Identification of priorities for nursing research in Spain: a Delphi study

AIM: The aim of this work was to identify priorities for nursing research in Spain. The Co-ordination and Development of Nursing Research Centre (Investén-isciii group) carried out the study using the Delphi technique during the period April 1998 to January 1999. METHODS: Study subjects were professionals involved in different nursing activities. From 1250 eligible professionals initially contacted, 452 (38%) responded in round 1 and 258 (57%) in round 2. But only 189 filled out correctly the questionnaires from both rounds of data collection (overall response rate was 21.6%). RESULTS: The participants identified priorities related to continuity and co-ordination of nursing care, quality of nursing care, impact of invasive techniques and treatments on the quality of life of patients, needs of the primary care givers, quality of life among elders, satisfaction of customers and needs of terminal patients and their families.     

Building consensus in defining and conceptualizing acceptability of healthcare: A Delphi study

Background

The concept of healthcare acceptability is important for nursing staff spending most of their time with patients. Nevertheless, acceptability remains confusing without a collective definition in existing literature.

Objective

This study aimed to create a consensus among experts on definition and conceptual framework of healthcare acceptability.

Methods

We conducted two rounds of Delphi surveys to collect opinions from experts on definition and conceptual framework of healthcare acceptability proposed following thematic content analysis. We calculated the consensus among experts using the modified Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and followed the guidance on conducting and reporting Delphi studies (CREDES) best practices.

Results

A total of 34 experts completed two rounds of Delphi survey. The definition was validated through consensus as: “a multi-construct concept describing the nonlinear cumulative combination in parts or in whole of experienced or anticipated specific healthcare from the relevant patients/participants, communities, providers/researchers or healthcare systems' managers and policy makers' perspectives in a given context.” The overall quality rating was 92.6% and 95.1% for the proposed definition and conceptual framework respectively.

Conclusion

Opinions collected from experts provided significant insights to build a consensus on healthcare acceptability advancing public health nursing.     

急诊科华法林相关致命性出血114例分析

目的:调查综合医院急诊科华法林相关致命性出血患者抗凝病因、出血易感因素和临床特点。方法:收集温州医科大学附属第一医院急诊科抢救室2017年1月至2020年2月期间收治的华法林相关致命性出血患者,用描述性研究方法分析其抗凝病因、出血易感因素和临床特点。根据出血时国际标准化比值(international normaliz...     

Fibrinogen levels during trauma hemorrhage,response to replacement therapy,and association with patient outcomes

Summary. Background: Low fibrinogen levels are known to occur in trauma. However, the extent of fibrinogen depletion during trauma hemorrhage, the response to replacement therapy and association with patient outcomes remain unclear. Objectives: The study aims were to: characterize admission fibrinogen level and correlate it with factors associated with injury; describe the time course of fibrinogen depletion and response to replacement therapy; determine the correlation of fibrinogen level with rotational thromboelastography (ROTEM) parameters; evaluate the effect of fibrinogen supplementation ex vivo; and establish the association between fibrinogen level and clinical outcomes. Methods: This was a prospective cohort study of 517 patients. Blood samples were drawn on admission and after admistration of every 4 units of packed red blood cells. Fibrinogen levels were determined with the Clauss method, and global hemostatic competence was assessed with thromboelastometry. The effect of fibrinogen supplementation was assessed in a subgroup of coagulopathic patients. Results: Low admission fibrinogen level was independently associated with injury severity score (P < 0.01), shock (P < 0.001), and prehospital fluid volume (P < 0.001). Fibrinogen supplementation during transfusion maintained but did not augment fibrinogen levels. Administration of cryoprecipitate was associated with improved survival. ROTEM parameters correlated with fibrinogen level, and ex vivo fibrinogen administration reversed coagulopathic ROTEM parameters. Fibrinogen level was an independent predictor of mortality at 24 h and 28 days (P < 0.001). Conclusions: Fibrinogen level is decreased in injured patients on admission and is associated with poor outcomes. ROTEM is a rapid means of assessing hypofibrinogenemia. Earlier administration of specific fibrinogen replacement may improve outcomes, and prospective controlled trials are urgently needed.     

