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The COVID-19 pandemic has caused major supply chain disruptions and unveiled the pressing need to improve supply chain resilience (SCRES). Industry 4.0 (I4.0) is a promising lever; however, its future in supply chain risk management (SCRM) is highly uncertain and largely unexplored. This paper aims to evaluate I4.0's potential to improve SCRES in a post-COVID-19 world. Based on current literature and multiple workshops, 13 future projections on potential I4.0 application areas in SCRM were developed. A two-round Delphi study among 64 SCRM experts with digital expertise was conducted to evaluate and discuss the projections regarding their probability of occurrence until 2030, their impact on SCRES, and their desirability. A fuzzy c-means algorithm was applied to cluster the projections based on the expert assessments. The expert evaluations led to three clusters on I4.0 application in SCRM: Four projections on generating data, increasing visibility, and building digital capabilities received considerable approval and are reliable to improve SCRES in 2030. Four projections enabling data sharing and processing were predominantly supported and demonstrated realization potential for 2030. Finally, five projections that require major supply network adaptations were deemed unlikely to improve SCRES in 2030. This paper answers several research calls by presenting empirical evidence on the pathway of I4.0 implementation in SCRM following the COVID-19 pandemic. Moreover, it evaluates a holistic set of technologies and indicates prioritization potentials to achieve SCRES improvements.
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BACKGROUND: A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises? METHODS: T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0. RESULTS: After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus. CONCLUSIONS: MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.
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Emergency Responders , Mass Casualty Incidents , Humans , Consensus , Delphi Technique , ExerciseABSTRACT
OBJECTIVE: To review and analyze the available information about the COVID-19 pandemic in Mexico and the determining factors for its transition to an endemic phase. MATERIALS AND METHODS: Prospective study based on the Delphi Method with the participation of a panel made up by specialists in infectious diseases, immunology, internal medicine, pulmonology, pediatrics and public health. RESULT(S): 2270 bibliographic sources were identified;after excluding those that offered repetitive information, 454 were included in the final analysis. The main factors that obstruct the transition from a COVID-19 pandemic to an endemic one were defined as the high capacity of SARS-CoV-2 to mutate (since the efficacy of anti-COVID-19 vaccines depends to a large extent on the genetic presentations of the virus) and the high prevalence in the country of comorbidities that make the population more vulnerable against the disease. Strengthening primary care and promoting a culture of surveillance and prevention are essential. CONCLUSION(S): It was concluded, by consensus, that there are factors that obstruct the passage of the COVID-19 pandemic to an endemic phase, including the intrinsic nature of disease control and the unpredictability of virus mutations.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Multiple sclerosis (MS) is an inflammatory condition affecting the central nervous system. Infection is a major consideration in the MS population due to its relevance to several stages of the disease process: (i) it has been suggested that infective processes may be 'triggering' or aetiological factors for MS, (ii) concurrent infection is known to exacerbate symptoms in MS, (iii) people with MS are at higher risk of infection when compared to the general population, and this risk is exaggerated in those receiving disease modifying therapies (DMTs). This guidance document was developed by specialists in the field of MS, Immunology, Infectious Disease and Pharmacy. A modified Delphi approach was used to develop clinically relevant, evidence-based consensus guidelines to help physicians navigate the complex interaction between DMTs and infectious diseases. We focus on specific risks predisposing people with MS to infection and how to manage these risks. We also provide recommendations on how to screen for, prevent, and manage infection in this population, in particular tuberculosis, progressive multifocal leukoencephalopathy, hepatitis B, human papillomavirus, herpetic and other opportunistic infections. We also discuss vaccination and the COVID-19 pandemic in people on DMTs.
