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

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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Management of patients admitted to hospital with acute vertebral fragility fractures: a modified Delphi study

Age and Ageing ◽

10.1093/ageing/afaa225 ◽

2020 ◽

Author(s):

Terence Ong ◽

Opinder Sahota ◽

John R F Gladman

Keyword(s):

Fragility Fracture ◽

Delphi Study ◽

Hospital Care ◽

Health Assessment ◽

Fragility Fractures ◽

Clinical Area ◽

Modified Delphi ◽

Line Imaging ◽

Strongly Agree ◽

Vertebral Fragility Fracture

Abstract Introduction Acute vertebral fragility fracture requiring hospital admission is common, painful and disabling. No comprehensive clinical guideline for their care exists. To support the development of such a guideline, we sought the views of experts in the field. Methods A modified Delphi study was used. A total of 70 statements were presented, using an online platform, over three consensus-seeking rounds, to participants with experience in the hospital care of patients with acute vertebral fragility fractures from UK-based specialist societies. Participants rated the level of their agreement with each statement on a 5-point Likert scale. Consensus was defined at 70% of respondents choosing either agree/strongly agree or disagree/strong disagree. Over the first two rounds, statements not reaching consensus were modified in subsequent rounds, and new statements proposed by participants and agreed by the research team could be added. Results There were 71 participants in the first round, 37 in the second round and 28 (most of whom were geriatricians) in the third round. Consensus was reached in 52 statements covering fracture diagnosis, second-line imaging, organisation of hospital care, pain management and falls and bone health assessment. Consensus was not achieved for whether vertebral fragility fractures should be managed in a specific clinical area. Discussion These findings provide the basis for the development of clinical guidelines and quality improvement initiatives. They also help to justify research into the merits of managing acute vertebral fragility fracture patients in a specific clinical area.

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Using the future to transform the design logic of schooling: Consensus statements from an expert panel

Policy Futures in Education ◽

10.1177/1478210320965020 ◽

2020 ◽

pp. 147821032096502

Author(s):

Jason McGrath ◽

John Fischetti

Keyword(s):

21St Century ◽

Delphi Study ◽

Policy Making ◽

Expert Panel ◽

Research Question ◽

Compulsory Schooling ◽

Modified Delphi ◽

Consensus Statements ◽

Future School ◽

Design Logic

We propose a framework of 29 Future School Elements that can be used to consider future models of schooling which we have organised across three pillars of pedagogy, policy and structure. We seek to position the framework within a futures approach to policy making that allows for greater diversity by providing a design logic that can be contextualised, is more pluralistic and can be shaped by a greater number of voices. The findings from our modified Delphi study involved an expert panel who examined the counterfactual research question ‘What if compulsory schooling was a 21st-century invention?’ Consensus statements were formed by the expert panel by rating items based on impact and equity. We explore ways in which utilising a foresight approach can provide a means to reshape future models of schooling in a meaningful and contemporary way that takes account of some of the challenges and forces that have prevented change.

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What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus

European Geriatric Medicine ◽

10.1007/s41999-019-00244-7 ◽

2019 ◽

Vol 10 (6) ◽

pp. 977-987 ◽

Cited By ~ 6

Author(s):

Romke van Balen ◽

Adam L. Gordon ◽

Jos M. G. A. Schols ◽

Yvonne M. Drewes ◽

Wilco P. Achterberg

Keyword(s):

Delphi Study ◽

Best Practice ◽

Elderly Care ◽

Quality Criteria ◽

Patient Outcome Assessment ◽

European Countries ◽

Treatment Programs ◽

Geriatric Rehabilitation ◽

Assessment Instruments ◽

Consensus Statements

Abstract Purpose Many European countries have developed services to rehabilitate the increasing number of older people who experience an acute or subacute decrease in function after a medical event such as a hip fracture or stroke. However, there are important differences between countries regarding patient selection, organization of services, length of stay, and content of the rehabilitation process. The lack of consensus around, and quality criteria for, geriatric rehabilitation limits opportunities for exchange of best practice and scientific research. Methods 33 experts, mostly geriatricians with experience in geriatric rehabilitation, from 18 European countries were invited to participate in a modified Delphi study. They were asked to react to 68 statements using a five-point Likert scale. The statements were formulated on the basis of literature review and practice experience, and were initially piloted among Dutch elderly care physicians. Consensus was defined beforehand as an Interquartile Range (IQR) of </= 1 for each statement. Results Consensus was reached on 61 (90%) statements after two rounds. The resulting consensus covers: the need for a multidisciplinary approach to Geriatric Rehabilitation after CGA; inclusion of patients with temporary confusion or cognitive decline; use of structured goal-oriented rehabilitation plans; the necessity of an early start of rehabilitation; preference for ambulatory rehabilitation or Geriatric Rehabilitation at home; the advantage of protocolled treatment programs; the need for consensus on patient outcome assessment instruments; and education and training in Geriatric Rehabilitation for healthcare professionals. Conclusion These consensus statements provide a first step towards more coherent organization and delivery of geriatric rehabilitation across Europe.

