Extended half-life recombinant factor VIII treatment of hemophilia A in Brazil: an expert consensus statement

Introduction Treatment of hemophilia A in Brazil is offered to all patients at no cost. However, several unmet medical needs exist. Method In this study, we applied the Delphi method to discuss with seven hemophilia A specialists the challenges that patients and the health system face regarding hemophilia A treatment and opportunities for improvement. Results A consensus was obtained regarding the number of weekly infusions and patient adherence to treatment. The bleeding profile, unfavourable pharmacokinetics (PKs), low adherence and high daily activity were patient profiles that would benefit from using the extended half-life (EHL) recombinant factor VIII (rFVIII). The advantages of treatment with the EHL rFVIII were the lower number of infusions per week, which could increase patient adherence and decrease the risk of bleeds, due to a more constant plasma level, a lower value. Additionally, the EHL rFVIII could improve quality of life, especially in patients with high daily activity, such as adolescents and young adults. The panelists mentioned that EHL rFVIII, if available, could be offered first to the priority group (adolescents between 12 and 19 years old), followed by adults (20 to 64 years old) and elderly people (over 65 years old). Conclusion In summary, the EHL rFVIII offers the optimal prophylaxis by decreasing the dose frequency, increasing the treatment adherence and improving the QoL, without compromising safety and efficacy.

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Fortalecimiento del liderazgo para la gestión educativa en las Américas: una estrategia de investigación-acción / Strengthening leadership for educational management in the Americas: an action research strategy / Fortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação

RESUMEN La formación de recursos humanos en salud es una preocupación recurrente. El Campus Virtual de Salud Pública (CVSP) es la plataforma educativa de la Organización Panamericana de Salud (OPS) que busca mejorar la accesibilidad a la educación en salud pública, con énfasis en la formación en liderazgo educativo orientado a planificar, implementar y evaluar políticas y acciones educativas. El objetivo de este trabajo es presentar los resultados de una consulta a personas expertas sobre el curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud", como parte de una estrategia de fortalecimiento de las capacidades de liderazgo para la gestión educativa en las Américas propuesta por el CVPS/OPS. Se realizó un estudio cualitativo de investigación-acción, con una metodología Delphi de dos iteraciones de consultas, una virtual y una presencial, a expertos en gestión educativa en organizaciones de salud. Los resultados muestran la relevancia que adquieren ocho dimensiones de análisis: el perfil de los destinatarios, las competencias, el enfoque y los contenidos, las actividades, la evaluación del y para el aprendizaje, la adaptabilidad, la implementación y el seguimiento durante y poscurso. La participación de actores de diferentes ámbitos geopolíticos en el diseño e implementación de una propuesta educativa regional promueve la transformación del contexto de aplicación y mejora su potencial adopción. Se destaca el lugar estratégico del curso como catalizador en la conformación y la consolidación de una red integrada de organizaciones para fortalecer el liderazgo educativo en las Américas, y la conveniencia de la estrategia metodológica empleada para mejorar la calidad de la formación de recursos humanos en salud.

ABSTRACT The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives. The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas. A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations. The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course. The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

RESUMO A formação de recursos humanos em saúde é uma preocupação recorrente. O Campus Virtual de Saúde Pública (CVSP) é a plataforma educacional da Organização Pan-Americana da Saúde (OPAS), que busca melhorar a acessibilidade à educação em saúde pública, com ênfase na formação de lideranças educacionais voltadas para o planejamento, a implementação e a avaliação de políticas e ações educacionais. O objetivo deste documento é apresentar os resultados de uma consulta com especialistas sobre o curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud" [Liderança para a Gestão Educacional em Organizações de Saúde], como parte de uma estratégia para fortalecer as capacidades de liderança para gestão educacional na Região das Américas proposta pelo CVPS/OPAS. Foi realizado um estudo qualitativo de pesquisa-ação utilizando o método Delphi com duas rodadas de consultas, uma virtual e outra presencial, a especialistas em gestão educacional em organizações de saúde. Os resultados mostram a relevância de oito dimensões de análise: perfil do público-alvo; competências; abordagem e conteúdo; atividades; avaliação de e para as aprendizagens; adaptabilidade; implementação; e acompanhamento durante e após o curso. A participação de atores de diferentes esferas geopolíticas no delineamento e na implementação de uma proposta educacional regional promove a transformação do contexto de aplicação e aumenta seu potencial de adoção. Destaca-se o posicionamento estratégico do curso como catalisador na criação e consolidação de uma rede integrada de organizações para fortalecer a liderança educacional na Região das Américas e a adequação da estratégia metodológica empregada para melhorar a qualidade da formação de recursos humanos em saúde.

