Aims: In-hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in-hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in-hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS. Methods: A three-round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT). Results: The expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered. Conclusions: A framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in-hospital prescribing errors and improve in-hospital medication safety.
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BACKGROUND AND PURPOSE: Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia.METHODS: The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia.RESULTS: Eight of 17 experts agreed to participate in the study. After 4 rounds, the participants reached consensus on the following definition: paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of dementia (eg, from active assistance (aka Mitgehen) to active resistance). The degree of resistance depends on the speed of movement (eg, slow > low resistance, fast > high resistance). The degree of paratonia is proportional to the amount of force applied and increases with progression of dementia. The resistance to passive movement is in any direction and there is no clasp-knife phenomenon.CONCLUSION: The Delphi procedure resulted in a comprehensive, operational definition of paratonia. Future research should focus on the reliability and validity of this definition.
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Achtergrond: Kwetsbaarheid is een term die veel en in toenemende mate wordt gebruikt in het omschrijven van individuen met een verhoogd risico op negatieve gezondheidsuitkomsten als gevolg van meerdere lichamelijke, psychische en/of sociale problemen. Kwetsbaarheid komt vaak voor bij ouderen. Desondanks gebruiken ouderen zelf deze term niet of nauwelijks. De volgende vragen staan centraal in dit onderzoek: welke woorden worden gebruikt in de Nederlandstalige literatuur en welke woorden herkennen en gebruiken ouderen zelf in het beschrijven van ouder worden en kwetsbaarheid?Methode: De methode was tweeledig: 1) bestuderen van Nederlandstalige grijze literatuur en 2) een Delphi-procedure. Eerst zijn termen uit de literatuur verzameld en vervolgens zijn de gevonden termen voorgelegd aan een ouderenpanel (>70 jaar, N=30). Daarnaast had het ouderenpanel de mogelijkheid om zelf nieuwe termen in te brengen. In drie ronden gaven zij aan of zij de termen herkennen dan wel gebruiken.Resultaten: In totaal zijn 187 termen voorgelegd aan het ouderenpanel. Na analyse zijn er 69 termen behouden die door ouderen herkend of gebruikt worden. De termen zijn onderverdeeld in verschillende categorieën. De categorie kwetsbaarheid komt niet terug in de definitieve lijst met termen, wegens te weinig herkenning en gebruik door de panelleden.Conclusie: Dit onderzoek laat zien welke alternatieve termen gehanteerd kunnen worden in schriftelijke en mondelinge communicatie met ouderen over thema’s als kwetsbaarheid en ouder worden.
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Background: Chronic constipation is common in people with intellectual disabilities, and seems to be highly prevalent in people with severe or profound intellectual and multiple disabilities (SPIMD). However, there is no current widely accepted definition for the constipation experienced by these individuals. Aim: This Delphi study aims to compile a list of operationalized criteria and symptoms of constipation in people with SPIMD based on practical experiences of and consensus between experts supporting them. Methods: A two-round Delphi study with an intermediate evaluation and analyses was conducted. Parents and relatives of persons with SPIMD and support professionals were included. The panel answered statements and open questions about symptoms and criteria of constipation. They were also requested to provide their opinion about classifying criteria and symptoms into domains. Answers to statements were analysed separately after both rounds with regard to consensus rate and displayed qualitatively; answers to open questions were analysed deductively. Results: In the first Delphi round (n = 47), consensus was achieved on criteria within the domains 'Defecation’ and 'Physical features', that were assigned to broader categories. Symptoms retrieved within the domain ‘Behavioural/Emotional’ were brought back to the panel as statements. After the second Delphi round (n = 38), consensus was reached on questions about domains, and for eight criteria (domain ‘Defecation’ n = 5; domain ‘Physical features n = 3). Within the domain ‘Behavioural/Emotional’, consensus was achieved for five symptoms. Criteria and symptoms with consensus >70% were considered ‘generic’ and
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Background: Motor learning is central to domains such as sports and rehabilitation; however, often terminologies are insufficiently uniform to allow effective sharing of experience or translation of knowledge. A study using a Delphi technique was conducted to ascertain level of agreement between experts from different motor learning domains (i.e., therapists, coaches, researchers) with respect to definitions and descriptions of a fundamental conceptual distinction within motor learning, namely implicit and explicit motor learning. Methods: A Delphi technique was embedded in multiple rounds of a survey designed to collect and aggregate informed opinions of 49 international respondents with expertise related to motor learning. The survey was administered via an online survey program and accompanied by feedback after each round. Consensus was considered to be reached if $70% of the experts agreed on a topic. Results: Consensus was reached with respect to definitions of implicit and explicit motor learning, and seven common primary intervention strategies were identified in the context of implicit and explicit motor learning. Consensus was not reached with respect to whether the strategies promote implicit or explicit forms of learning. Discussion: The definitions and descriptions agreed upon may aid translation and transfer of knowledge between domains in the field of motor learning. Empirical and clinical research is required to confirm the accuracy of the definitions and to explore the feasibility of the strategies that were identified in research, everyday practice and education.