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A Delphi Study to Detect Deficiencies and Propose Actions in Real Life Treatment of Neovascular Age-Related Macular Degeneration

Journal of Ophthalmology ◽

10.1155/2014/595132 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Alfredo García-Layana ◽

Luis Arias ◽

Marta S. Figueroa ◽

Javier Araiz ◽

José María Ruiz-Moreno ◽

...

Keyword(s):

Macular Degeneration ◽

Delphi Study ◽

Online Survey ◽

Real Life ◽

Age Related Macular Degeneration ◽

Modified Delphi ◽

Age Related ◽

Consensus Statements ◽

High Level ◽

Level Of Agreement

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD).Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations.Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics.Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

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Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419882654 ◽

2019 ◽

Vol 23 (5_suppl) ◽

pp. 32S-39S

Author(s):

Perla Lansang ◽

Irene Lara-Corrales ◽

James N. Bergman ◽

Chih-ho Hong ◽

Marissa Joseph ◽

...

Keyword(s):

Atopic Dermatitis ◽

Health Care Professionals ◽

Pediatric Patients ◽

Pediatric Population ◽

Extensive Experience ◽

Modified Delphi ◽

Consensus Document ◽

Consensus Statements ◽

Practical Guidance ◽

Iterative Voting

This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.

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Toward best practice methods for delirium biomarker studies: An international modified Delphi study

International Journal of Geriatric Psychiatry ◽

10.1002/gps.5292 ◽

2020 ◽

Vol 35 (7) ◽

pp. 737-748 ◽

Cited By ~ 2

Author(s):

Ingrid Amgarth‐Duff ◽

Annmarie Hosie ◽

Gideon Caplan ◽

Meera Agar

Keyword(s):

Delphi Study ◽

Best Practice ◽

Modified Delphi ◽

Practice Methods

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.6.peds18243 ◽

2018 ◽

Vol 22 (6) ◽

pp. 701-709 ◽

Cited By ~ 1

Author(s):

Nikita G. Alexiades ◽

Edward S. Ahn ◽

Jeffrey P. Blount ◽

Douglas L. Brockmeyer ◽

Samuel R. Browd ◽

...

Keyword(s):

Spinal Cord ◽

Best Practices ◽

Delphi Study ◽

Wound Complications ◽

Tethered Spinal Cord ◽

Saline Irrigation ◽

Gram Negative ◽

Modified Delphi ◽

Dural Closure ◽

Dural Graft

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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Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

International Journal of Language & Communication Disorders ◽

10.1111/1460-6984.12489 ◽

2019 ◽

Vol 54 (5) ◽

pp. 841-854 ◽

Cited By ~ 1

Author(s):

Hannah Roberts ◽

Nan Greenwood

Keyword(s):

Delphi Study ◽

Best Practice ◽

Disorders Of Consciousness ◽

Speech And Language ◽

Language Therapy ◽

Speech And Language Therapy ◽

Modified Delphi

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Measurement of person-centered care delivery of adult oncology in Ontario, Canada.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.223 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 223-223 ◽

Cited By ~ 2

Author(s):

Lesley Moody ◽

Erica Bridge ◽

Suman Dhanju ◽

Brett Nicholls ◽

Simron Singh

Keyword(s):

Literature Review ◽

Focus Groups ◽

Best Practice ◽

Assessment Tool ◽

Care Delivery ◽

Guideline Implementation ◽

Healthcare Providers ◽

Daily Practice ◽

Modified Delphi ◽

Strongly Agree

223 Background: In the Ontario, Canada, cancer system, the provincially endorsed Person Centred Care (PCC) Guideline provides recommendations for healthcare providers to implement PCC in the delivery of adult oncology services. However, it is unknown whether healthcare providers have incorporated these recommendations into their daily practice within the Regional Cancer Programs (RCPs). The purpose of this study was to develop an assessment tool to evaluate the implementation of the PCC Guideline in Ontario RCPs. Methods: Tool development consisted of a 3-step process: 1) literature review to identify relevant measures, 2) Modified Delphi with a panel of experts (n = 8), and 3) focus groups with patient/family advisors (n = 5) and RCP PCC leads (i.e., designated individual responsible for PCC deliverables) (n = 7). Results: Through the literature review, two relevant tools were identified ( i.e., Institute for Patient- and Family-Centered Care’s Hospital Assessment Tool and Accreditation Canada’s Cancer Care Standards), resulting in 187 measures deemed appropriate to include in the assessment tool. In round one of the Modified Delphi, each measure was evaluated independently by a panel of experts using a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to assess both the importance and feasibility of each measure. Sixty-seven measures were rated 4 or above by 70% of the experts. Consistent with Modified Delphi best practice, these measures were discussed during the second round with the panel of experts. An additional 33 measures were removed due to similarities/duplications. Nine measures were added. The 42 measures were presented to patient/family advisors and the RCP PCC Leads during focus groups and evaluated based on importance and feasibility of assessing PCC implementation in the RCPs. Wording recommendations were made and two additional measures were added. The final tool includes 44 measures to evaluate PCC implementation within the RCPs. The assessment tool was disseminated to the 14 RCPs in October 2016. Conclusions: The results of this assessment will provide an understanding of the current state of PCC Guideline implementation in Ontario, in order to identify facilitators and barriers to implementation.

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