Construction of residents' healthy lifestyle cognitive index system in the context of carbon peaking and carbon neutrality / 环境与职业医学

Background Healthy lifestyle is one of the important factors affecting individual health. How to promote residents' cognition of healthy lifestyle has become an urgent practical problem for the whole society. However, there is no residents' healthy lifestyle cognitive indexes available with consideration of carbon peaking and carbon neutrality. Objective To construct a cognitive index system for providing effective assessment on residents' cognition of healthy lifestyle under the background of carbon peaking and carbon neutrality. Methods Based on the health belief model, a preliminary cognitive index system of residents' healthy lifestyle under the background of carbon peaking and carbon neutrality was proposed after literature study and relevant policy review. Then three rounds of indicator importance evaluation and screening by Delphi method were conducted before the index system was finally constructed. The weights of all levels of indicators were determined using analytic hierarchy process. In addition, a self-assessment questionnaire was developed based on the index system. The questionnaire was utilized to conduct a survey among 200 residents by convenience sampling in Shenyang, Liaoning Province from November to December 2021. The survey was used to examine the reliability and validity of the indicator system. Results The effective recovery rates of the three rounds of Delphi method were all 100%. The authority coefficient was 0.84. The Kendall's W consistency test showed good expert consistency (P<0.001). Finally, a cognitive index system of residents' healthy lifestyle under the background of carbon peaking and carbon neutrality was initially constructed, including 4 first-level indicators, 8 second-level indicators, and 35 third-level indicators. Among them, the weights of the first-level indicators were 0.4541 for practice cognition, 0.2248 for benefit and obstacle cognition, 0.1626 for action clue cognition, and 0.1585 for risk cognition, respectively. The correlation coefficients between each indicator were from 0.586 to 0.977 (P<0.01). The overall Cronbach's α coefficient was 0.95, indicating high reliability. Invited experts agreed that the entries were representative and the content validity of the constructed indicator system was good. The factor analysis also showed that the structure validity was good. Conclusion The proposed index system for residents' cognition of healthy lifestyle show good reliability and validity, which can be used as an effective assessment tool for residents' healthy lifestyle cognition under the background of carbon peaking and carbon neutrality. It can provide a scientific and theoretical basis for promoting residents' cognition and practice of healthy lifestyle.

Construction of ESER Doctor-patient Communication Model from the Perspective of Cancer Patients / 中国医学伦理学

To construct a simple and two-way interactive doctor-patient communication mode, in order to provide guidance tools for doctor-patient communication, improve the effectiveness of doctor-patient communication for cancer patients, optimize medical experience, reduce doctor-patient disputes, and provide new perspectives and ideas for the study of doctor-patient communication. Literature review and qualitative research were used to construct the index framework of ESER doctor-patient communication model, and Delphi method was used to revise and improve the index content, and evaluate its reliability and validity. The results showed that after two rounds of expert letter consultation, the final ESER doctor-patient communication mode was established, including 4 primary-level indicators, 8 second-level indicators and 40 third-level indicators. The positive coefficient of experts was 100% in both rounds. The authority coefficient of experts was 0.85 in the first round and 0.91 in the second round, indicated a high degree of overall authority. Coefficient of variation (CV) were less than 0.25, and the Kendall’s W coefficient for significant χ2 test, P values were less than 0.05, which was statistically significant. It can be considered that the coordination degree of experts was high; Cronbach’s α coefficients in the first and second rounds of importance evaluation were 0.952 and 0.971, respectively, which indicated that the index framework had good reliability and validity. Based on the needs of cancer patients for doctor-patient communication, build a two-way interactive ESER doctor-patient communication mode, integrate medicine and humanities, which can be used as a guiding tool for medical staff to communicate with cancer patients, so as to enable doctors and patients to achieve mutual trust, cooperation and win-win results.

