Ascertaining top evidence in emergency medicine: A modified Delphi study

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 291-295 ◽  
Author(s):  
Stephanie J. Bazak ◽  
Jonathan Sherbino ◽  
Suneel Upadhye ◽  
Teresa Chan
Keyword(s):  
Emergency Medicine ◽  
Delphi Study ◽  
Expert Consensus ◽  
Junior Resident ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Quality Of Patient Care ◽  
Transition Into Practice ◽  
Junior Residents

AbstractObjectivesThe application of evidence-informed practice in emergency medicine (EM) is critical to improve the quality of patient care. EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. Our study’s objective was to formulate a list of “top papers” in the field of EM using a Delphi approach to achieve an expert consensus.MethodsParticipants were recruited from all 14 specialty EM programs across Canada by a nomination process by the program directors. The modified Delphi survey consisted of three study rounds, each round sent out via email. The study tool was piloted first with McMaster University’s specialty EM residents. During the first round, participants individually listed top papers relevant to EM. During the two subsequent rounds, participants ranked the papers listed in the first round, with a chance to adjust ranking based on group responses.ResultsA total of eight EM specialty programs responded with 30 responses across the three rounds. There were 119 studies suggested in the first round, and, by the third round, a consensus of>70% agreement was reached to generate the final list of 29 studies.ConclusionsWe produced, via an expert consensus, a list of top studies relevant for Canadian EM physicians in training. It can be used as an educational resource for junior residents as they transition into practice.

Critical Concepts in Disaster Medicine for Saudi Arabian Emergency Residency Programs: A Delphi Study

2019 ◽  
Vol 34 (s1) ◽  
pp. s113-s113
Author(s):  
Bader Alossaimi ◽  
Michael Molloy ◽  
Alexander Hart ◽  
Amalia Voskanyan ◽  
Ritu Sarin ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Saudi Arabia ◽  
Delphi Study ◽  
Healthcare Providers ◽  
Saudi Arabian ◽  
Disaster Medicine ◽  
Expert Consensus ◽  
System Response ◽  
Delphi Approach ◽  
Residency Curriculum

Introduction:Saudi Arabia, the largest country in the Middle East, has suffered numerous terrorist attacks and is the location of Hajj, one of the world’s largest annual mass gatherings. Healthcare providers’ pre-incident knowledge and understanding of basic disaster medicine (DM) concepts are crucial for a unified and effective health-system response. Introducing healthcare providers to best practices is a stated vision of the Saudi Commission for Health Specialties. Standardizing DM curriculum taught to physicians during their residency training will assist this goal.Aim:To produce expert consensus on the most critical DM topics for the residency curriculum in emergency medicine (EM) in the Kingdom of Saudi Arabia.Methods:Utilizing a Delphi approach, a panel of Saudi Arabian experts in DM and EM residency directors were surveyed regarding potential DM topics for EM residency curricula. The first round comprised of open-ended questions seeking lists of suggested DM curriculum topics. In subsequent rounds, each participant received a questionnaire asking them to review the items contributed in the first round, summarized by the investigation team. The participants rated each item on a five-point Likert Scale to establish preliminary priorities and added their comments. In further rounds, participants reviewed and prioritized subjects until they reached a consensus of >=80%.Results:The study is ongoing and full data will be available in the new year.Discussion:This expert consensus from major stakeholders can be used to improve the foundation of the DM curriculum. The Delphi Method gives an evidence-based approach to identification and prioritization of subjects, which should be integrated within the Saudi Arabian Emergency Medicine Residency Curriculum. It also can be used as a cornerstone for implementation in other medical education programs across the Kingdom in the future.

scholarly journals A European Research Agenda for Geriatric Emergency Medicine: a modified Delphi study

2020 ◽  
Author(s):  
Simon P. Mooijaart ◽  
Christian H. Nickel ◽  
Simon P. Conroy ◽  
Jacinta A. Lucke ◽  
Lisa S. van Tol ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Delphi Study ◽  
Research Agenda ◽  
Online Survey ◽  
Future Research ◽  
European Research ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Research Questions ◽  
Geriatric Emergency Medicine