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Background: Promoting the immunity of pregnant women during the Covid-19 pandemic through vaccination against SARS-CoV-2 infection is one of the main challenges. It is important to manage the information related to receiving the vaccine and its possible complications for surveillance of its safety and to deal with the challenges. Based on this, it is necessary to design a national information management system for the COVID-19 vaccination. Objective(s): To promote the safety of pregnant women by providing a national model of an information management system for pregnant women's COVID-19 vaccination in Iran. Method(s): The present research was of applied descriptive type. Based on the review of articles and information sources and a com-parative study of the information management and surveillance system for the vaccination of pregnant women in developed coun-tries, and according to the country's organizational structure, the national model of the information management system for pregnant women's COVID-19 vaccination was designed for Iran. Then the validation of the model was examined in two steps using the Delphi technique. Finally, after analyzing the data, the final model was presented. Result(s): The findings were categorized into two main groups, including the structural components (responsible organization and databases, surveillance center, participating organizations, and data sources) and informational process (data set, data collection, quality control, data exchanges, data processing, reporting) that reached 100% consensus of experts. Conclusion(s): For developing IMS for the COVID-19 vaccination of pregnant women, it is necessary to specify the responsible organization and the participating centers, create surveillance centers and databases, and define the information management system process.Copyright © 2023, Author(s).
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Introduction. The poster of the Dutch Myositis Working Group (DMWG) aims to inform people about her goals, activities and ambitions. The group is run by seven patients, representing all types of myositis, supported by Spierziekten Nederland, the umbrella patient organization for neuromuscular disorders in The Netherlands and 4 myositis specialists as medical advisors. Chair: Ingrid de Groot. Contact email: myositis@spierziekten.nl Goals and ambitions of the Dutch myositis working group: * I n collaboration with medical advisors to provide information about IIM (idiopathic inflammatory myopathies) or myositis to newly diagnosed patients and their families: IIM types, symptoms, diagnosis, (new) treatment options, prognosis, inform them about the myositis expertise centres etc. * To connect and support people with all types of IIM: dermatomyositis (DM), polymyositis (PM), Anti Synthetase Syndrome (ASyS), immune mediated necrotizing myopathy (IMNM), juvenile dermatomyositis (JDM), overlap myositis. * To raise awareness of myositis among the public, health care professionals and researchers, pharmaceutical companies? * To collaborate with clinicians, researchers and funds on a national and international level with the aim to improve (clinical) care and research. * To stimulate and participate in the development and conducting of clinical trials. * To collaborate with myositis working groups and patient organisations abroad. * To represent the patient perspective within in the Myositis Network Netherlands and (inter)national myositis study groups. * Patient advocacy. Activities and services: * In person or online meetings aiming to offer moral support and an opportunity to share experiences, concerns etc. or just to socialize. Three times a year we organize separate meetings for people with IBM, for people with other IIM and for caregivers. * Website updates on treatment, guidelines, (inter)national research, activities and actualities (e.g. Covid situation). * Supply patients with brochures for GP/ family doctor, physiotherapist etc. * Online (secured) platform for members. * Annual patient conference with diagnosis specific scientific programs. * Monthly newsletters: these are personalized which means they contain mainly news on the receivers type of IIM (e.g. IBM or ASyS) and information on general topics concerning all people with IIM or neuromuscular disorder. * In person meetings and / or online webinars on general topics e.g. living with a chronic condition, work, pain, fatigue. * Annual meetings with medical advisors: the working group pays a visit to all medical advisors in their respective hospitals. * Representation at (inter)national conferences. * Representation in projects such as guidelines development. * Collaboration in (inter)national studies leading to enrolling Dutch patients, researchers and clinicians in multi-centre studies, (co-) authorships in publications and to presentations during conferences (Treat NMD, IMACS, MNN). * To advise and recommend on research proposals from patient perspective. * To advise decision makers on continuation of expert centres from patient perspective. Collaborations: * Myositis Network Netherlands: patient representation on the board. * OMERACT (Outcome Measures in Rheumatology): Patient Research Partner of the Myositis Working Group. * IMACS (International Myositis Assessment and Clinical Studies Group): steering committee member of Exercise & Rehabilitation Group, led by Helene Alexanderson, ass.prof PhD, RPT). * ENMC (European Neuromuscular Centre): patient representation in myositis workshops. * EULAR (European League against Rheumatism): member