Methodological Evaluation of Advantages of Traditional Chinese Medicine Treatment of Sjögren's Syndrome / 中国实验方剂学杂志

Screening and evaluating the diseases responding specifically to traditional Chinese medicine （TCM） will help to highlight the advantages of TCM treatment， and the evaluation method should be standardized with consideration to the unique characteristics of the diseases. The incidence of Sjögren's Syndrome （SS） is increasing year by year， while the pathogenesis of this disease remains unclear. Modern therapies for this disease include biological agents and immunosuppressants， which generally have unsatisfactory efficacy. The TCM treatment of SS focuses on the harmony of the physical and mental health. The Rheumatology Branch of the China Association of Chinese Medicine organizes experts in TCM， Western medicine， and evidence-based medicine to form working groups. Delphi method and bibliometric method were used for analysis， and SS was selected as a disease responding specifically to TCM. Furthermore， the evaluation system was established for this disease， and the consensus regarding this disease was reached after seminar discussion. This paper summarized the whole process of the evaluation of the advantages of TCM treatment of SS. First， because TCM atomization is widely used in clinical practice and enriches TCM administration methods， this therapy is included after other non-drug therapies were taken as characteristic therapies. Second， the evaluation indicators of therapeutic effect should be determined with consideration to international acceptance and the current research status. Third， the expression method should be accurate， standardized， and objective， highlight the natural advantages of TCM， and avoid arbitrary extension. This paper provides a reference for clinicians to explore other diseases responding specifically to TCM.

Resource utilization and costs related to the management of obstructive hypertrophic cardiomyopathy under the Brazilian supplementary healthcare system´s perspective: results from a modified Delphi panel / Utilização de recursos e custos relacionados ao manejo da cardiomiopatia hipertrófica obstrutiva sob a perspectiva do sistema de saúde suplementar brasileiro: resultados de um painel Delphi modificado

Objective: To generate data on the costs associated with the diagnosis and treatment of obstructive ypertrophic cardiomyopathy (HCM) from the perspective of the private health system in Brazil. Methods: A modified Delphi panel including seven different specialists (three clinical cardiologists with experience in obstructive HCM, two hemodynamicists with experience in septal ablation and two cardiac surgeons with expertise in myectomy), from two Brazilian states (São Paulo and Pernambuco), was conducted between August and November 2022. Two rounds of questions about the use of healthcare resources according to the functional class (NYHA I-IV) and a panel in a virtual platform were conducted to obtain the final consensus. Micro-costing defined costs and unit values were determined based on official price lists. Results: The total diagnosis cost per patient was estimated at BRL 11,486.81. The obstructive HCM management costs analysis showed average annual costs per patient of BRL 17,026.74, BRL 19,401.46, BRL 73,310.07, and BRL 94,885.75 for the functional classes NYHA I, NYHA II, NYHA III, and NYHA IV, respectively. The average costs per patient related to procedures in a year were BRL 12,698.53, BRL 13,462.30, BRL 58,841.67, and BRL 75,595.90 for the functional classes NYHA I, II, III, and IV, respectively. Conclusions: The annual costs of HCM management increased according to the functional class, highlighting the need for safe and effective strategies to improve patient's NYHA functional class while promoting a decrease in the need for invasive therapies.

