Guidelines for the conservative treatment of spinal deformities – Questionnaire for a Delphi consensus

Background: Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use.Objective: We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities.Method: A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities.Results: Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value.Conclusion: This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities.Clinical implications: A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

The use of WeChat in higher education: Investigation of Chinese students in Australia

With the increasing popularity of social technologies, many Chinese students use WeChat for their studies in Australia. However, there have been limited studies about how students effectively use WeChat for their academic activities and the impacts on students' academic achievements. Therefore, this study focuses on the relationship between WeChat usage and academic activities of university students in Australia. Using a modified Delphi technique, we conducted three online focus groups of 16 university students who had an experience of WeChat. A thematic analysis revealed that the usage of WeChat could impact their academic performance, and many international students had challenges to be familiarised with a new digital environment in Australia. The findings contribute to much clear understanding of how students utilise WeChat for academic activities to provide a better usage of social media for university students.

Establishing an expert consensus for the operational definitions of asthma-associated infectious and inflammatory multimorbidities for computational algorithms through a modified Delphi technique

Background A subgroup of patients with asthma has been reported to have an increased risk for asthma-associated infectious and inflammatory multimorbidities (AIMs). To systematically investigate the association of asthma with AIMs using a large patient cohort, it is desired to leverage a broad range of electronic health record (EHR) data sources to automatically identify AIMs accurately and efficiently. Methods We established an expert consensus for an operational definition for each AIM from EHR through a modified Delphi technique. A series of questions about the operational definition of 19 AIMS (11 infectious diseases and 8 inflammatory diseases) was generated by a core team of experts who considered feasibility, balance between sensitivity and specificity, and generalizability. Eight internal and 5 external expert panelists were invited to individually complete a series of online questionnaires and provide judgement and feedback throughout three sequential internal rounds and two external rounds. Panelists’ responses were collected, descriptive statistics tabulated, and results reported back to the entire group. Following each round the core team of experts made iterative edits to the operational definitions until a moderate (≥ 60%) or strong (≥ 80%) level of consensus among the panel was achieved. Results Response rates for each Delphi round were 100% in all 5 rounds with the achievement of the following consensus levels: (1) Internal panel consensus: 100% for 8 definitions, 88% for 10 definitions, and 75% for 1 definition, (2) External panel consensus: 100% for 12 definitions and 80% for 7 definitions. Conclusions The final operational definitions of AIMs established through a modified Delphi technique can serve as a foundation for developing computational algorithms to automatically identify AIMs from EHRs to enable large scale research studies on patient’s multimorbidities associated with asthma.

Are Physical Therapeutics Important for Stroke Patients to Recover Their Cardiorespiratory Fitness?

Background and Objectives: Aspects of improving cardiorespiratory fitness should be factored into therapeutics for recovery of movement in stroke patients. This study aimed to recommend optimized cardiorespiratory fitness therapeutics that can be prescribed to stroke patients based on a literature review and an expert-modified Delphi technique. Materials and Methods: we searched PubMed, Embase, CINAHL, and Cochrane databases and yielded 13,498 articles published from 2010 to 2019 to support the development of drafts. After applying the exclusion criteria, 29 documents were analyzed (drafts, 17 articles; modified Delphi techniques, 12 articles). This literature was reviewed in combination with the results of a modified Delphi technique presented to experts in the physical medicine and rehabilitation field. Analysis of the literature and survey results was conducted at the participating university hospital. Results: the results of this analysis were as follows: first, 12 intervention items derived through a researcher’s literature review and a Delphi technique questionnaire were constructed using the Likert scale; second, we asked the experts to create two modified Delphi techniques by reconstructing the items after statistical analysis for each order comprising five categories, and 15 items were finally confirmed. Conclusions: the recommendations in this study may lead to the development of a standard decision-making process for physiotherapists to improve their patients’ cardiorespiratory fitness. Moreover, the study results can help prescribers document patient care to reduce prescription errors and improve safety. In the future, multidisciplinary studies could potentially provide better therapeutics alternatives for cardiorespiratory fitness.

Classification of Patients for whom benefit no longer outweighs harm of long-term opioid therapy: Protocol for a Delphi study (Preprint)

UNSTRUCTURED Introduction: Patients with chronic pain who have been prescribed long term opioid therapies often come to a point where the benefits of their therapy are out weighted by the risks associated with taking such a high dose of opioid medication. These patients need to taper off their opioid therapy while simultaneously treating their chronic pain. At the 2019 Veterans' Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regards to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation where patients needed to have their opioid dependency and chronic pain simultaneously treated. Given the ability of a Delphi method to synthesize input from a broad range of experts, we felt this technique could be used to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Methods: This would be a modified Delphi technique involving three rounds. The first round would be a series of open ended questions asking about the necessity of this diagnostic entity, how this condition is different from OUD, and what it's possible diagnostic criteria would be. After synthesizing the responses collected, a second round would be conducted to ask participants to rate the different responses offered by their peers. These ratings would be collected, analyzed, and would generate a final potential definition for this clinical phenomena. In the third round we would circulate this definition and would hopefully gain consensus. Dissemination: This protocol has been approved by the Internal Review Board at the Connecticut VA and the study is in process. We hope that other researchers can use this protocol to conduct similar studies and further explore how patients with concurrent chronic pain and opioid dependency can be best served.

Identifying competencies for future graphic design graduates in Malaysia: A Delphi study

Traditionally, graphic design (GD) education focuses on the training of technical production skills to prepare graduates for entry-level employment. However, due to the new challenges and the expanding opportunities of emerging practices, GD graduates are expected to master a wide range of additional competencies beyond traditional scope. The study aims to identify the competencies required by future GD graduates in the context of Malaysia. A two-round modified Delphi technique was used to gain consensus from a panel of experts consisted of design educators and industry practitioners regarding the competencies needed by the graduates for effective work performance. A total of 108 competencies were generated. All accepted competencies were ranked ‘very important’ and ‘extremely important’ by at least 75 percent of the respondents in Round Two. These competencies could be classified into 29 subdomains under five components, i.e., cognitive competence, functional competence, personal competence, ethical competence, and meta-competencies. The findings of this study are useful for enhancing the education and employability of graphic designers as they provide a common vocabulary to relevant stakeholders about the standards of performance for new entrants to the GD profession.

Developing a hospital accreditation model: a Delphi study

Background Hospital accreditation (HA) is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program. Methods This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country’s health system, university professors in the fields of health policy and management across the country. Results A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers (“Management and leadership”, “Planning”, “Education and Research”, “employee management”, “patient management”, “resource management”, and “process management”) and three are the results (“employee results”, “patient and society results” and “hospital results”). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model’s total scores respectively. Then, about 150 accreditation standards were written and verified. Conclusions A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020

The number of articles related to antimicrobial stewardship published each year has increased significantly over the last decade. Keeping up with the literature, particularly the most innovative, well-designed, or applicable to one’s own practice area, can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network reviewed antimicrobial stewardship-related, peer-reviewed literature from 2020 that detailed actionable interventions. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for teaching and training, and to identify novel or optimized stewardship opportunities within one’s institution.