of PARE and Patient Research Partner. * GCOM. * ERN - NMD (European Reference Network for Neuromuscular Diseases): member of NMD working group led by em. prof. dr. Marianne de Visser. * Patient organizations for people living with myositis . We are in this together Since myositis is a (very) rare disease, the 'myositis community' is a small one although we're happy to say that it is expanding quite rapidly. Through our inte sive involvement in several national and international studies and research projects we now have close contacts with many myositis experts across the globe, which makes it easier to keep up with actualities and developments concerning research, treatment etc. and to disseminate this knowledge to our members. This helps us to inform, support and advocate for the Dutch people living with myositis and their families and at the same time it offers opportunities to give something back: by sharing with the research community and clinicians our experiential knowledge of the consequences of myositis on everyday life. That way we can contribute to more meaningful research. We can only go forward if we do this together! That is why we are very ambitious in our efforts to contribute to myositis research. Here we list our collaborative efforts: * In 2019 the Myositis Network Netherlands of clinicians and researchers with expertise in IIM was established in which the DMWG is representing the patient perspective by a member on the board. * In OMERACT Myositis Working Group a member of the DMWG is one of the two Patient Research Partners and as such an equal partner of this study aiming to define a set of core patient reported domains with regard to the quality of life and respective instruments for use in IIM. The involvement of the DMWG has led to the opportunity for Dutch patients to participate in Delphi surveys and to an opportunity for Dutch myositis clinics to collaborate in the longitudinal study that emerged from this. * The IMACS network is an important part of our international network. One of our DMWG members is member of the Executive Committee of the Exercise & Rehabilitation Group and as such can facilitate for Dutch patients to become involved in the current study with the ultimate objective to develop recommendations for exercise in all types of IIM. * Members of the DMWG participated in several ENMC workshops on IIM as patient representatives and will continue to do so in the future. * Through a PARE membership in EULAR and membership of the study group of 'collaborative research' the DMWG hopes to raise awareness of myositis within the influential EULAR community and to speak up on behalf of the patients in Europe living with IIM. * One of our members is member of the GCOM committee responsible for the patient program of GCOM and shares the ambitions of this GCOM committee to increase the involvement of patients in this very important IIM conference. * One DMWG member joined the ERN- Neuromuscular Disease group and as such represents the people with IIM living throughout Europe. * DMWG has ambitions to empower people living with IIM and to connect with them, crossing borders by doing so. We have close and amicable relationships with patient organisations in Australia, Czech Republic, Germany, Sweden, UK and USA. * Empowering patients is one of our goals and we accomplished this for instance in Sweden. On invitation by prof. dr. Ingrid Lundberg our chair visited the Karolinska Institute, spent a week with their myositis team and in return was one of the speakers on the annual patient meeting and helped the Swedish patients establish their own myositis working group.
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Background and objective: Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Material(s) and Method(s): This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Result(s): One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusion(s): Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.Copyright © 2022
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PurposeThe business environment is increasingly volatile, complex, uncertain and ambiguous. Today, COVID-19 represents a super-disruption situation. This paper aims to explore small and medium-sized enterprises' (SMEs') resilience from continuous improvement lenses. It explores the role of continuous improvement in building organizational resilience across SMEs.Design/methodology/approachA Delphi methodology has been adopted to capture evidence and opinions from 38 experts from several Jordan-based SMEs through three-online rounds.FindingsThe study finds that continuous improvement enhances SMEs' resilience in the short term and long term. It can translate the concept of resilience into tangible working constructs for SMEs in visualizing and making decisions about their risks, adapting, absorbing changes and prevailing over time. The role of continuous improvement in building organizational resilience is fourfold;continuous improvement is a cyclical process;it has a vital cultural aspect and can be considered a business philosophy. It also emphasizes a holistic change approach based on small but constant changes. However, SMEs' leaders must consider several issues for effective continuous improvement, including a continuous improvement culture and a results-focused approach.Originality/valueOrganizational resilience has been studied across various contexts;however, there are still unanswered questions for SMEs' resilience. This study contributes to theory and practice by examining the role of continuous improvement in SMEs' resilience.
