scholarly journals BoNT-A for Post-Stroke Spasticity: Guidance on Unmet Clinical Needs from a Delphi Panel Approach

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 236
Author(s):  
Alessio Baricich ◽  
Theodore Wein ◽  
Nicoletta Cinone ◽  
Michele Bertoni ◽  
Alessandro Picelli ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Daily Practice ◽  
Delphi Process ◽  
Delphi Panel ◽  
Extensive Literature ◽  
Delphi Consensus ◽  
Patient Centered ◽  
Web Based ◽  
Post Stroke

There is extensive literature supporting the efficacy of botulinum toxin (BoNT-A) for the treatment of post-stroke spasticity, however, there remain gaps in the routine management of patients with post-stroke spasticity. A panel of 21 Italian experts was selected to participate in this web-based survey Delphi process to provide guidance that can support clinicians in the decision-making process. There was a broad consensus among physicians that BoNT-A intervention should be administered as soon as the spasticity interferes with the patients’ clinical condition. Patients monitoring is needed over time, a follow-up of 4–6 weeks is considered necessary. Furthermore, physicians agreed that treatment should be offered irrespective of the duration of the spasticity. The Delphi consensus also stressed the importance of patient-centered goals in order to satisfy the clinical needs of the patient regardless of time of onset or duration of spasticity. The findings arising from this Delphi process provide insights into the unmet needs in managing post-stroke spasticity from the clinician’s perspective and provides guidance for physicians for the utilization of BoNT-A for the treatment of post-stroke spasticity in daily practice.

scholarly journals Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244485
Author(s):  
Caroline Verhestraeten ◽  
Gijs Weijers ◽  
Daphne Debleu ◽  
Agnieszka Ciarka ◽  
Marc Goethals ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Practitioner ◽  
General Practitioners ◽  
Early Stage ◽  
Blood Analysis ◽  
Care Process ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Heart Failure Patients

Aims Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. Methods and results The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Conclusions Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.

scholarly journals Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Marco Daperno ◽  
Alessandro Armuzzi ◽  
Silvio Danese ◽  
Walter Fries ◽  
Giuseppina Liguori ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Unmet Needs ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Delphi Process ◽  
Delphi Consensus ◽  
Medical Needs

Background. The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient’s quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods. With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results. Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions. The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician’s perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.

scholarly journals An Educational Forum to Engage Infectious Diseases and Microbiology Residents in Resource Stewardship Modelled after the Choosing Wisely Campaign

2015 ◽  
Vol 26 (5) ◽  
pp. 231-233 ◽  
Author(s):  
Derek R MacFadden ◽  
Wayne L Gold ◽  
Ibrahim Al-Busaidi ◽  
Jeffrey D Craig ◽  
Dan Petrescu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Care Delivery ◽  
Daily Practice ◽  
Choosing Wisely ◽  
Delphi Panel ◽  
Potential Harm ◽  
Modified Delphi ◽  
Five Practices

BACKGROUND: Rising costs present a major threat to the sustainability of health care delivery. Resource stewardship is increasingly becoming an expected competency of physicians. The Choosing Wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents.METHODS: During the 2014 Annual Canadian Infectious Disease and Microbiology Resident Retreat in Toronto, Ontario, infectious disease (n=50) and microbiology (n=17) residents representing 11 Canadian universities from six provinces, were invited to participate in a modified Delphi panel. Participants were asked, in advance of the retreat, to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s) and/or potential harm to patients. Submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices. A finalized list was created for both educational purposes and for residents to consider enacting; however, it was not intended to replace formal society-endorsed statements. A follow-up survey at two-months was conducted.RESULTS: Consensus was reached by the residents regarding five low-value practices within the purview of infectious diseases and microbiology physicians. After the retreat, 20 participants (32%) completed the follow-up survey. The majority of respondents (75%) believed that the session was at least as relevant as other sessions they attended at the retreat, including 95% indicating that at least some of the material discussed was new to them. Since returning to their home institutions, nine (45%) respondents have incorporated what they learned into their daily practice; four (20%) reported that they have considered initiating a project related to the session; and one (5%) reported having initiated a project.CONCLUSIONS: The present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low-value practices. Embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession.

scholarly journals Multi-Agent System for Post-Stroke Medical Monitoring in Web-Based Platform

2020 ◽  
Vol 13 (2) ◽  
pp. 46
Author(s):  
Eduardo S. Rios-Ramos ◽  
Roberto A. Melendez-Armenta ◽  
Jose A. Vazquez-Lopez ◽  
Luis A. Morales-Rosales
Keyword(s):  
Multi Agent System ◽  
Medical Monitoring ◽  
Agent System ◽  
Web Based ◽  
Control Plan ◽  
Medical Specialists ◽  
Post Stroke ◽  
Multi Agent ◽  
Communication And Coordination