Objetivo: Gerar dados acerca dos custos associados ao diagnóstico e tratamento da cardiomiopatia hipertrófica (CMH) obstrutiva, sob a perspectiva do sistema de saúde privado no Brasil. Métodos: Um painel Delphi modificado incluindo sete especialistas (três cardiologistas clínicos com experiência em CMH obstrutiva, dois hemodinamicistas com experiência em ablação de septo e dois cirurgiões cardíacos com experiência em miectomia) de dois estados brasileiros (São Paulo e Pernambuco) foi conduzido entre agosto e novembro de 2022. Foram realizadas duas rodadas de perguntas acerca da utilização de recursos de acordo com a classe funcional (NYHA I-IV) e uma reunião virtual para obtenção do consenso final. Os custos foram definidos por meio de microcusteio, e os valores unitários foram definidos com base em listas de preço oficiais. Resultados: O custo total do diagnóstico por paciente foi estimado em R$ 11.486,81. A análise de custos de manejo da CMH obstrutiva mostrou custos médios anuais por paciente de R$ 17.026,74, R$ 19.401,46, R$ 73.310,07 e R$ 94.885,75 para as classes funcionais NYHA I, NYHA II, NYHA III e NYHA IV, respectivamente. Os custos médios por paciente relacionados a procedimentos em um ano foram de R$ 12.698,53, R$ 13.462,30, R$ 58.841,67 e R$ 75.595,90 para as classes NYHA I, II, III e IV, respectivamente. Conclusões: Os custos anuais com o manejo da CMH aumentam de acordo com a classe funcional, destacando a necessidade de estratégias seguras e eficazes capazes de melhorar a classe funcional NYHA do paciente, ao mesmo tempo que promove diminuição da necessidade de terapias invasivas.

Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Recomendaciones de expertos acerca del uso de teduglutide en pacientes pediátricos con sindrome de intestino corto / Expert recommendations on the use of teduglutide in pediatric patients with short bowel syndrome

Resumen El síndrome de intestino corto es una entidad de baja incidencia en los pacientes pediátricos, pero se asocia con elevadas tasas de morbimortalidad. El abordaje de estos pacientes por un equipo interdisciplinario de expertos enfocados en la rehabilitación intestinal mejora los resultados a corto y a largo plazo. Entre los recursos disponibles para el tratamiento se incluye el teduglutide, un análogo del péptido similar al glucagón tipo 2 (GLP-2) elaborado mediante técnicas recombinantes. Por medio de la aplicación del método Delphi, a partir de la evidencia disponible y de la experiencia de los autores, se proponen recomendaciones para el uso de teduglutide, dirigidas a los profesionales de la salud que tratan a los pacientes pediátricos con síndrome de intestino corto, así como a las autoridades sanitarias.

Abstract Short bowel syndrome is a low-incidence disorder among pediatric patients, but it is associated with high morbidity and mortality rates. Management of these patients by an interdisciplinary team of experts focused on intestinal rehabilitation improves short- and long-term outcomes. Available resources for treatment include teduglutide, a glucagon-like peptide type 2 (GLP-2) analog made by recombinant techniques. Considering the available evi dence and the authors' experience, Delphi-based recommendations for the use of teduglutide are suggested for healthcare professionals who treat pediatric patients with short bowel syndrome, as well as for health authorities.

Validación de intervención psicoeducativa para mejorar el afrontamiento y adaptación de familiares en la UCI / Psychoeducational Intervention Validation to Improve Relatives in the ICU Coping and Adaptation / Validação de uma intervenção psicoeducativa para melhorar o enfrentamento e adaptação de familiares na UTI