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BACKGROUND: Reconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning. METHODS: A multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses. RESULTS: One-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each. CONCLUSIONS: Strong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost-benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.
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Health Personnel , Hospitals , Rehabilitation , Humans , Australia , Consensus , Delphi Technique , Surveys and QuestionnairesABSTRACT
BACKGROUND: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.
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Depression , Mental Health , Humans , Depression/diagnosis , Depression/therapy , First Aid , Argentina , Chile , Delphi Technique , Surveys and QuestionnairesABSTRACT
Pathogen sequencing guided understanding of SARS-CoV-2 evolution during the COVID-19 pandemic. Many health systems developed pathogen genomics services to monitor SARS-CoV-2. There are no agreed guidelines about how pathogen genomic information should be used in public health practice. We undertook a modified Delphi study in three rounds to develop expert consensus statements about how genomic information should be used. Our aim was to inform health protection policy, planning and practice. Participants were from organisations that produced or used pathogen genomics information in the United Kingdom. The first round posed questions derived from a rapid literature review. Responses informed statements for the subsequent rounds. Consensus was accepted when 70â% or more of the responses were strongly agree/agree, or 70â% were disagree/strongly disagree on the five-point Likert scale. Consensus was achieved in 26 (96â%) of 27 statements. We grouped the statements into six categories: monitoring the emergence of new variants; understanding the epidemiological context of genomic data; using genomic data in outbreak risk assessment and risk management; prioritising the use of limited sequencing capacity; sequencing service performance; and sequencing service capability. The expert consensus statements will help guide public health authorities and policymakers to integrate pathogen genomics in health protection practice.
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COVID-19 , Public Health , Humans , Delphi Technique , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2/genetics , United Kingdom , GenomicsABSTRACT
Purpose: Since the corona pandemic, the use of video consultation has increased markedly. For vulnerable groups such as oncological patients, the advantages seem obvious. But how, compared to face-to-face consultation, does video consultation potentially change the doctor-patient relationship? Which barriers may hinder the effective use of this consultation format in practice? We are presenting first results from a study, funded by Federal Ministry of Health, which will provide the basis for a hands-on guide for both physicians and patients on how to improve the video consultations. Method(s): We use a quasi-experimental mixed-methods design to analyze qualitative and quantitative differences between face-to-face and video consultations. Data collection will be completed by June 2022. We will record N = 64 videos (n = 32 for each consultation format) with gynecological and urological cancer patients. After the consultation, all patients answer a questionnaire with questions about their consultation experience. For quantitative analyses, the counseling sessions will be systematically compared in terms of verbal and nonverbal communication patterns. Relative frequencies of eye contact and the information exchanged will be compared using chi2 -tests. The validated questionnaire MAPPIN'Obsdyad will be used to assess the quality of shared decision-making parameters. In addition, semi-structured interviews will be conducted with n = 10 physicians and n = 10 patients experienced with video consultation, for which a qualitative content analysis will be conducted. Expected results: We present a complex methodological approach we used to approach the comparison of video vs. face-to-face consultations. We will also present first evidence on how video consultations change the doctor-patient interaction. Discussion(s): We show possible limitations and barriers of video consultations. Within the framework of a Delphi process, we will use the results to develop recommendations outlining best practices of video consultations for both physicians and patients.
