• Keywords
• Delphi 7,

• Conspectus
• Programové vybavení. Programové prostředky

• Keywords
• informační technologie, Delphi,

• Conspectus
• Programové vybavení. Programové prostředky

• MeSH
• Pharmaceutical Preparations supply & distribution   MeSH
• Mathematics MeSH
• Prognosis MeSH
• Pharmacy Administration MeSH
• Statistics as Topic MeSH
• Health Systems Plans MeSH

• MeSH
• Pharmaceutical Preparations MeSH
• Surveys and Questionnaires MeSH
• Pharmacy Administration MeSH
• Statistics as Topic MeSH

IMPORTANCE: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment. OBJECTIVE: To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS. DESIGN, SETTING, AND PARTICIPANTS: The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022. MAIN OUTCOMES/MEASURES: The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1. RESULTS: In the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup. CONCLUSIONS AND RELEVANCE: This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

• MeSH
• Delphi Technique MeSH
• Adult MeSH
• Eosinophilia * chemically induced   diagnosis   therapy   MeSH
• Consensus MeSH
• Drug Hypersensitivity Syndrome * diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

• MeSH
• Delphi Technique MeSH
• Gastrectomy MeSH
• Weight Loss MeSH
• Consensus MeSH
• Humans MeSH
• Obesity, Morbid * surgery   MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Gastric Bypass * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program. METHODS: A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale. A diverse, representative group was targeted. Consensus was achieved when greater than 70% respondents rated a domain as critical (> or = 7 on the 9 point Likert scale). RESULTS: 35 international ECPR experts from 9 countries formed the expert panel, with a median number of 14 years of ECMO practice (interquartile range 11-38). Participant response rates were 97% (survey round one), 63% (virtual meeting) and 100% (survey round two). After the second round of the survey, 47 consensus statements were formed outlining a core set of competencies required for ECPR provision. We identified key elements required to safely train and perform ECPR including skill pre-requisites, surrogate skill identification, the importance of competency-based assessment over volume of practice and competency requirements for successful ECPR practice and skill maintenance. CONCLUSIONS: We present a series of core competencies, training requirements and ongoing governance protocols to guide safe ECPR implementation. These findings can be used to develop training syllabus and guide minimum standards for competency as the growth of ECPR practitioners continues.

• MeSH
• Accreditation MeSH
• Delphi Technique MeSH
• Cardiopulmonary Resuscitation * methods   MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Chyby v komunikaci mezi zdravotníky byly vyhodnoceny jako jedna z hlavních příčin preventabilních pochybení ve zdravotnictví a nedostatečné předání informací o pacientovi může vést k jeho poškození a vzniku chyby v pozdější fázi léčby. Standardizací a zlepšením procesu předání pacientů může být zlepšena bezpečnost poskytované péče. Kvalita předávání pacientů se liší. Rozdíly byly nalezeny v metodě předávání, jazyce, úrovni vzdělání a zkušeností. Z tohoto důvodu se Zdravotnická záchranná služba hl. m. Prahy rozhodla standardizovat předávání informací z přednemocniční péče směrem ke kontaktním místům nemocnic. Článek představuje postup při výběru a tvorbě formuláře pro strukturované předání informací o pacientovi pomocí akčního výzkumu a modifikované Delphi metody. Prezentovaný formulář obsahuje zásadní informace pro identifikaci poskytovatele přednemocniční péče a výjezdové skupiny, základní popis onemocnění nebo úrazu, vitální hodnoty pacienta a provedenou terapii. Formulář je uzpůsoben jak pro pacienty s nižší prioritou ošetření, tak pro kriticky ohrožené.

Failures in communication have been identified as a major cause of preventable medical errors and of poor handovers resulting in adverse effects for the patient. Miscommunication and information loss during handover are acknowledged as contributing factors to adverse events. Patient safety can be improved by ameliorating the handover process and by standardising the processes. The quality of patient handover varies, the chief differences being in the handover method, language, level of education and expertise. For this reason, the Prague Emergency Medical Services decided to standardise the process of information handover from pre-hospital to in-hospital care. This paper presents a process for choosing and creating a system of structured information handover using action research and the modified Delphi method. The presented system contains essential information for identifying the pre-hospital care provider and the crew, the basic disease or injury, the patient’s vital signs and the treatment. The system is tailored to both low and high priority patients.