Introducción: la hospitalización de una paciente afecta directamente el estado de salud de sus familiares, por lo tanto, se requiere de una intervención psicoeducativa que reduzca el efecto ocasionado en las familias para favorecer el afrontamiento y la adaptación. Objetivo: determinar los componentes con mayor consenso entre profesionales expertos para validar una intervención psicoeducativa que mejore el afrontamiento y la adaptación en familiares de pacientes hospitalizados en la Unidad de Cuidados Intensivos (UCI). Método: estudio cuantitativo y descriptivo realizado con la técnica Delphi, por medio de una única ronda entre profesionales de la salud con experiencia mayor a 2 años en atención a pacientes críticos o investigación en esta área. Resultados: se obtuvieron 14 ítems distribuidos de la siguiente manera: matriz de componentes (3 ítems) y protocolo de la intervención (11 ítems). El 7,14 % de los ítems logró un consenso total, el 85,7 % aceptable y solo el 7,14 % de los ítems no alcanzó un consenso. Conclusiones: los componentes, actividades y acciones propuestas en la intervención psicoeducativa a través de la matriz de componentes como el protocolo de intervención, según el consenso de expertos, es pertinente, congruente, factible y genera impacto, lo cual permite mejorar el afrontamiento y adaptación de familiares de pacientes hospitalizados en UCI. La intervención requiere ser validada por medio de una prueba piloto y un estudio cuasi-experimental que permita medir el impacto de estos resultados.

Introduction: A patient's hospitalization directly affects the health status of their relatives, therefore, a psychoeducational intervention is required to reduce the effect on families, favoring coping and adaptation. Objective: Determine the components with the highest consensus among experts to operationalize psychoeducational intervention that improves coping and adaptation in relatives of hospitalized patients in Intensive Care Units (ICU). Methodology: Primary quantitative and descriptive study, carried out using the Delphi technique, through a single round among health professionals with more than 2 years of experience in critical patient care or research in this area. Results: 14 items were obtained, distributed as follows: component matrix (3 items) and intervention protocol (11 items). 7.14 % of the items reached a total consensus, 85.7 % acceptable and only 7.14 % of the items did not reach a consensus. Conclusions: The components, activities and actions proposed in the psychoeducational intervention through the matrix of components, such as the intervention protocol, according to the consensus of experts proves to be pertinent, congruent, feasible, and generates impact. This allows to improve coping and adaptation of hospitalized patients in ICU's relatives. The intervention needs to be validated by means of a pilot test and a quasi-experimental study that allow measuring the impact of these results.

Introdução: A hospitalização de um paciente afeta diretamente o estado de saúde de seus familiares, portanto, é necessária uma intervenção psicoeducacional que reduza o efeito causado nas famílias, favorecendo o enfrentamento e a adaptação. Objetivo: Determinar os componentes de maior consenso entre os especialistas para operacionalizar a intervenção psicoeducacional que melhora o enfrentamento e a adaptação em familiares de pacientes internados em UTI. Metodologia: Estudo primário, quantitativo e descritivo, realizado pela técnica Delphi, por meio de rodada única, entre profissionais de saúde com mais de 2 anos de familia na assistência ao paciente crítico ou em pesquisa na área. Resultados: foram obtidos 14 itens, assim distribuídos: matriz de componentes (3 itens) e protocolo de intervenção (11 itens). 7,14 % dos itens alcançaram consenso total, 85,7 % aceitáveis e apenas 7,14 % dos itens não alcançaram consenso. Conclusões: Os componentes, atividades e ações propostas na intervenção psicoeducacional através da matriz de componentes como o protocolo de intervenção, segundo o consenso dos especialistas é pertinente, congruente, factível e gera impacto, o que permite melhorar o enfrentamento e adaptação dos familiares de pacientes internados em UTI. A intervenção familia ser validada por meio de um teste piloto e um estudo quase-experimental que permita mensurar o impacto desses resultados.

Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique

Abstract This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.

