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3 results

  • A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

  • Eric S. Weinstein, Joseph L. Cuthbertson, Luca Ragazzoni, Manuela Verde
  • Journal:
    Prehospital and Disaster Medicine / Volume 35 / Issue 5 / October 2020
    Published online by Cambridge University Press:
    09 July 2020, pp. 538-545
    Print publication:
    October 2020
    • Article
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      • Open access
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  • Introduction:

    Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).

    Objective:

    What is appropriate SMR in RSEs?

    Methods:

    The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.

    Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.

    For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.

    Results:

    Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.

    Conclusions:

    Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

  • Checking the quality of clinical guidelines using automated reasoningtools

  • ARJEN HOMMERSOM, PETER J. F. LUCAS, PATRICK VAN BOMMEL
  • Journal:
    Theory and Practice of Logic Programming / Volume 8 / Issue 5-6 / November 2008
    Published online by Cambridge University Press:
    01 November 2008, pp. 611-641

  • Requirements about the quality of clinical guidelines can be represented byschemata borrowed from the theory of abductive diagnosis, using temporal logicto model the time-oriented aspects expressed in a guideline. Previously, we haveshown that these requirements can be verified using interactive theorem provingtechniques. In this paper, we investigate how this approach can be mapped to thefacilities of a resolution-based theorem prover, otter and acomplementary program that searches for finite models of first-order statements,mace-2. It is shown that the reasoning required for checking thequality of a guideline can be mapped to such a fully automated theorem-provingfacilities. The medical quality of an actual guideline concerning diabetesmellitus 2 is investigated in this way.

  • 2 - How to define the questions

    • By Ann Møller, The Cochrane Anaesthesia Review Group, Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book:
    Evidence-based Anaesthesia and Intensive Care
    Published online:
    05 September 2009
    Print publication:
    09 October 2006, pp 3-6

  • Summary

    The practice of evidence-based medicine (EBM) begins with the formulation of a clinical question. Clinical questions consist of three parts: the patient or population, the interventions to be compared and the clinically relevant outcomes. This chapter describes a strategy for formulating answerable clinical questions. The formulation of the clinical question is the starting point; whether you intend to use EBM in the handling of an individual patient, if you are writing a clinical guideline for the department you work in, or you are preparing a systematic review. When performing a systematic review, the approach could be to include a wide group of patients and if plausible, plan some subgroup analysis in advance if there is a suspicion that some groups will be different from the others. Spending time and energy, formulating the clinical question before undertaking the literature search, and appraisal, are likely to improve the outcome of the process.