• MeSH
• Forms as Topic * MeSH
• Humans MeSH
• Patient Handoff * organization & administration   statistics & numerical data   MeSH
• Emergency Medical Services organization & administration   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: There has been increasing interest in en bloc resection of bladder tumour (ERBT) as an oncologically noninferior alternative to transurethral resection of bladder tumour (TURBT) with fewer complications and better histology specimens. However, there is a lack of robust randomised controlled trial (RCT) data for making recommendations. OBJECTIVE: We aimed to develop a consensus statement to standardise various aspects of ERBT for clinical practice and to guide future research. DESIGN, SETTING, AND PARTICIPANTS: We developed the consensus statement on ERBT using a modified Delphi method. First, two systematic reviews were performed to investigate the clinical effectiveness of ERBT versus TURBT (effectiveness review) and to identify areas of uncertainty in ERBT (uncertainties review). Next, 200 health care professionals (urologists, oncologists, and pathologists) with experience in ERBT were invited to complete a two-round Delphi survey. Finally, a 16-member consensus panel meeting was held to review, discuss, and re-vote on the statements as appropriate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Meta-analyses were performed for RCT data in the effectiveness review. Consensus statements were developed from the uncertainties review. Consensus was defined as follows: (1) ≥70% scoring a statement 7-9 and ≤15% scoring the statement 1-3 (consensus agree), or (2) ≥70% scoring a statement 1-3 and ≤15% scoring the statement 7-9 (consensus disagree). RESULTS AND LIMITATIONS: A total of 10 RCTs were identified upon systematic review. ERBT had a shorter irrigation time (mean difference -7.24 h, 95% confidence interval [CI] -9.29 to -5.20, I2 = 85%, p < 0.001) and a lower rate of bladder perforation (risk ratio 0.30, 95% CI 0.11-0.83, I2 = 1%, p = 0.02) than TURBT, both with moderate certainty of evidence. There were no significant differences in recurrences at 0-12, 13-24, or 25-36 mo (all very low certainty of evidence). A total of 103 statements were developed, of which 99 reached a consensus. A summary of statements is as follows: ERBT should always be considered for treating non-muscle-invasive bladder cancer; ERBT should be considered feasible even for bladder tumours larger than 3 cm; number and location of bladder tumours are not major limitations in performing ERBT; the planned circumferential margin should be at least 5 mm from any visible bladder tumour; after ERBT, additional biopsy of the tumour edge or tumour base should not be performed routinely; for the ERBT specimen, T1 substage, and circumferential and deep resection margins must be assessed; it is safe to give a single dose of immediate intravesical chemotherapy, perform second-look transurethral resection, and give intravesical bacillus Calmette-Guérin (BCG) therapy after ERBT; and in studies of ERBT, both per-patient and -tumour analysis should be performed for different outcomes as appropriate. Important outcomes for future ERBT studies were also identified. A limitation is that as consensus statements are brief, concise and binary in nature, areas of uncertainty that are complex in nature may not be addressed adequately. CONCLUSIONS: We have provided the most comprehensive review of the evidence base to date using a meta-analysis where appropriate and applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and mobilised the international urology community to develop a consensus statement on ERBT using transparent and robust methods. The consensus statement will provide interim guidance for health care professionals who practice ERBT and inform researchers regarding ERBT-related studies in the future. PATIENT SUMMARY: En bloc resection of bladder tumour (ERBT) is a surgical technique aiming to resect a bladder tumour in one piece. We included an international panel of experts to agree on the best practice of ERBT, and this will provide guidance to clinicians and researchers in the future.

• MeSH
• Cystectomy methods   standards   MeSH
• Delphi Technique MeSH
• Humans MeSH
• Urinary Bladder Neoplasms surgery   MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Research Support, Non-U.S. Gov't MeSH
• Systematic Review MeSH