Assessment of mouth breathing by Speech-Language Pathologists: an international Delphi consensus

ABSTRACT Purpose mouth breathing (MB) has detrimental effects on children's growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist's (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. Methods A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. Results Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. Conclusion The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method / Construção de um instrumento de avaliação nutricional para a população pediátrica com câncer (ANPEDCancer): validação de conteúdo pelo método Delphi

ABSTRACT Objective: To develop and establish content validation of a nutritional assessment tool for pediatric cancer patients using the Delphi method. Methods: A literature review was performed and the nutritional assessment in pediatrics and cancer construct was discussed with experts. Forty-six nutrition experts from Brazil with experience in oncology participated in the panel. Rounds were held to discuss and judge the items that should be included in this tool. With the aid of an algorithm, it was possible to simultaneously consider the adequacy, relevance and measurement of the items. The consensus was reached with an agreement equal to or greater than 80% among the experts. Results: From the 7 domains suggested by the literature, the first round generated 81 items, which were assessed for adequacy, relevance and the possibility of being measured in the routine of nutritional assessment, by specialists in the following two rounds. The percentage of specialists who responded to each round was high (above 90%) and the dropout rate between the stages was relatively low. After applying the algorithm, the ANPEDCancer tool had 36 items considered appropriate by specialists from the five different geographical regions of Brazil. Conclusions: The Delphi method allowed the construction and content validation of the nutritional assessment tool for children and adolescents with cancer, providing the first stage for use in the Brazilian hospital setting.

RESUMO Objetivo: Desenvolver e estabelecer a construção, a validação de conteúdo e a elaboração de um plano de ação para cada diagnóstico nutricional de um instrumento de avaliação nutricional para pacientes pediátricos com câncer por meio do método Delphi. Métodos: Foi realizada uma revisão da literatura e discutido com especialistas o constructo avaliação nutricional em pediatria em câncer. Participaram do painel 46 especialistas nutricionistas do Brasil com experiência em oncologia. Rodadas ocorreram, para discutir e julgar os itens que deveriam constar do instrumento. Com o auxílio de um algoritmo, foi possível ponderar simultaneamente a adequação, relevância e mensuração dos itens. O consenso foi atingido com concordância igual ou superior a 80% entre os especialistas. Resultados: Com base nos sete domínios sugeridos pela literatura científica, a primeira rodada gerou 81 itens, que foram avaliados quanto à adequação, relevância e possibilidade de ser medido na rotina de avaliação nutricional pelos especialistas nas duas rodadas seguintes. O percentual de especialistas que responderam a cada rodada foi alto (acima de 90%), e a desistência entre as etapas, relativamente baixa. Após aplicação do algoritmo, o instrumento ANPEDCancer contou com 36 itens considerados apropriados pelos especialistas das cinco distintas regiões geográficas do Brasil. Conclusões: O método Delphi permitiu a construção e validação de conteúdo do instrumento de avaliação nutricional para crianças e adolescentes com câncer, fornecendo uma primeira versão a ser aplicada e avaliada no cenário hospitalar brasileiro.

Trend in incidence of stroke in Nanshan District from 2010 to 2021 / 预防医学

Objective@# To establish a comprehensive health evaluation index system for HIV-infected pregnant women in floating populations, so as to support the elimination of mother-to-child transmission of HIV. @*Methods@# The preliminary framework of the comprehensive health evaluation indicators was constructed based on literature review and focus group discussion. Experts from maternal and child healthcare, clinical medicine and public health were invited to participate in two-round Delphi consultations. The indicators were scored and weighed according to the importance, priority and measurability, and determined according to means and coefficients of variation of scores. The effectiveness of the consultation was evaluated by positive coefficient, authority coefficient and coordination coefficient.@*Results@# Twenty-six experts participated in this study, including 19 women. There were 5 experts aged 30-40 years, 14 experts aged 41-50 years, and 7 experts aged 51 years and over. There were 17 experts with a master degree and above. All experts had vice senior professional titles and above. The positive coefficients in the two rounds of consultations were 96.30% and 100.00%, the authority coefficients were 0.84 and 0.89, respectively. Finally, 4 primary indicators (individuals and families, disease factors, social environment, health service utilization) and 50 secondary indicators were identified, with the coefficients of variation ranging from 0.084 to 0.236 and the coordination coefficients ranging from 0.282 to 0.405 (all P<0.001). Among the secondary indicators, getting antiviral drugs at the place of residence was restricted to floating populations or not (0.780), HIV viral load during pregnancy (0.750), the registration of maternal and childbirth care manuals at the place of residence was restricted to floating populations or not (0.749), and first-trimester registration or not (0.738) had a high weight. @*Conclusion @#This index system can provide the reference for evaluating the health equity of HIV-infected pregnant and lying-in women in floating populations.

