Measuring Seclusion in Psychiatric Intensive Care: Development and Measurement Properties of the Clinical Seclusion Checklist

Background: Acute psychiatric units in general hospitals must ensure that acutely disturbed patients do not harm themselves or others, and simultaneously provide care and treatment and help patients regain control of their behavior. This led to the development of strategies for the seclusion of a patient in this state within a particular area separated from other patients in the ward. While versions of this practice have been used in different countries and settings, a systematic framework for describing the various parameters and types of seclusion interventions has not been available. The aims of the project were to develop and test a valid and reliable checklist for characterizing seclusion in inpatient psychiatric care.Methods: Development and testing of the checklist were accomplished in five stages. Staff in psychiatric units completed detailed descriptions of seclusion episodes. Elements of seclusion were identified by thematic analysis of this material, and consensus regarding these elements was achieved through a Delphi process comprising two rounds. Good content validity was ensured through the sample of seclusion episodes and the representative participants in the Delphi process. The first draft of the checklist was revised based on testing by clinicians assessing seclusion episodes. The revised checklist with six reasons for and 10 elements of seclusion was tested with different response scales, and acceptable interrater reliability was achieved.Results: The Clinical Seclusion Checklist is a brief and feasible tool measuring six reasons for seclusion, 10 elements of seclusion, and four contextual factors. It was developed through a transparent process and exhibited good content validity and acceptable interrater reliability.Conclusion: The checklist is a step toward achieving valid and clinically relevant measurements of seclusion. Its use in psychiatric units may contribute to quality assurance, more reliable statistics and comparisons across sites and periods, improved research on patients' experiences of seclusion and its effects, reduction of negative consequences of seclusion, and improvement of psychiatric intensive care.

Development and Validation of a Competency-Based Education Model Suitable for Undergraduate Human Nutrition and Dietetics Training in Uganda: A Modified Delphi Process

Background Competency-based education (CBE) equips health professionals with the requisite competencies for health systems performance. This study aimed to develop and validate a CBE model suitable for teaching Human Nutrition/Human Nutrition and Dietetics (HN/HND) at the undergraduate level in Uganda. Methods The study was undertaken in two main phases, (1) competency needs assessment and (2) model development and content validation. The later had three iterative stages: a needs assessment results validation workshop; an expert focus group discussion to develop a draft CBE model framework; and consensus development-itself undertaken in two modified Delphi rounds to ascertain participant consensus on the relevance and suitability of the competency domains, subdomains, and statements comprised in the developed draft CBE framework for undergraduate HN/HND training in Uganda. In the modified Delphi process, participants indicated the degree to which they agreed or disagreed with each of the given statements on five-point Likert-type items of strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree as well as the level of training they recommended the given competency statement to be learned. The workshop had 31 participants, the focus group eight, while the first and second Delphi rounds had 70 and 55 participants respectively. Results In total, seven competency domains, 24 subdomains, and 190 competency statements were developed. Content analysis and analysis of percentage responses for each competency statement were done with participant consensus set at ≥80%. All the seven domains (100%); 22 (91.7%) of the 24 subdomains; and 153 (87.9%) of the 174 analysed competency statements were evaluated as both relevant and suitable for undergraduate HN/HND training and hence included in the validated CBE model. Conclusion This study evaluated the relevancy and suitability of seven competency domains prevention and management of malnutrition; nutrition in the lifecycle; food security, food safety, agriculture, and livelihoods promotion; ethics and professionalism in nutrition and dietetics; research and data analysis; policy, advocacy, and social and behaviour change communication; and nutrition leadership and management for undergraduate HN/HND training in Uganda. The study recommends translating the developed CBE model into a standard curriculum that can be taught and evaluated.

REHBaR: a Publication Guideline for Homeopathic Basic Research

Background: Specific efficacy of homeopathically prepared substances in high dilution levels is controversial due to the comparably low number of randomized controlled clinical trials and due to the low concentrations of the substances potentised. No generally accepted theoretical model is currently available to explain specific effects of such preparations. In order to unequivocally demonstrate any such effects, experimental research has to meet very high standards. Aims: Objective was to compile guidelines for homeopathic basic research regarding experimental design, implementation, execution, evaluation and publication. Methods: A Delphi Process was conducted, involving European researchers who published experimental work within the last five years. The Delphi process included a total of five rounds, three rounds of adjusting and phrasing plus two consensus conferences [1]. Eligible criteria were collected from existing publications concerned with the quality of homeopathic basic research. In advance a short questionnaire was sent to a selection of research institutes in Germany active in non-homeopathic basic research. Results: Regarding experimental design, the most important points to consider are: randomized and coded (blinded) allocation of the treatments, several independent experiments (including independent production lots), potentised or succussed controls, positive controls (to control reactivity of the system) and systematic negative control experiments to document test system stability and adequacy of the statistical evaluation [1–4]. A detailed publication guideline for authors was developed. REHBaR (Reporting experiments in Homeopathic Basic Research) provides a checklist of 23 items, supplemented with detailed examples [4]. Background, objectives and possible hypotheses should be given in the part ‘introduction’. Special emphasis is put on the ‘materials and methods’ section, where a detailed description of chosen controls, object of investigation, experimental setup, replication, parameters, intervention, allocation, blinding, and statistical methods is required. The section ‘results’ should present sufficient details on analyzed data, descriptive as well as inferential. Authors should discuss their results and give an interpretation in the context of current evidence. Conclusions: Guidelines how to prepare detailed and informative publications are very common in clinical research [5]. To the best to our knowledge REHBaR is the first guideline to be applied by authors when preparing their manuscripts and to be used by scientific journals in the reviewing process in the field of homeopathic basic research. Furthermore the REHBaR guideline can be helpful for planning and conducting experiments as it includes fundamental qualitative standards. To which extent REHBAR can be used also as an instrument to evaluate the quality of a publication will be discussed.