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The concept of immersion has been widely used for the design and evaluation of user experiences. Augmented, virtual and mixed-reality environments have further sparked the discussion of immersive user experiences and underlying requirements. However, a clear definition and agreement on design criteria of immersive experiences remains debated, creating challenges to advancing our understanding of immersive experiences and how these can be designed. Based on a multidisciplinary Delphi approach, this study provides a uniform definition of immersive experiences and identifies key criteria for the design and staging thereof. Thematic analysis revealed five key themes – transition into/out of the environment, in-experience user control, environment design, user context relatedness, and user openness and motivation, that emphasise the coherency in the user-environment interaction in the immersive experience. The study proposes an immersive experience framework as a guideline for industry practitioners, outlining key design criteria for four distinct facilitators of immersive experiences–systems, spatial, empathic/social, and narrative/sequential immersion. Further research is proposed using the immersive experience framework to investigate the hierarchy of user senses to optimise experiences that blend physical and digital environments and to study triggered, desired and undesired effects on user attitude and behaviour.
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Little is known about which self-management behaviors have the highest potential to influence exacerbation impact in COPD patients. We aimed to reach expert consensus on the most relevant set of self-management behaviors that can be targeted and influenced to maximize reduction of exacerbation impact. Materials and methods A 2-round Delphi study was performed using online surveys to rate the relevance and feasibility of predetermined self-management behaviors identified by literature and expert opinion. Descriptive statistics and qualitative analyses were used. Results An international expert panel reached consensus on 17 self-management behaviors focusing on: stable phase (n=5): pharmacotherapy, vaccination, physical activity, avoiding stimuli and smoking cessation; periods of symptom deterioration (n=1): early detection; during an exacerbation (n=5): early detection, health care contact, self-treatment, managing stress/anxiety and physical activity; during recovery (n=4): completing treatment, managing stress/anxiety, physical activity and exercise training; and after recovery (n=2): awareness for recurrent exacerbations and restart of pulmonary rehabilitation. Conclusion This study has provided insight into expert opinion on the most relevant and feasible self-management behaviors that can be targeted and influenced before, during and after an exacerbation to exert the highest magnitude of influence on the impact of exacerbations. Future research should focus at developing more comprehensive patient-tailored interventions supporting patients in these exacerbation-related self-management behaviors.
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Background: For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. Methods: An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). Results: Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role. Conclusions: SDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.
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Amidst escalating environmental and social challenges, this study explores regenerative business models’ definition and characteristics. While sustainable models have made considerable strides in research, policy, and practice, the advent of regenerative business models offers a progressive leap forward. Regenerative business models aspire to contribute to ecological restoration and societal well-being. The regenerative business model concept is, however, still in its infancy and lacks a comprehensive definition. Our study aims to expand this knowledge, using a Delphi-inspired approach that builds on the knowledge of academic and business experts. Our approach includes three rounds of surveys: an open-ended survey, a survey for rating and ranking the earlier responses of all participants, and a final survey to select key characteristics. We investigate patterns and distinctions among regenerative, regenerative business, and regenerative business models, and analyze their positioning vis-a-vis circular and net-positive models. Findings underscore that organizations adopting regenerative business models focus on planetary health and societal well-being. They generate value across multiple stakeholder levels, including nature, societies, customers, suppliers, shareholders, and employees. Despite overlapping with circular and net-positive models, regenerative business models also emphasize interdependencies between humans and nature, and provide a more holistic approach, centered on restoration rather than mere mitigation.
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PurposeInternationally, many differences are observed regarding the practice of geriatric rehabilitation for older people living at home. To improve international collaboration and research on this topic, we aimed to reach a consensus on terminology, organisational aspects, and outcome domains to focus on.MethodsWe conducted a three-round online Delphi study among 60 (Home-based) geriatric rehabilitation experts from 14 countries. In the first round, we collected diverse perspectives and input through statements and questions. In the subsequent rounds, participants rated statements on a 5-point Likert scale. Each statement could be accompanied by written feedback. After each round, results were presented anonymously to the participants, and statements on which no consensus was reached were rephrased. Consensus was defined as 70% or more participants (fully) agreeing with a statement.ResultsSixty, 52, and 46 experts completed rounds 1, 2 and 3, respectively. After two rounds, we reached a consensus on ten statements and on the remaining four in the last round. A consensus was reached on the terminology used (i.e., home-based geriatric rehabilitation) and on several organisational aspects (e.g., essential aspects to consider for starting home-based geriatric rehabilitation and the importance of a knowledgeable case manager). Lastly, experts agreed that participation and activity are the most important outcome domains to focus on.ConclusionsThrough an international Delphi study, we reached consensus on various important aspects of home-based geriatric rehabilitation. These outcomes provide a basis for further development of this emerging field.
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