Development of a core outcome set for venous leg ulceration (CoreVen) research evaluations (protocol)

BackgroundA venous leg ulcer is a chronic leg wound caused by poor venous blood circulation in the lower limbs. It is a recurring condition causing pain, malodour, reduced mobility, and depression. Randomised controlled trials evaluating treatments for venous leg ulcers provide important evidence to inform clinical decision-making. However, for findings to be useful, outcomes need to be clinically meaningful, consistently reported across trials, and fully reported. Research has identified the large number of outcomes reported in venous leg ulcer trials, impacting both synthesis of results, and clinical decision-making. To address this, a core outcome set will be developed. A core outcome set is an agreed standardised set of outcomes which should be, as a minimum, measured and reported in all trials which evaluate treatment effectiveness for a given indication. A core outcome set has the potential to reduce research waste, improve the utility of RCTs, reduce reporting bias, facilitate treatment comparisons across different sources of evidence and expedite the production of systematic reviews, meta-analyses and evidence-based clinical guidelines.AimThe aim of this project is to develop a core outcome set for research evaluating the effectiveness of interventions for treating venous leg ulceration.MethodsThrough a scoping review of the literature on venous leg ulceration, we will firstly identify a list of candidate outcome domains (broad categories in relation to what is being measured) from randomised controlled trials and qualitative research, and outcomes (specific methods in relation to what is being measured). In two further stages, we will use the resulting lists of outcome domains and outcomes to design two online surveys. A range of stakeholders will be invited to participate in the surveys and they will be asked to indicate which outcome domains and outcomes are most important and should be considered as core in future research reports.     

脉搏波形采集与辅助诊断系统的设计

在分析现有脉搏信号测量技术及其处理方法的基础上，设计了以AT89S52单片机为下位机，PC机为上位机的脉搏信号采集装置。利用Delphi强大的数据库支持特性和Delphi与Matlab混合编程技术，开发了脉搏信号辅助诊断系统。该系统界面友好，操作简单，数据处理能力强，实现了脉搏信号的采集，脉搏波形的实时显示、回放等功能。通过对临床患者脉搏数据的实际采集和处理，验证了该系统的有效性和实用性。     

血液病专科护士培养模式构建

目的构建血液病专科护士培养模式,为提高血液病专科护士能力提供参考。方法检索专科护士培养的国内外文献及政策法规,对1 792名血液科护士及6名专家进行问卷调查,获取血液病专科护士培养需求及建议,构建血液病专科护士培养模式草案,针对草案邀请15名专家进行两轮Deiphi专家函询,确定血液病专科护士培养模式各级指标及权重。结果两轮函询专家积极系数均为100%,权威系数为0.83,肯德尔协调系数为0.24（P＜0.05）,专家意见趋于一致。经两轮函询,最终形成包含7个一级指标、31个二级指标、111个三级指标的血液病专科护士培养模式。结论本研究构建的血液病专科护士培养模式科学、可靠,对于血液病专科护士的培养具有指导意义。     

Discrepancies Between Australian Eating Disorder Clinicians and Consumers Regarding Essential Components of Dietetic Treatment

BackgroundA recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment.ObjectiveThis study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non–dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment.Design and participants/settingThe ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non–dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23).Main outcome measuresStatements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale.Statistical analysis performedOne-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings.ResultsThirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants’ understanding of core responsibilities of dietitians in ED treatment and dietitians “drifting” from delivering evidence-based components of dietetic treatment.ConclusionsResults of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with individuals with lived experience.     

What components are important for effective healthcare alliance governance? Findings from a modified Delphi study in New Zealand

Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes an integrated and whole of systems approach to care. Little is known about the model in healthcare, nor what those involved in an alliance should be focused upon. Using a modified Delphi method, this research presents a set of components that research participants agreed should underpin development of an effective alliance governance arrangement.These characteristics include a systems perspective—a truly shared governance protocol based on a shared vision and a common purpose; performance measurement—collecting and using real-time data that depicts the realities of an end-to-end system to establish better and more achievable goals based on alliance performance; a relational perspective to promote trust, respect and collaboration amongst alliance members, who historically have been competing for contracts and resources; structural changes that enable and promote a shared governance system; and, finally, equity and inclusion to ensure a diverse alliance which promotes diversity of ideas, and involvement of all stakeholders in the decision making process. This research is relevant to policymakers seeking to develop effective alliance-type arrangements as well as to those involved in the practice of alliance governance.     

《严重过敏反应急救指南》临床问题与结局指标的收集和确定

目的: 确定纳入《严重过敏反应急救指南》的临床问题与结局指标。方法: 由指南指导委员会7位临床医学、药学及护理学专家参考国际指南指导项目组起草、修订拟纳入指南的临床问题与结局指标初稿。临床问题分为背景问题与前景问题,其中背景问题在专家共识组共22位临床专家修订后直接纳入指南范围,前景问题与结局指标将通过三轮德尔菲法对共识组临床专家咨询形成终稿。研究在方法学家全程监督下完成,并通过分析积极系数、变异系数与分值频率等指标进行质量控制。结果: 问题征集初拟共纳入34个前景问题、6个背景问题及6个结局指标,背景问题经专家组修订后直接纳入指南。使用德尔菲法(Delphi method)对前景问题与结局指标的重要程度进行分级后,最终确定28个关键前景问题及6个结局指标纳入指南范围。其中,4个结局指标为关键性结局,其余2个为重要结局,纳入的28个关键前景问题分为严重过敏反应的诊断、救治准备、救治措施及救治后的管理四个部分,另有5个重要问题和1个次要问题此次未纳入指南,供指南修订或更新时参考或讨论。研究中专家响应的积极程度高,积极系数为100%;前景问题的共识程度高,4分及以上的问卷频率均≥0.75;结局指标中,病死率及疾病严重程度的共识程度高,变异系数≤15%。结论: 在全面严谨的信息收集基础上,以德尔菲法的方式确定了需要纳入《严重过敏反应急救指南》的临床问题与结局指标为该指南的后续制定工作奠定了基础。     

What does it mean to involve consumers successfully in NHS research? A consensus study

OBJECTIVE: To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. DESIGN: Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. SETTING AND PARTICIPANTS: Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. MAIN OUTCOME MEASURES: Consensus on principles and indicators of successful consumer involvement in NHS research. RESULTS: Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. CONCLUSIONS: Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice.     

安宁疗护高级实践护士核心能力指标体系的构建

目的:构建安宁疗护专业高级实践护士的核心能力指标体系.方法:通过文献回顾,根据专家协调小组意见,自行设计专家咨询问卷,对全国7个省份15所医院从事临终护理实践、护理管理、姑息医疗以及从事院校安宁疗护教育4个领域的23名资深专家进行两轮德尔菲专家咨询.结果:构建的安宁疗护高级实践护士的核心能力指标体系包括沟通及合作能力、...     

介入专科护士理论知识体系的构建

目的通过构建介入专科护士理论知识体系,为介入专科护士培养和理论课程设置提供参考。方法应用德尔菲法对16名专家进2轮函询,确立理论知识大纲要点。结果 2轮专家函询的积极性均为100%,专家咨询的权威系数为0.89,判断系数0.89,熟悉程度0.89,均>0.7。最终确定的理论知识体系包括5项一级指标,21项二级指标。结论介入专科护士理论知识体系专家意见集中,可信度高,能为介入专科护士理论课程培训的设置提供参考依据。