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Coronavirus disease (COVID-19) and confinement have affected access to the health system and have impacted people's mental health, particularly families of children with autism spectrum disorder (ASD). Objective(s): To investigate the perceptions of parents of children with ASD regarding benefits, positive changes, and difficulties in behavioral management at home during the first confinement due to COVID-19 in Chile. Subjects and Methods: We performed an exploratory cross-sectional qualitative study including 118 parents of individuals with ASD aged between 2 and 15 years. An online questionnaire, prepared by a multidisciplinary committee of national experts using Delphi methodology was applied, which contains four open-ended questions related to children's behavior (difficulties, improvements, benefits, and professional support required) during the pan-demic. Result(s): Parents perceived that confinement increased emotional stress for adults and chil-dren, which could exacerbate behavioral problems. The interviewees perceived improvements in child social-affective, individual autonomy, and communication skills. The family and resilience aspects, such as time-sharing that emerged during the pandemic to support children's needs, were appreciated. Parents also reported the need for professional support in behavioral and emotional management during confinement. Conclusion(s): Caregivers value the integration of the family into therapies during confinement. It is necessary to complement these results with additional studies exploring different life contexts of families with children with ASD in Chile and the impacts of long-term confinement. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.
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With the rapid changes taking place in international manufacturing, there is a need for new theories linking the drivers for manufacturing location decisions to the influence of government. A Delphi study in 2017 of senior industrialists in Europe from capital intensive, complex technology manufacturing sectors provided evidence on the importance of government-specific factors for final location decisions. This was because of the influence of government policies as an exogenous factor on the drivers for international manufacturing, including cost effective, flexible supply chains and the use of the new technologies of Industry 4.0, in an uncertain global political climate. The findings are used to develop a new theoretical framework comprising the decision onion and the government policy matrix for multinational company manufacturing location decisions. This systematic approach to the influence of government will assist in the development of policy in the post-Covid 19 era of transformational change in industrial location strategies.
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INTRODUCTION: The CURE Drug Repurposing Collaboratory (CDRC) partnered with the SCCM Discovery VIRUS COVID-19 Registry (VIRUS) to develop and build a minimal dataset for drug repurposing research for COVID-19. This use case required a cross-sectional dataset to avoid the perceived risk of identifiability through serial laboratory results or vital sign patterns. The work took place as part of the early stages of a project funded by HHS Assistant Secretary for Planning and Evaluation to automate data extraction from the electronic health record. METHOD(S): As part of an ongoing evaluation of the dataset's utility, CDRC performed factor selection analysis to explore relationships between baseline, median, and peak laboratory values and the patient outcomes. The primary outcomes of interest in this analysis were 28-day all-cause mortality and hospital length of stay (LOS). Serum creatinine, leukocyte count, lactate dehydrogenase (LDH), international normalized ratio (INR), and PaO2:FiO2 (P:F) ratio were examined as predictors of key outcomes. Data for 17,144 patients were obtained from VIRUS: COVID-19 Registry. Data were cleaned and an analysis dataset was constructed. Records with excessive missingness were excluded and liberal clinical plausibility rules were applied. Analysis used logistic regression with least absolute shrinkage and selection operator (LASSO) along with 10-fold cross validation. The cohort was randomly divided into training and testing sets at a 9:1 ratio. The study was IRB exempted. RESULT(S): Following a year-long Delphi process, the investigators identified 35 key data elements including primary outcomes. Modeling for 28-day mortality: median creatinine (n=4,304), baseline leukocytes (n=3,731), median LDH (n=1,854), maximum INR (n=1,972), and median PF ratio (n=1,000) were most predictive. Modeling for LOS: median creatinine, maximum leukocytes, baseline LDH, baseline INR, and median PF ratio were most predictive. CONCLUSION(S): This analysis provides guidance for the evaluation of the CURE ID dataset. The data will ultimately be displayed in a publicly explorable interface through the CURE ID application and website hosted by the National Center for Advancing Translational Science at NIH in partnership with the FDA.