Construction of a core competency training indicator system for high-level public health talents / 预防医学

Objective@#To construct a core competency training indicator system for high-level public health talents using the Delphi method, so as to provide insights into optimization of high-level public health talents training.@*Methods@#Based on review of publications pertaining to core competency training for high-level public health talents, in combination with public health priorities and development needs in China, a preliminary indicator system was constructed. Twenty public health experts were invited for two rounds of Delphi expert consultation. Indicators were screened based on the frequency of full marks, mean score and coefficient of variation (CV), and the weight of indicators was determined using the Entropy weight method. The effectiveness of the Delphi expert consultation was evaluated using the active degree, authority coefficient and the consistency degree. @*Results@#Twenty experts participated in the consultation, including 12 men, and there were 6 experts at ages of 30 to 39 years, 8 at ages of 40 to 49 years, and 6 at ages of 50 years and older. There were 17 experts with an educational level of master and above, 19 with senior professional titles and all experts had working experiences for 10 years and longer. The active degrees were 95.24% and 100.00% for two rounds of consultations, and the overall authority coefficient was 0.87. Following two rounds of consultations, all CVs were reduced to below 0.25, and the coordination coefficients were all statistically significant (P<0.05), with a higher coordination coefficient in the second round of consultation than in the first round. The constructed core competency training indicator system for high-level public health talents included four primary indicators, including health protection, health service improvement, health promotion, and essential quality, with weights of 0.388, 0.310, 0.122 and 0.180, 11 secondary indicators, with high weights seen for protection of human health from threats (0.178), monitoring and assessment of health service utilization (0.157) and promotion of health service quality and access (0.112), and 70 tertiary indicators, with high weights seen for Chinese writing (0.038), capability for health policy suggestions (0.034) and global perspective (0.030).@*Conclusion@#The core competency training indicator system for high-level public health talents constructed in this study may provide insights into training of high-level public health talents.

A Health Education Program for Home Emergency Management of Acute Complications of Diabetes in the Elderly / 中国医学科学院学报

Objective To establish a health education program for home emergency management of acute complications of diabetes in the elderly.Methods The program was drafted by literature review and panel discussion.The final draft was formed after two rounds of correspondence from 13 experts.Results The recovery rate of the two rounds of expert correspondence was 100%,and the expert authority coefficient was 0.98.The Kendall's harmony coefficients of the two rounds of correspondence were 0.263 and 0.212 respectively(both P<0.001).The established health education program included indicators of three categories:early stage of acute complications of diabetes at home(understanding the inducing factors),emergency warning(quick and early identification in case of emergency),and emergency treatment at home.Conclusion The contents of the health education program are systematic and reliable and meet the needs of health education for home emergency management of the elderly with diabetes.

Exploring the application value of the modified Delphi method in the development process of acupuncture and moxibustion guideline recommendations based on the WFAS Clinical Practice Guideline for Female Urinary Incontinence / 中国针灸

Taking the recommendations development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Clinical Practice Guideline for Female Urinary Incontinence as an example, this study analyzed the consensus expert composition, specific consensus process, and results in the development of the guideline's recommendations. It systematically examined the advantages of using the modified Delphi method in the formation of recommendations for acupuncture and moxibustion clinical practice guideline, with the aim of providing reference for the development of acupuncture and moxibustion guidelines in the same field.

