk ◽  
Simon French
Keyword(s):  
Delphi Study ◽  
Best Practice ◽  
Standard Protocol ◽  
Research Experience ◽  
Multicenter Studies ◽  
Stiffness Measurement ◽  
Delphi Approach ◽  
Spinal Stiffness ◽  
Human Participants ◽  
Rolling Wheel

Abstract Background Spinal stiffness assessment has the potential to become an important clinical measure. Various spinal stiffness-testing devices are available to help researchers objectively evaluate the spine and patient complaints. One of these is VerteTrack, a device capable of measuring posteroanterior displacement values over an entire spinal region. This study aimed to develop a best-practice protocol for evaluating spinal stiffness in human participants using VerteTrack. Methods Twenty-five individuals with research experience in measuring spinal stiffness, or who were trained in spinal stiffness measurement using the VerteTrack device, were invited to participate in this 3-Round Delphi study. Answers to open-ended questions in Round 1 were thematically analyzed and translated into statements about VerteTrack operation for spinal stiffness measurements. Participants then rated their level of agreement with these statements using a 5-point Likert scale in Rounds 2 and 3. A descriptive statistical analysis was performed. Consensus was achieved when at least 70% of the participants either strongly agreed, agreed, (or strongly disagreed, disagreed) to include a statement in the final protocol. Results Twenty participants completed Round 1 (80%). All these participants completed Rounds 2 and 3. In total, the pre-defined consensus threshold was reached for 67.2% (123/183) of statements after three rounds of surveys. From this, a best-practice protocol was created. Conclusions Using a Delphi approach, a consensus-based protocol for measuring spinal stiffness using the VerteTrack was developed. This standard protocol will help to improve the accuracy, efficiency, and safety of spinal stiffness measurements, facilitate the training of new operators, increase consistency of these measurements in multicenter studies, and provide the synergy and potential for data comparison between spine studies internationally. Although specific to VerteTrack, the resulting standard protocol could be modified for use with other devices designed to collect spinal stiffness measures.

Consensus for statements regarding a definition for spinal osteoarthritis for use in research and clinical practice: A Delphi study

2021 ◽  
Author(s):  
Katie Luca ◽  
Alessandro Chiarotto ◽  
Flavia Cicuttini ◽  
Laura Creemers ◽  
Evelien Schepper ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Delphi Study ◽  
Spinal Osteoarthritis

Knowledge transfer in IS offshoring: a Delphi study of the offshore coordinator role

2019 ◽  
Vol 21 (1) ◽  
pp. 36-62 ◽  
Author(s):  
Artur Strasser ◽  
Markus Westner ◽  
Susanne Strahringer
Keyword(s):  
Knowledge Transfer ◽  
Delphi Study ◽  
Management Skills ◽  
Content Type ◽  
Hard Skills ◽  
Two Factors ◽  
Research Findings ◽  
Strong Consensus ◽  
Practical Implications ◽  
Is Offshoring

Purpose This paper aims to investigate the main tasks, necessary skills, and the implementation of the offshore coordinator’s role to facilitate knowledge transfer in information systems (IS) offshoring. Design/methodology/approach This empirical exploratory study uses the classical Delphi method that includes one qualitative and two quantitative rounds to collect data on IS experts’ perceptions to seek a consensus among them. Findings The participants agreed, with strong consensus, for a set of 16 tasks and 15 skills. The tasks focused primarily on relationship management and facilitating knowledge transfer on different levels. The set of skills consists of approximately 25 per cent “hard” skills, e.g. professional language skills and project management skills, and approximately 75 per cent “soft” skills, e.g. interpersonal and communication skills and the ability to deal with conflict. Two factors mainly influence implementing the offshore coordinator role: project size and the number of projects to be supported simultaneously. Practical implications The findings provide indications of how to define and fulfill this crucial role in practice to facilitate the knowledge transfer process in a positive way. Originality/value Similarities in previous research findings are aggregated to examine the intermediate role in detail from a consolidated perspective. This results in the first comprehensive set of critical tasks and skills assigned to the competency dimensions of the universal competency framework, demonstrating which and how many competency dimensions are critical.

scholarly journals Development of a screening tool for pelvic floor dysfunction in female athletes: protocol of a Delphi consensus

2022 ◽  
Author(s):  
Silvia Giagio ◽  
Andrea Turolla ◽  
Tiziano Innocenti ◽  
Stefano Salvioli ◽  
Giulia Gava ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Pelvic Floor ◽  
Delphi Study ◽  
Sports Medicine ◽  
Screening Tool ◽  
Female Athletes ◽  
Pelvic Floor Dysfunction ◽  
Negative Influence ◽  
Delphi Consensus

Background/aim: Several epidemiological studies have found a high prevalence of Pelvic Floor Dysfunction (PFD) among female athletes. However, according to several authors, these data could even be underestimated, both in research and clinical practice. Screening for potential PFD is often delayed and risk factors are not often evaluated. As a consequence, withdrawal from sport, negative influence on performance, worsening symptoms and unrecognized diagnosis may occur. The aim of our research is to develop a screening tool for pelvic floor dysfunction in female athletes useful for clinicians (musculoskeletal/sport physiotherapists, sports medicine physicians, team physicians) to guide referral to a PFD expert (e.g. pelvic floor/women's health physiotherapist, gynecologist, uro-gynecologist, urologist). Methods: A 2-round modified Delphi study will be conducted to ascertain expert opinion on which combination of variables and risk factors should be included in the screening tool. Conclusion: The implementation of the present screening tool into clinical practice may facilitate the referral to a PFD expert for further assessment of the pelvic floor and therefore, to identify potential dysfunction and, eventually, the related treatment pathway.

