Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study

OBJECTIVEComplications after complex tethered spinal cord (cTSC) surgery include infections and cerebrospinal fluid (CSF) leaks. With little empirical evidence to guide management, there is variability in the interventions undertaken to limit complications. Expert-based best practices may improve the care of patients undergoing cTSC surgery. Here, authors conducted a study to identify consensus-driven best practices.METHODSThe Delphi method was employed to identify consensual best practices. A literature review regarding cTSC surgery together with a survey of current practices was distributed to 17 board-certified pediatric neurosurgeons. Thirty statements were then formulated and distributed to the group. Results of the second survey were discussed during an in-person meeting leading to further consensus, which was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree).RESULTSSeventeen consensus-driven best practices were identified, with all participants willing to incorporate them into their practice. There were four preoperative interventions: (1, 2) asymptomatic AND symptomatic patients should be referred to urology preoperatively, (3, 4) routine preoperative urine cultures are not necessary for asymptomatic AND symptomatic patients. There were nine intraoperative interventions: (5) patients should receive perioperative cefazolin or an equivalent alternative in the event of allergy, (6) chlorhexidine-based skin preparation is the preferred regimen, (7) saline irrigation should be used intermittently throughout the case, (8) antibiotic-containing irrigation should be used following dural closure, (9) a nonlocking running suture technique should be used for dural closure, (10) dural graft overlay should be used when unable to obtain primary dural closure, (11) an expansile dural graft should be incorporated in cases of lipomyelomeningocele in which primary dural closure does not permit free flow of CSF, (12) paraxial muscles should be closed as a layer separate from the fascia, (13) routine placement of postoperative drains is not necessary. There were three postoperative interventions: (14) postoperative antibiotics are an option and, if given, should be discontinued within 24 hours; (15) patients should remain flat for at least 24 hours postoperatively; (16) routine use of abdominal binders or other compressive devices postoperatively is not necessary. One intervention was prioritized for additional study: (17) further study of additional gram-negative perioperative coverage is needed.CONCLUSIONSA modified Delphi technique was used to develop consensus-driven best practices for decreasing wound complications after cTSC surgery. Further study is required to determine if implementation of these practices will lead to reduced complications. Discussion through the course of this study resulted in the initiation of a multicenter study of gram-negative surgical site infections in cTSC surgery.

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Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified Delphi study

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.10.peds20778 ◽

2021 ◽

pp. 1-12

Author(s):

Nikita G. Alexiades ◽

Belinda Shao ◽

Bruno P. Braga ◽

Christopher M. Bonfield ◽

Douglas L. Brockmeyer ◽

...

Keyword(s):

Cervical Spine ◽

Best Practices ◽

Delphi Study ◽

Best Practice ◽

Pediatric Patients ◽

Modified Delphi ◽

Consensus Statements ◽

Cervical Traction ◽

Outcomes For Children ◽

Strongly Agree

OBJECTIVE Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy. METHODS A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS After the initial round, consensus was achieved with 40 statements regarding the following topics: goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice. CONCLUSIONS In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.

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High Prevalence of Gram-Negative Rod and Multi-Organism Surgical Site Infections after Pediatric Complex Tethered Spinal Cord Surgery: Preliminary Report from a Single-Center Study

Pediatric Neurosurgery ◽

10.1159/000508753 ◽

2020 ◽

Vol 55 (2) ◽

pp. 92-100

Author(s):

Nikita G. Alexiades ◽

Belinda Shao ◽

Lisa Saiman ◽

Neil Feldstein ◽

Richard C.E. Anderson

Keyword(s):

Spinal Cord ◽

Preliminary Report ◽

Surgical Site Infections ◽

Tethered Spinal Cord ◽

Single Center ◽

Gram Negative ◽

Single Center Study ◽

High Prevalence ◽

Spinal Cord Surgery ◽

Center Study

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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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Recommendations to improve the harmonisation of colorectal cancer cell percentage estimation in molecular oncology: a modified Delphi study

