ObjectiveDelphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice.Methodology and Main FindingThree electronic data bases were searched over a 30 years period (1978–2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility.ConclusionThe use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.

SummaryIn women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 9 10 9 /l in 35Á6% of pregnancies. During pregnancy the median platelet count nadir was 66 9 10 9 /l (25th-75th percentile: 42-117), with platelet count <30 9 10 9 /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 9 10 9 /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6Á8-20Á2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53Á9% vs. 10Á3%, P < 0Á001). For 8Á3% of the pregnancies (95% CI: 3Á8-15Á1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16Á7, 95% CI: 2Á61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.

Unlike TUG scores, the CogTUG score was not associated a history of falls in frail older outpatients with gait disorders. Our results underline that weight loss and low muscle strength are related to falls.

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Background:Surgical revision rate of rhinoplasty is from 5% to 15% in literature. The aims of our study were to define the rate and the predictive factors for surgical revision of rhinoplasty.Methods:We have realized a single-center case/control study including 62 patients who underwent surgical revision among 732 patients who underwent closed rhinoplasty between 2005 and 2015. Data of each rhinoplasty were collected from medical records and photographs. Statistical analyses were used.Results:The surgical revision rate was 8.6%. After multivariate analysis, 4 factors were statistically significant and independently associated with surgical revision: “preexisting respiratory functional disorder” [odds ratio OR = 3.30; 95% CI (1.47–7.76); P = 0.004], “wide nasal bone and side walls” [OR = 3.94; 95% CI (1.49–11.25); P = 0.007], “deviated nasal bone and side walls” [OR = 2.68; 95% CI [1.14–6.58]; P = 0.02] and the use of camouflage grafts [OR = 0.26; 95% CI [0.07–0.89]; P = 0.04].Conclusions:Closed rhinoplasties have similar revision rate to open techniques. Revision surgeries are justified by functional or aesthetic disorders. The interests of this study are to better inform patients and to adapt operative management. We provide here some recommendations with focus on the keys to successful rhinoplasty surgery.

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