Stroke is an injury to blood vessels in the brain and affects their cells; this causes the person to lose the functionality of their body and autonomy. The rehabilitation involves a set of activities for the medical specialists, that is, to have a strict control in the care of the patient, which includes the diets, therapies and ingestion of drugs so that the recovery of the patient is carried out in an optimal way and can be reintegrated into their family, social and work environment. This means that achieving communication and coordination among the members of the health area represents a problem; there is no established structured control plan and physicians need to modify them to adjust to the new situation, which is in accordance with the patient clinical needs. Thus, finding a solution to this problem becomes extremely important and, in this work, we propose a multi-agent system for post-stroke monitoring aimed at medical specialists. The main objective of this research is to communicate and coordinate the follow-up of the patient for the reduction of the damages caused by the stroke using the theory of artificial intelligence agents. The results of this research include the multi-agent system in web-based platform, description of the agents and finally, the implementation of the web system oriented to medical specialists.

scholarly journals Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

BJS Open ◽  
2021 ◽  
Vol 5 (5) ◽  
Author(s):  
T N Grove ◽  
C Kontovounisios ◽  
A Montgomery ◽  
B T Heniford ◽  
A C J Windsor ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Preoperative Assessment ◽  
Life Assessment ◽  
Response Analysis ◽  
Delphi Consensus ◽  
Web Based ◽  
Midline Laparotomy

Abstract Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. Methods The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. Results Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. Conclusion Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

scholarly journals DEVELOPMENT OF QUALITY INDICATORS FOR PHARMACEUTICAL CARE PERFORMANCE ASSESSMENT IN NIGERIAN COMMUNITY PHARMACIES: A DELPHI PANEL

2021 ◽  
pp. 50-55
Author(s):  
OKPALANMA NNEOMA ◽  
EKWUNIFE OBINNA
Keyword(s):  
Quality Management ◽  
Literature Review ◽  
Pharmaceutical Care ◽  
Quality Indicators ◽  
Delphi Panel ◽  
Community Pharmacies ◽  
Extensive Literature ◽  
Core Components ◽  
Care Performance

Objective: This study aimed to develop quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies. Methods: We searched for existing quality indicators through an extensive literature review. The identified quality indicators consisted of thirty-four items in 10 core components. The Delphi method was used to arrive at a consensus on quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies by surveying a panel of experts. There were 3 rounds of the Delphi panel conducted by consulting a panel of 10 experts in pharmaceutical care practice. A mean score>3.5, median>3.5, an absolute value between the median and mode<1.00 was used to establish consensus on the quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies. Results: Ten studies met the inclusion criteria. A list of 33 quality indicators comprising of 10 core components emerged from the extensive literature review. They included quality management, documentation of care, communication with the patient, management of clinical risk in pharmacy, compounding, dispensing and patient care, follow-up of pharmacotherapy counselling, drug inventory and stocking, training of pharmaceutical staff. At the end of the round three votings, 24 statements of the quality indicator reached consensus in nine core components: quality management (5), continuity of care (1), communication with patients (3), clinical risk management (5), dispensing (1), follow-up of pharmacotherapy (3), counselling (1), logistics (3), training of pharmacy staff (2). Conclusion: This study developed a set of 24 quality indicators for assessing pharmaceutical care performance in community pharmacies in Nigeria.

scholarly journals Place in therapy of innovative drugs in multiple myeloma in 2021 and 2023 according to an expert panel Delphi consensus

2021 ◽  
Vol 8 ◽  
pp. 80-86
Author(s):  
Mario Boccadoro ◽  
Patrizia Berto ◽  
Sara Bringhen ◽  
Elena Zamagni ◽  
Patrizia Tosi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Expert Panel ◽  
New Drugs ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Web Based ◽  
Combination Treatments ◽  
Italian Market ◽  
New Diagnosis ◽  
Innovative Drugs

Introduction: The objective of this study was to understand the potential use of single agents and drug combinations in multiple myeloma (MM) across treatment lines in the years 2021 and 2023. Methods: The method used was Delphi Panel Method survey, administered to European Myeloma Network (EMN) Italy Working Group centres. Future treatments were identified assessing all available web-based information sources, including therapies (single drugs or combinations) with strong evidence of efficacy, likely to be on the Italian market in 2021 and 2023. Participants were asked to report on the likelihood of prescription for MM therapies, across treatment lines. Results: Across the 15 centres taking part in the survey, about 890 patients per year are forecasted to receive a new diagnosis of MM. In 2021, the Panel forecasted 66% of 1L-TE (transplant eligible) patients will be treated with bortezomib-thalidomide-dexamethasone (VTD) and 32% of patients with daratumumab-bortezomib-thalidomide-dexamethasone (DVTd), with a substantial decrease of VTD (15%) and a marked increase of DVTd (81%) forecasted for 2023. The 2L and 3L R(lenalidomide)-based combination treatments are expected to drop and will likely be substituted by a steep increase in P(pomalidomide)-based regimes (from 7% to 23%). On the contrary, in 3L treatment, all combination therapies (with the exception of IsaPd – isatuximab-pomalidomide-dexamethasone) are expected to lose market share in favour of the most recent new therapies. Conclusions: Expert Panel agrees that many different new drugs and combinations will be used in MM, with different mechanisms of action, both at diagnosis and in subsequent phases of the disease, with a corresponding decline of the drugs currently used.