Delivery of Virtual Care in Oncology: Province-Wide Interprofessional Consensus Statements Using a Modified Delphi Process

Virtual cancer care (i.e., teleoncology) was rapidly adopted during the COVID-19 pandemic to meet the needs of patients with cancer. However, there is a paucity of guidance for clinicians regarding virtual cancer care. We sought to develop consensus-based statements to guide the optimal provision of virtual care for clinicians caring for patients with cancer, using a modified Delphi consensus process with a 29-member panel consisting of an interprofessional group of clinicians caring for patients with cancer and patient representatives. The consensus process consisted of two rounds and one synchronous final consensus meeting. At the end of the modified Delphi process, 62 of 62 statements achieved consensus. Fifty-seven statements reached consensus in the first round of the process. Concerns regarding the ability to convey difficult news virtually and maintaining similar standards as in-person care without disproportionate strain on clinicians and patients were addressed in the consensus process. We achieved interprofessional consensus on virtual cancer care practices. Further research examining the impact of virtual cancer care on person-centred and clinical outcomes are needed to inform practices during the COVID-19 pandemic and beyond.

Data collection for outbreak investigations: process for defining a minimal data set using a Delphi approach

Background Timely but accurate data collection is needed during health emergencies to inform public health responses. Often, an abundance of data is collected but not used. When outbreaks and other health events occur in remote and complex settings, operatives on the ground are often required to cover multiple tasks whilst working with limited resources. Tools that facilitate the collection of essential data during the early investigations of a potential public health event can support effective public health decision-making. We proposed to define the minimum set of quantitative information to collect whilst using electronic device or not. Here we present the process used to select the minimum information required to describe an outbreak of any cause during its initial stages and occurring in remote settings. Methods A working group of epidemiologists took part in two rounds of a Delphi process to categorise the variables to be included in an initial outbreak investigation form. This took place between January–June 2019 using an online survey. Results At a threshold of 75 %, consensus was reached for nineteen (23.2%) variables which were all classified as ‘essential’. This increased to twenty-six (31.7%) variables when the threshold was reduced to 60% with all but one variable classified as ‘essential’. Twenty-five of these variables were included in the ‘Time zero initial case investigation’ ‘(T0)’ form which was shared with the members of the Rapid Response Team Knowledge Network for field testing and feedback. The form has been readily available online by WHO since September 2019. Conclusion This is the first known Delphi process used to determine the minimum variables needed for an outbreak investigation. The subsequent development of the T0 form should help to improve the efficiency and standardisation of data collection during emergencies and ultimately the quality of the data collected during field investigation.

Development and Validation of a Competency-Based Education Model Suitable for Undergraduate Human Nutrition and Dietetics Training in Uganda: A Modified Delphi Process

Background: Competency-based education (CBE) equips health professionals with the requisite competencies for health systems performance. This study aimed to develop and validate a CBE model suitable for teaching Human Nutrition/Human Nutrition and Dietetics (HN/HND) at the undergraduate level in Uganda. Methods: The study was undertaken in two main phases, (1) competency needs assessment and (2) model development and content validation. The later had three iterative stages: a needs assessment results validation workshop; an expert focus group discussion to develop a draft CBE model framework; and consensus development-itself undertaken in two modified Delphi rounds to ascertain participant consensus on the relevance and suitability of the competency domains, subdomains, and statements comprised in the developed draft CBE framework for undergraduate HN/HND training in Uganda. In the modified Delphi process, participants indicated the degree to which they agreed or disagreed with each of the given statements on five-point Likert-type items of strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree as well as the level of training they recommended the given competency statement to be learned. The workshop had 31 participants, the focus group eight, while the first and second Delphi rounds had 70 and 55 participants respectively. Results: In total, seven competency domains, 24 subdomains, and 190 competency statements were developed. Content analysis and analysis of percentage responses for each competency statement were done with participant consensus set at ≥80%. All the seven domains (100%); 22 (91.7%) of the 24 subdomains; and 153 (87.9%) of the 174 analysed competency statements were evaluated as both relevant and suitable for undergraduate HN/HND training and hence included in the validated CBE model. Conclusion: This study evaluated the relevancy and suitability of seven competency domains prevention and management of malnutrition; nutrition in the lifecycle; food security, food safety, agriculture, and livelihoods promotion; ethics and professionalism in nutrition and dietetics; research and data analysis; policy, advocacy, and social and behaviour change communication; and nutrition leadership and management for undergraduate HN/HND training in Uganda. The study recommends translating the developed CBE model into a standard curriculum that can be taught and evaluated.

Expert Consensus on the Contraindications and Cautions of Foam Rolling—An International Delphi Study

Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.

Abstract 10336: ECPR 2 : Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering out-of-hospital cardiac arrest (OHCA), though limited data exists regarding detailed best practices for the complex process of initiating ECPR following OHCA. Hypothesis: Expert consensus using a modified Delphi process can systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. Methods: We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale. Results: Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and four primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 216 items. The panel ultimately reached consensus on 95 items: Prior to Patient Arrival (8 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (17), and Post-Cannulation (26). Conclusion: We present a list of essential items for initiation of ECPR following adult non-traumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings can benefit centers currently performing ECPR for OHCA in quality assurance and performance improvement, and can serve as a template for new ECPR programs to follow.