10.26226/morressier.5b4709886f4cb3001095199e ◽

2018 ◽

Author(s):

Kelly Dufraing ◽

Anca Oniscu ◽

Caterina Marchiò

Keyword(s):

Colorectal Cancer ◽

Cancer Cell ◽

Delphi Study ◽

Colorectal Cancer Cell ◽

Modified Delphi ◽

Molecular Oncology ◽

Cell Percentage

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European List of Essential Medicines for Medical Education: a protocol for a modified Delphi study

BMJ Open ◽

10.1136/bmjopen-2020-045635 ◽

2021 ◽

Vol 11 (5) ◽

pp. e045635

Author(s):

Erik Donker ◽

David Brinkman ◽

Milan Richir ◽

Paraskevi Papaioannidou ◽

Robert Likic ◽

...

Keyword(s):

Medical Education ◽

Delphi Study ◽

Medical Training ◽

Medical Center ◽

European Countries ◽

Essential Medicines ◽

Ethical Review ◽

Junior Doctors ◽

Direct Supervision ◽

Modified Delphi

IntroductionJunior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education.Methods and analysisThis modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in ≥80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision.Ethics and disseminationThe study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO‐ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.

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Barriers and facilitators to the implementation of interventions for medically unexplained symptoms in primary care: A modified Delphi study

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110386 ◽

2021 ◽

Vol 143 ◽

pp. 110386

Author(s):

Denise J.C. Hanssen ◽

Anika Ras ◽

Judith G.M. Rosmalen

Keyword(s):

Primary Care ◽

Delphi Study ◽

Medically Unexplained Symptoms ◽

Barriers And Facilitators ◽

Modified Delphi ◽

Medically Unexplained ◽

Unexplained Symptoms

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Expert Consensus on Clinical Application of Lateral Lumbar Interbody Fusion: Results From a Modified Delphi Study

Global Spine Journal ◽

10.1177/21925682211012688 ◽

2021 ◽

pp. 219256822110126

Author(s):

Yong Hai ◽

Jingwei Liu ◽

Yuzeng Liu ◽

Tie Liu ◽

Xinuo Zhang ◽

...

Keyword(s):

Lumbar Spine ◽

Delphi Method ◽

Delphi Study ◽

Interbody Fusion ◽

Expert Consensus ◽

Lumbar Spine Surgery ◽

Study Group ◽

Lumbar Interbody Fusion ◽

Modified Delphi ◽

Chinese Study

Study Design: Modified Delphi study. Objective: The objective of this study was to establish expert consensus on the application of lateral lumbar interbody fusion (LLIF) by using the modified Delphi study. Methods: From June 2019 to March 2020, Members of the Chinese Study Group for Lateral Lumbar Spine Surgery were selected to collect expert feedback using the modified Delphi method where 65 spine surgeons from all over China agreed to participate. Four rounds were performed: 1 face-to-face meeting and 3 subsequent survey rounds. The consensus was achieved with ≥a 70.0% agreement for each question. The recommendation of grade A was defined as ≥90.0% of the agreement for each question. The recommendation of grade B was defined as 80.0-89.9% of the agreement for each question. The recommendation of grade C was defined as 70.0-79.9% of the agreement for each question. Results: A total of 65 experts formed a panelist group, and the number of questionnaires collected was 63, 59, and 62 in the 3 rounds. In total, 5 sections, 71 questions, and 382 items achieved consensus after the Delphi rounds including summary; preoperative evaluation; application at the lumbar spinal stenosis, lumbar disc herniation, lumbar spondylolisthesis, adult degenerative scoliosis, postoperative adjacent segmental degeneration, and revision surgery; complications; and postoperative follow-up evaluation of LLIF. Conclusion: The modified Delphi method was utilized to ascertain an expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery to inform clinical decision-making in the application of LLIF. The salient grade A recommendations of the survey are enumerated.

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