What fixes can improve cancer care quality at safety-net hospitals?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 243-243
Author(s):  
Nina A. Bickell ◽  
Alexandra Moss ◽  
Bonnie Bellacera ◽  
Rebeca Franco ◽  
Ann Scheck McAlearney
Keyword(s):  
Breast Cancer ◽  
Private Practice ◽  
Cancer Care ◽  
Organizational Factors ◽  
Safety Net ◽  
Poor Quality ◽  
System Support ◽  
Patient Centered ◽  
Web Based

243 Background: Safety-net hospitals are at higher risk of poor quality cancer care and vary in levels of quality performance. Types of quality problems may differ and require different interventions. We undertook this study to identify organizational factors affecting quality and assess the early findings of the innovation’s impact on hand-offs between specialists. Methods: As part of a RCT testing a web-based tracking and feedback innovation to close referral loops, new breast cancer cases are rapidly ascertained, and post-surgical medical and radiation oncologist visits are assessed. Surgeons are alerted to patients who do not show to oncology visits to stimulate action. Of 153 enrolled women (98 Intervention/ 55 Control), 4% are white. In addition, we conducted 90 key informant interviews in 9 safety-net hospitals in the NYC metropolitan area and performed a qualitative comparative analysis (QCA), a method to assess causal complexity, to identify organizational factors associated with poor quality. Results: No-shows at oncology appointments triggering surgeon feedback occurred for 5/98 (5%) new breast cancer patients. QCA revealed 6 conditions associated with poor quality-defined as underuse of needed adjuvant treatment: information sharing; follow-up; system support; patient-centered culture; flexibility and private practice. All high-performing hospitals had a patient-centered culture, strong follow-up approaches and shared information. Some of these high-quality sites had robust system support while others had creative workarounds (flexibility) or were responsive to their private practice patients. Overall, these pathways had high consistency (.88) and coverage (.72). Only hospitals with both poor follow-up and system support activated the web-based feedback. Conclusions: Safety-net hospitals with poor follow-up capabilities may benefit from an innovation designed to improve hand-offs across specialties. This trial continues to accrue; we are monitoring the innovation’s effectiveness. Clinical trial information: NCT01544374.

scholarly journals Definitions and Concepts on Keratoconus and Ectatic Corneal Diseases: Panamerican Delphi Consensus — A Pilot for the Global Consensus on Ectasias

2014 ◽  
Vol 3 (3) ◽  
pp. 99-106 ◽  
Author(s):  
Victor L Perez ◽  
Juan Carlos Abad ◽  
José Alvaro P Gomes
Keyword(s):  
Latin American ◽  
Front Surface ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Web Based ◽  
Global Consensus ◽  
Delphi Approach ◽  
Disease Staging ◽  
Question Survey

ABSTRACT Purpose To establish consensus on definitions and concepts of keratoconus and ectatic corneal diseases by using Delphi approach. Materials and methods Seventeen Latin American experts on keratoconus and ectatic corneal diseases participated in a 3-round Delphi panel approach. A web-based 12 question survey was answered by panelists in two rounds, followed by life discussion meeting. A two-third majority strategy was defined as a consensus. Results Corneal ectatic diseases were defined as progressive thinning conditions without acute stromal inflammation, and were classified as keratoconus, pellucid marginal degeneration (PMD), keratoglobus, and ectasia after trauma or surgery. The pattern of thinning was considered the main aspect for the classification of ectatic diseases, but criteria for staging the disease needs to be improved. Corneal tomography with 3D reconstruction, distinguished from Placido-disk based front surface topography was elected as the diagnostic procedure currently capable of detecting the earliest clinical ectatic changes. Biomechanical alterations were considered to be the first event for ectasia development. Eye rubbing was directly related to the development and progression of ectasia. Inflammation was considered as a possible event on the physiopathology. Keratoconus was considered as a bilateral disease, with often asymmetric presentation, while ectasia may occur unilaterally if there is significant corneal insult, leading to biomechanical failure. No consensus was achieved for the definitions on forme fruste keratoconus (FFKC). Conclusion Consensus was achieved on definitions of corneal ectatic diseases. Disease staging, including criteria for FFKC or subclinical ectasia remains controversial. A larger consensus including experts from different groups around the world is needed. How to cite this article Ambrósio RJr, Belin MW, Perez VL, Abad JC, Gomes JAP. Definitions and Concepts on Keratoconus and Ectatic Corneal Diseases: Panamerican Delphi Consensus — A Pilot for the Global Consensus on Ectasias. Int J Kerat Ect Cor Dis 2014;3(3):99-106.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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