Abstract Purpose Geriatric Emergency Medicine (GEM) focuses on delivering optimal care to (sub)acutely ill older people. This involves a multidisciplinary approach throughout the whole healthcare chain. However, the underpinning evidence base is weak and it is unclear which research questions have the highest priority. The aim of this study was to provide an inventory and prioritisation of research questions among GEM professionals throughout Europe. Methods A two-stage modified Delphi approach was used. In stage 1, an online survey was administered to various professionals working in GEM both in the Emergency Department (ED) and other healthcare settings throughout Europe to make an inventory of potential research questions. In the processing phase, research questions were screened, categorised, and validated by an expert panel. Subsequently, in stage 2, remaining research questions were ranked based on relevance using a second online survey administered to the same target population, to identify the top 10 prioritised research questions. Results In response to the first survey, 145 respondents submitted 233 potential research questions. A total of 61 research questions were included in the second stage, which was completed by 176 respondents. The question with the highest priority was: Is implementation of elements of CGA (comprehensive geriatric assessment), such as screening for frailty and geriatric interventions, effective in improving outcomes for older patients in the ED? Conclusion This study presents a top 10 of high-priority research questions for a European Research Agenda for Geriatric Emergency Medicine. The list of research questions may serve as guidance for researchers, policymakers and funding bodies in prioritising future research projects.

scholarly journals Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Arif Hussain ◽  
Gabriele Via ◽  
Lawrence Melniker ◽  
Alberto Goffi ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Expert Panel ◽  
Point Of Care ◽  
Expert Consensus ◽  
Future Research ◽  
Point Of Care Ultrasound ◽  
The Past ◽  
Modified Delphi ◽  
Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

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

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.

scholarly journals A Modified Delphi Study to Prioritize Content for a Simulation‐based Pediatric Curriculum for Emergency Medicine Residency Training Programs

2019 ◽  
Vol 4 (4) ◽  
pp. 369-378
Author(s):  
Jennifer Mitzman ◽  
Ilana Bank ◽  
Rebekah A. Burns ◽  
Michael C. Nguyen ◽  
Pavan Zaveri ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Residency Training ◽  
Delphi Study ◽  
Training Programs ◽  
Modified Delphi ◽  
Simulation Based

scholarly journals Management of Pyrexia Associated with the Combination of Dabrafenib and Trametinib: Canadian Consensus Statements

2021 ◽  
Vol 28 (5) ◽  
pp. 3537-3553
Author(s):  
Alia Thawer ◽  
Wilson H. Miller ◽  
Nancy Gregorio ◽  
Joël Claveau ◽  
Sudha Rajagopal ◽  
...  
Keyword(s):  
Working Group ◽  
Treatment Algorithm ◽  
Practice Variation ◽  
Routine Practice ◽  
Group Consensus ◽  
Therapeutic Approaches ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Consensus Statements

The combination of dabrafenib and trametinib is a well-established treatment for BRAF-mutated melanoma. However, the effectiveness of this approach may be hindered by the development of treatment-related pyrexia syndrome, which occurs in at least 50% of treated patients. Without appropriate intervention, pyrexia syndrome has the potential to worsen and can result in hypotension secondary to dehydration and associated organ-related complications. Furthermore, premature treatment discontinuation may result in a reduction in progression-free and overall survival. Despite existing guidance, there is still a wide variety of therapeutic approaches suggested in the literature for both the definition and management of dabrafenib and trametinib-related pyrexia. This is reflected in the practice variation of its prevention and treatment within and between Canadian cancer centres. A Canadian working group was formed and consensus statements were constructed based on evidence and finalised through a two-round modified Delphi approach. The statements led to the development of a pyrexia treatment algorithm that can easily be applied in routine practice. The Canadian working group consensus statements serve to provide practical guidance for the management of dabrafenib and trametinib-related pyrexia, hopefully leading to reduced discontinuation rates, and ultimately improve patients’ quality of life and cancer-related outcomes.