Research on Construction of Training Course on Palliative Care for Medical Student Volunteers / 中国医学伦理学

【Objective:】 To construct a palliative care training course for medical student volunteers, so as to provide reference for palliative care institutions to carry out palliative care training for medical student volunteers. 【Methods:】 Based on literature review, semi-structured interviews and the expert group meeting method, the first draft of the palliative care training course for medical student volunteers was drawn up. Then two rounds of expert consultation with 16 experts in relevant fields by Delphi method was conducted. 【Results:】 The positive coefficients of the two rounds of expert consultation were 89% and 100%, respectively. The expert authority coefficients of the two rounds were both 0.89. The Kendall coefficient of the second round was 0.196 to 0.328 (P<0.05). The final form of palliative care training course for medical student volunteers was consisted of 5 primary indicators (training objective, training content, training hour, training method, and assessment method), 23 secondary indicators, and 41 tertiary indicators. 【Conclusion:】 The palliative care training course for medical student volunteers is comprehensive and practical in content, scientific and reliable in construction, which can be used for hospice care institutions to provide palliative care volunteer service training for medical student volunteers, in order to improve the quality of volunteer service.

Development of a plant-based culinary nutrition model for sports science students

@#Introduction: Food and fitness levels are key factors required to maintain functional life. Hence, nutrition education is crucial in spreading awareness among Sports Science students. There is a paucity of plant-based nutrition knowledge and plantbased culinary skills for fitness locally. Therefore, this study aimed to develop a valid Plant-Based Culinary Nutrition Model (PBCNM) with nutrition knowledge and basic culinary skills to improve fitness among Sports Science students. Methods: This exploratory sequential mixed method study consisted of 2 phases. In Phase 1, a three-round modified Delphi method was conducted with 13 experts to generate a questionnaire that was validated. Lawshe worksheet determined the content validity ratio (CVR) for an item. Content validity index (CVI) for each section and the overall instrument was calculated. In Phase 2, quantitative data collection and analysis addressed the research questions and research gaps leading to model development. A total of 271 undergraduate Sports Science students at higher learning institutions were recruited as respondents. Results: In Phase 1, CVR of the overall survey was 1.0 and CVI was 0.834. Subsequently, the questionnaire was pilot tested for reliability and a Cronbach’s alpha score of 0.836 was obtained for the overall questionnaire. In Phase 2, the respondents’ mean and standard deviation score for the model’s components and needs was 4.21±0.73 for items 1-15. The integration of experts’ perspectives on the need of PBCNM for fitness and feedback from respondents resulted in the development of PBCNM. Conclusion: This study highlighted PBCNM as a helpful guideline for better fitness management.

Validity and reliability of online questionnaire on awareness, knowledge, attitude and self-efficacy (AKAS) on healthy eating for nutrition education and promotion

@#Introduction: This study entailed the process of developing an online questionnaire to determine awareness, knowledge, attitude and self-efficacy (AKAS) on healthy eating for nutrition education. Currently, there is no local validated questionnaire that can be used to assess AKAS on healthy eating among Filipino adults. Methods: The study developed the questionnaire based on theoretical frameworks and literature review. The draft questionnaire underwent three stages of development: (1) online modified Delphi technique composing of seven subject matter experts (SME) for content validity; (2) online cognitive debriefing with 32 participants (14 nutrition experts and 18 general public) for construct validity; and (3) online pre-testing with 35 participants (non-nutritionists) using test-retest method. Results: For first stage, the questionnaire contained 16 questions for awareness, 17 questions for knowledge, 17 questions for attitude, and 15 questions for self-efficacy. For second stage, significantly different scores (p-value<0.00) between nutritionist experts and general public were observed, showing good construct validity. For third stage, Spearman’s correlation of test-retest method was 0.640. The questionnaire yielded Cronbach’s alpha of 0.467 to 0.923 (round 1) and 0.435 to 0.923 (round 2). A second analysis was done to improve the internal consistency of the questionnaire. By combining two question categories (awareness and knowledge), the Cronbach’s alpha increased to 0.659 (round 2), and by deleting three questions in attitude category, the Cronbach’s alpha improved to 0.626 (round 2). Conclusion: The process used ensured the questionnaire’s validity and reliability. Hence, this online questionnaire may be adopted by parties interested in developing and assessing nutrition education.