scholarly journals Can serum ferritin levels predict the severity of dengue early?: an observational study

2019 ◽  
Vol 7 (3) ◽  
pp. 876
Author(s):  
Velammal Petchiappan ◽  
Thaha Mohammed Hussain ◽  
Saravanan Thangavelu
Keyword(s):  
Platelet Count ◽  
Clinical Practice ◽  
Observational Study ◽  
Hospital Stay ◽  
Serum Ferritin ◽  
Early Recognition ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Severe Dengue ◽  
Elderly Subjects

Background: Dengue infection is a major public health threat; early recognition is crucial to improve the survival in severe dengue. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. We analyzed whether serum ferritin can be used to predict the severity at an earlier stage.Methods: A hospital based prospective observational study was done involving 119 dengue cases diagnosed by positive NS1 antigen or dengue specific serology (capture ELISA). Serum ferritin was measured in all at the time of diagnosis. Clinical and platelet count monitoring was done daily; classified as severe and non-severe according to 2009 WHO criteria.Results: Out of 119, 5 developed severe dengue; patients with severe dengue had significantly lower median platelet count (p<0.0001); higher ferritin levels (p=0.03) and hospital stay (p<0.0001) than non-severe group. Age had a significant negative co-relation with platelet count (r= -0.427; p<0.0001); positive correlation with ferritin levels (r=0.16; p=0.08) and hospital stay (r= 0.26; p=0.004) indicating that elderly subjects are at risk of severe disease. Serum ferritin levels negatively correlated with the platelet count (r= -0.51 p<0.001). High ferritin levels in severe cases are noted from day 4 of clinical illness.Conclusions: Elevated serum ferritin levels can be used as a potential early prognostic marker to predict the severity of dengue infection in clinical practice.

Finding Consensus on Integrating Neuroeducation into Trauma-Informed Counseling Practice: A Delphi Study

2021 ◽  
Author(s):  
Jenna Epstein ◽  
Rachel McRoberts
Keyword(s):  
Counselor Education ◽  
Delphi Study ◽  
Counselor Education And Supervision ◽  
Educational Methods ◽  
Counseling Practice ◽  
Essential Components ◽  
Trauma Informed ◽  
Study Support ◽  
Perceived Impact

A Delphi Study was carried out to investigate what experts considered essential components for integrating neuroeducation into trauma-informed counseling practice. After initial recruitment, a total of 14 trauma-informed counseling experts participated in a 4-round Delphi Study, in which main areas of brain education and associated educational methods were identified. Additionally, a richer description of the perceived impact of neuroeducation on clients was discussed. The results of this Delphi Study support the integration of a number of neuroeducation topics and methods into trauma-informed counseling practice and further support the need for incorporation of neuroeducation into counselor education and supervision.

P12.06 Unmet needs and wish for support of informal caregivers of primary brain tumour patients

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii31-ii32
Author(s):  
L Pointon ◽  
R Grant ◽  
S Peoples ◽  
S Erridge ◽  
P Sherwood ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Disease Progression ◽  
Family Caregivers ◽  
Brain Tumour ◽  
Unmet Needs ◽  
Emotional Health ◽  
Informal Caregivers ◽  
Family Members ◽  
Primary Brain Tumour ◽  
Caregiver Needs

Abstract BACKGROUND Most primary brain tumour patients rely on informal caregivers (i.e. family members or friends) for practical and emotional support. While caregiving can be rewarding, it also commonly leads to significant burden. In developing support for caregivers, it is vital to distinguish between caregivers’ unmet needs, and their actual wish for support to resolve unmet needs. We aimed to 1) identify the presence and magnitude of unmet needs; 2) examine associations between unmet needs and desire for support; 3) evaluate perceived usefulness of caregiver needs screening in clinical practice. MATERIAL AND METHODS Family caregivers of patients with primary brain tumours were recruited and asked to complete an adapted version of the Caregiver Needs Screen (CNS). This covered the level of distress resulting from 33 common issues in neuro-oncology caregiving (scale 0–10), and wish for information or support for any issue (yes/no). In addition, participants were asked to rank (0–7) their experience of using the CNS based on items covering ‘ease of us’, ‘usefulness’ and ‘satisfaction’. Descriptive and correlational analyses were applied. RESULTS Caregivers (N=79) reported between 1–33 unmet needs (M=17.20, sd=7.98) but did not always wish for support for each need (range 0–28, M=4.71, sd=6.63). Most distressing items were patient’s fatigue (M=5.58), recognising signs of disease progression (M=5.23), changes in patients’ thinking or behaviour (M=5.04), patient distress or sadness (M=4.68), and changes in caregivers’ own emotional health (M=4.44). A weak correlation was found between the total number of unmet needs and the desire for support (r=0.296, p=0.014). Caregivers most often desired support with recognising disease progression (N=24), managing medications and side-effects (N=18), and least often with managing spiritual issues (N=0), communication with (grand)children (N=2) and communication with family members and friends (N=3). Caregivers evaluated the CNS tool positively (mean item scores ranging 4.19–6.21 out of 7). CONCLUSION Family caregivers of brain tumour patients experience distress resulting from many neuro-oncology specific needs, but this is not directly related to a wish for support or information. Caregiver needs screening could be useful to tailor support or information to suit caregivers’ preferences in clinical practice.

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