Ongoing and Focused Provider Performance Evaluations in Emergency Medicine: Current Practices and Modified Delphi to Guide Future Practice

2019 ◽  
Vol 35 (4) ◽  
pp. 306-314 ◽  
Author(s):  
Laura E. Walker ◽  
Michael P. Phelan ◽  
Matthew Bitner ◽  
Eric Legome ◽  
Christian A. Tomaszewski ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Best Practice ◽  
Online Survey ◽  
Performance Evaluations ◽  
Provider Performance ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Future Practice ◽  
Insight Into ◽  
Current Practices

The Joint Commission requires ongoing and focused provider performance evaluations (OPPEs/FPPEs). The authors aim to describe current approaches in emergency medicine (EM) and identify consensus-based best practice recommendations. An online survey was distributed to leaders in EM to gain insight into current practices. A modified Delphi approach was then used to develop consensus to recommend best practice. A variety of strategies are currently in use for OPPE/FPPE. “Peer reviewed cases with opportunity for improvement” was identified as a preferred metric for OPPE. Although the preference was for use of peer review in OPPE, a consistent and standard adoption of robust internal care review processes is needed to establish expected norms. National benchmarking is not available currently. This was a limited survey of self-identified leaders, and there is an opportunity for additional engagement of leaders in EM to identify a unified approach that appropriately relates to patient outcomes.

scholarly journals Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study (Preprint)

2021 ◽  
Author(s):  
Amish Acharya ◽  
Gaby Judah ◽  
Hutan Ashrafian ◽  
Viknesh Sounderajah ◽  
Nick Johnstone-Waddell ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Delphi Study ◽  
Evidence Synthesis ◽  
Population Screening ◽  
Free Text ◽  
Screening Programs ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Screening Services

BACKGROUND The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. OBJECTIVE The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. METHODS This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. RESULTS The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. CONCLUSIONS The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/32660

scholarly journals Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study

10.2196/32660 ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. e32660
Author(s):  
Amish Acharya ◽  
Gaby Judah ◽  
Hutan Ashrafian ◽  
Viknesh Sounderajah ◽  
Nick Johnstone-Waddell ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Delphi Study ◽  
Evidence Synthesis ◽  
Population Screening ◽  
Free Text ◽  
Screening Programs ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Screening Services

Background The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID) PRR1-10.2196/32660

scholarly journals Determining electrocardiography training priorities for medical students using a modified Delphi method

2020 ◽  
Author(s):  
Charle Andre Viljoen ◽  
Rob Scott Millar ◽  
Kathryn Manning ◽  
Vanessa Celeste Burch
Keyword(s):  
Medical Students ◽  
Delphi Method ◽  
Delphi Study ◽  
Delphi Technique ◽  
Expert Panel ◽  
Expert Consensus ◽  
Modified Delphi ◽  
Wide Range ◽  
Life Threatening ◽  
Curriculum Specialists

Abstract BackgroundAlthough electrocardiography is considered a core learning outcome for medical students, there is currently little curricular guidance for undergraduate ECG training. Owing to the absence of expert consensus on undergraduate ECG teaching, curricular content is subject to individual opinion. The aim of this modified Delphi study was to establish expert consensus amongst content and context experts on an ECG curriculum for medical students.MethodsThe Delphi technique, an established method of obtaining consensus, was used to develop an undergraduate ECG curriculum. Specialists involved in ECG teaching were invited to complete three rounds of online surveys. An undergraduate ECG curriculum was formulated from the topics of ECG instruction for which consensus (i.e. ≥75% agreement) was achieved. ResultsThe panellists (n=131) had a wide range of expertise (42.8% Internal Medicine, 22.9% Cardiology, 16% Family Medicine, 13.7% Emergency Medicine and 4.6% Health Professions Education). Topics that reached consensus to be included in the undergraduate ECG curriculum were classified under technical aspects of performing ECGs, basic ECG analysis, recognition of the normal ECG and abnormal rhythms and waveforms and using electrocardiography as part of a clinical diagnosis. This study emphasises that ECG teaching should be framed within the clinical context. Course conveners should not overload students with complex and voluminous content, but rather focus on commonly encountered and life-threatening conditions, where accurate diagnosis impacts on patient outcome. A list of 23 “must know” ECG diagnoses is therefore proposed.ConclusionA multidisciplinary expert panel reached consensus on the ECG training priorities for medical students.

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