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Objectives: Due to the rapid development of the Internet and Internet of Things technology, as well as the catalysis of the COVID-19 epidemic and the favorable policy environment, China's online medical services has developed rapidly. But some serious problems also emerged, such as diseases diagnosis and treatment by artificial intelligence instead of by clinicians on some online medical service platforms, drugs prescribing before prescriptions, patient information leaking, etc. The assessment of drugs using health technology assessment (HTA) methods has been matured in recent years in China, but the assessment mechanism of online diagnosis and treatment behavior is still blank. This study plans to fill this gap. Method(s): Assessment mechanism of Chinese guide for medicine comprehensive evaluation and Guidance of Deliberative process for HTA were used as references. The framework was developed based on input-throughput-output model and was subjected to two rounds of consultation using Delphi method. Members with different backgrounds, perspectives and expertise relevant to online medical services were included to ensure the representativeness of the framework. Result(s): A framework for assessment mechanism of online diagnosis and treatment behavior was developed, which consists of the assess reasons, objects, organizations, time, participants and methods of all types of online diagnosis and treatment behaviors. Conclusion(s): This framework for assessment mechanism of online diagnosis and treatment behavior clarified the dimensions and indicators of online diagnosis and treatment behavior from the perspectives of medical security, network security, service quality, economy, and appropriateness, as well as the entire process of assessment operations. it is in line with Chinese policy requirements and will provide useful tool for the governments, medical institutions and research establishments. Copyright © 2022
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Aims: The burden of the COVID-19 pandemic resulted in an unintended reduction of available healthcare capacity for regular care. To guide prioritization of semi-elective surgery in times of scarcity, we previously developed a decision model to quantify the expected health loss due to delay of surgery, in an academic setting. The aim of this study is to validate our decision model in a non-academic setting and include additional surgical procedures. Method(s): In this study, we used the previously published three-state cohort state-transition model, to evaluate the health effects of surgery postponement for 28 surgical procedures commonly performed in non-academic hospitals. Scientific literature and national registries yielded nearly all input parameters, except for the quality of life estimates which were obtained from experts using the Delphi method. Two expert panels, one from a single non-academic hospital and one from different nonacademic hospitals in the Netherlands, were invited to estimate quality of life weights. We compared estimated model results (disability adjusted life years (DALY)/month of surgical delay) based on the QoL estimates from the two panels by calculating the mean difference and the correlation between the ranks of the different surgical procedures. The eventual model was based on the combined QoL estimates from both panels. Result(s): Pacemaker implantation was associated with the most DALY due to surgical delay (0.05 DALY/month, 95% CI 0.03-0.10) and hemithyreoidectomy with the least DALY/month (0.01 DALY/month, 95% CI 0.00-0.01). The overall mean difference between the two panels was 0.00 (95% CI -0.01 to 0.00). The correlation between ranks was 0.98 (p<0.001). Conclusion(s): Our study provides an accurate overview of incurred health loss due to surgical delay for frequently performed non-academic surgeries. The quality of life estimates used in our model are robust and validate towards a different group of experts. These results enrich our earlier published results on academic surgeries and contribute to prioritizing a more complete set of surgeries.
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The use of an aromatase inhibitor (AI) in combination with ovarian function suppression (OFS) has become the mainstay of adjuvant endocrine therapy in high-risk premenopausal patients with hormone receptor-positive breast cancer. Although five years of such therapy effectively reduces recurrence rates, a substantial risk of late recurrence remains in this setting. Multiple trials have shown that extending AI treatment beyond five years could offer further protection. However, as these studies comprised only postmenopausal patients, no direct evidence currently exists to inform about the potential benefits and/or side effects of extended AI + OFS therapies in premenopausal women. Given these grey areas, we conducted a Delphi survey to report on the opinion of experts in breast cancer treatment and summarize a consensus on the discussed topics. A total of 44 items were identified, all centred around two main themes: 1) defining reliable prognostic factors to pinpoint premenopausal patients eligible for endocrine therapy extension; 2) designing how such therapy should optimally be administered in terms of treatment combinations and duration based on patients' menopausal status. Each item was separately discussed and anonymously voted by 12 experts representing oncological institutes spread across Italy. The consensus threshold was reached in 36 out of 44 items (82%). Herein, we discuss the levels of agreement/disagreement achieved by each item in relation to the current body of literature. In the absence of randomized trials to guide the tailoring of extended AI treatment in premenopausal women, conclusions from our study provide a framework to assist routine clinical practice.
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Learning Objective: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.
ABSTRACT
Learning Objectives: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.