应用Delphi法建立术前访视模式的效果评价

目的 探讨应用Delphi法建立的术前访视模式的应用效果.方法 采用Delphi法建立术前访视标准化程序,比较采用术前访视标准化程序前后的患者平均住院时间、住院费用及患者满意度.结果 采用经Delphi法建立的术前访视模式后,同类型手术患者的住院时间、治疗费用及患者满意度均较未使用前有明显改善.结论 Delphi法用于建立医院术前访视标准化程序,具有针对性强、代表性强、权威程度高的优点,充分利用了优秀的医疗经验,为患者提供均一、稳定的术前准备工作,为患者获得更好的医疗服务打下了基础,值得临床推广应用.     

Predictive model integrating dynamic parameters for massive blood transfusion in major trauma patients: The Dynamic MBT score

Background

Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.

Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand

BACKGROUND: Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies. AIM: The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria. METHODS: Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold. FINDINGS: Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark. CONCLUSIONS: When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.     

微血流成像联合超声造影诊断猪肾创伤伴活动性出血的实验研究

目的 探讨微血流成像（MFI）联合超声造影（CEUS）在猪肾创伤伴活动性出血诊断及定位中的应用价值。方法 选取健康巴马小型猪10只,建立肾创伤伴活动性出血模型。模型建立成功后进行CEUS及MFI检查,比较MFI联合CEUS与CEUS诊断及定位活动性出血的准确率;应用MFI联合CEUS测量活动性出血受损血管破口内径。结果 1只巴马小型猪由于麻醉原因在实验过程中意外死亡,剩余9只巴马小型猪共成功构建18处肾创伤伴活动性出血灶。CEUS与MFI联合CEUS诊断活动性出血的准确率分别为77.78%、94.44%,二者比较差异无统计学意义;CEUS与MFI联合CEUS定位活动性出血的准确率分别为55.56%、94.44%,二者比较差异有统计学意义（P<0.05）。MFI联合CEUS测得活动性出血受损血管破口内径为1.54～2.42 mm,平均（1.94±0.29）mm。结论 MFI联合CEUS能清晰显示猪肾创伤灶内受损血管,准确诊断活动性出血,且定位活动性出血的能力优于CEUS。     

Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task Force

BACKGROUND: Recombinant activated factor VII (rFVIIa) has been approved by the U.S. Food and Drug Administration (FDA) for almost a decade for hemophilic patients with inhibitors. Its off-label use as a hemostatic agent in massive bleeding caused by a wide array of clinical scenarios is rapidly expanding. While evidence-based guidelines exist for rFVIIa treatment in hemophilia, none are available for its off-label use. Objectives: The aim of this study is to develop expert recommendations for the use of rFVIIa in patients suffering from uncontrolled bleeding (with special emphasis on trauma) until randomized, controlled trials allow for the introduction of more established evidence-based guidelines. METHODS: A multidisciplinary task force comprising representatives of the relevant National Medical Associations, experts from the Medical Corps of the Army, Ministry of Health and the Israel National Trauma Advisory Board was established in Israel. Recommendations were construed based on the analysis of the first 36 multi-trauma patients accumulated in the prospective national registry of the use of rFVIIa in trauma, and an extensive literature search consisting of published and prepublished controlled animal trials, case reports and series. The final consensus guidelines, together with the data of the first 36 trauma patients treated in Israel, are presented in this article. RESULTS: Results of the first 36 trauma patients: The prolonged clotting assays [prothrombin time (PT) and partial thromboplastin time (PTT)] shortened significantly within minutes following administration of rFVIIa. Cessation of bleeding was achieved in 26 of 36 (72%) patients. Acidosis diminished the hemostatic effect of the drug, while hypothermia did not affect it. The survival rate of 61% (22/36) seems to be favorable compared with published series of similar, or less severe, trauma patients (range 30%-57%). CONCLUSIONS: As a result of the lack of controlled trials, our guidelines should be considered as suggestive rather than conclusive. However, they provide a valuable tool for physicians using rFVIIa for the expanding off-label clinical uses.