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Results for “Delphi Technique”

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PubMed2004

Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus.

OBJECTIVES: Exercise is an effective and commonly prescribed intervention for lower limb osteoarthritis (OA). Many unanswered questions remain, however, concerning the practical delivery of exercise therapy. We have produced evidence-based recommendations to guide health-care practitioners. METHODS: A multidisciplinary guideline development group was formed from representatives of professional bodies to which OA is of relevance and other interested parties. Each participant contributed up to 10 propositions describing key clinical points regarding exercise therapy for OA of the hip or knee. Ten final recommendations were agreed by the Delphi technique. The research evidence for each was determined. A literature search was undertaken in the Medline, PubMed, EMBASE, PEDro, CINAHL and Cochrane databases. The methodological quality of each retrieved publication was assessed. Outcome data were abstracted and effect sizes calculated. The evidence for each recommendation was assessed and expert consensus highlighted by the allocation of two categories: (1) strength of evidence and (2) strength of recommendation. RESULTS: The first round of the Delphi process produced 123 propositions. This was reduced to 10 after four rounds. These related to aerobic and strengthening exercise, group versus home exercise, adherence, contraindications and predictors of response. The literature search identified 910 articles; 57 intervention trials relating to knee OA, 9 to hip OA and 73 to adherence. The evidence to support each proposition is presented. CONCLUSION: These are the first recommendations for exercise in hip and knee OA to clearly differentiate research evidence and expert opinion. Gaps in the literature are identified and issues requiring further study highlighted.

Contraindications↗

PubMed1997

The applicability of selected rational-emotive therapy principles for pastoral counseling.

Examines the compatibility and possibility of communication between pastoral counseling and Rational-Emotive Therapy (RET). Uses a Delphi technique to determine whether a randomly selected group of pastoral counselors (N = 15) believe that the basic principles of RET can be used without surrendering theological tenets foundational to pastoral counseling. Concludes that some RET principles may be applicable for pastoral counseling.

Data Collection↗

PubMed1992

Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials--results of a consensus development (Delphi) exercise.

Defining the minimum clinically important difference or delta to be detected in a clinical trial depends on a number of factors including the research hypothesis, patient characteristics, the nature of the intervention and the trial design. In 2 studies, we have developed standardized procedures for conducting outcome measurement based on current Food and Drug Administration and European League Against Rheumatism guidelines for osteoarthritis clinical trials, and determined the standard deviation for these outcome measures. In the final component of this series of studies, we have used a Delphi technique to establish estimates for delta, and calculated the sample size requirements under 2 different conditions of Type I and Type II error probabilities.

Clinical Trials as Topic↗

PubMed1991

Rheumatoid arthritis antirheumatic drug trials. III. Setting the delta for clinical trials of antirheumatic drugs--results of a consensus development (Delphi) exercise.

Defining the minimum clinically important difference or delta to be detected in a clinical trial depends on a number of factors including the research hypothesis, patient characteristics, the nature of the intervention and the trial design. In 2 previous studies, we have developed standardized procedures for conducting outcome measurement based on current Food and Drug Administration and European League Against Rheumatism guidelines for RA clinical trials, and thereafter, determined the standard deviation for these outcome measures. In the final component of this series of studies, we employed a Delphi technique to establish estimates for delta and calculated the sample size requirements under different conditions of Type I and Type II error probabilities.

Arthritis, Rheumatoid↗

PubMed2004

Resource utilisation for neuropsychiatric disorders in developing countries: a multinational Delphi consensus study.

BACKGROUND: Substantial information is now available at a global and regional level relating to the burden of mental disorders, yet hardly any international data are available on the resources that are needed to respond to this global burden. AIMS: The aim of this study was to develop consensus-driven estimates of resource utilisation, coverage and adherence for key mental health care interventions capable of reducing leading neuropsychiatric causes of disease burden. METHODS: A resource utilisation questionnaire was developed for a series of mental health care interventions for schizophrenia, affective and anxiety disorders, alcohol misuse, epilepsy and Alzheimer's disease. Expert opinion surveys using a Delphi approach were conducted in seven countries (Brazil, China, Egypt, Ghana, India, Mexico and Thailand). Initial results were fed back to participants in order to elicit a second, final set of consensus estimates. Mean and median values were calculated, together with measures of dispersion and agreement. RESULTS: Sixty-seven psychiatrists took part in the first Delphi round and 60 completed the seven consensus panels in the second Delphi round. Expected resource use was highest for acute psychosis, mania, severe depression and severe dementia (at least monthly outpatient visits, and over 25% of cases admitted to hospital with an average length of stay one month). Aggregated estimates for current treatment coverage ranged from below 20% for Alzheimer's disease to 60% for epilepsy. Coverage and adherence levels for affective disorders were both below 50%. CONCLUSION: The Delphi technique proved to be a feasible and efficient method for data collection and consensus generation concerning mental health care resource utilisation. Results provide a set of range estimates for mental health resource planning and evaluation in a variety of developing regions.

Delphi Technique↗

PubMed1990

[The basic minimum set of data in primary care. A Delphi study].

The term basic minimal unit of data in primary care is used for those essential data required so that all primary care professionals may carry out their work. The results of a study performed with the Delphi technique about the basic unit of data by 35 Spanish physician are reported. The results are distributed in three areas: clinical interview (12 basic data were considered), clinical history (27 essential data) and health care performance (19 minimal data).

Data Collection↗

PubMedDate not supplied

Health needs of school-age children in two midwestern counties.

Administrators, school nurses, and informed parents (N = 113) were queried by means of the Delphi Technique to determine priority health needs and barriers in two midwestern counties. Needs of health education and school nurses and barriers of restricted resources received top ranking by all participant groups. Descriptive measures were computed by using Kendall's tau.

Child↗

PubMed1990

A methodology for validating nursing diagnoses.

A methodologic approach consisting of four phases is proposed for validating nursing diagnoses. The sequential phases include use of the Delphi technique, magnitude estimation scaling, patient observation, and testing nursing interventions through clinical trials. The proposed methodologic approach is a strategy for researching the diagnosis and treatment of human responses to actual or potential health problems--the foundation for nursing practice.

Clinical Nursing Research↗

PubMedDate not supplied

Quantifying case management workloads: Development of the PACE tool.

In 1999, the Clinical Resource Management (CRM) group at Saint Alphonsus Regional Medical Center in Boise, Idaho, implemented a specialty-based nursing case management model for individual caseload assignment of all inpatient admissions. This model assigns caseloads by proportion determined by physician specialty type. This model does not consider patient acuity and may have weaknesses associated with self-report. In addition, time requirements for effective case management outcomes are not always reflected in admission volumes alone. This article describes the development and pilot testing of the Patient Acuity Case management Evaluation (PACE) measurement tool. Five phases of methodological development are discussed: (1) conceptualization phase, (2) content development, (3) Delphi technique using expert opinion and critique, (4) inter (intrarater reliability testing, and (5) pilot testing of acuity tool. Examples of instrument development throughout these phases are included. This instrument is expected to provide verifiable measurement of individual and group case management workload.

Attitude of Health Personnel↗

PubMed1996

Improving self-efficacy in nursing research.

THE PURPOSE OF this project was to increase research activities of practicing nurses at one large healthcare facility. The members of the nursing research committee at this institution planned a participatory learning experience with the goal of increasing the nurses' self-efficacy toward conducting research. Increased self-efficacy was the impetus for stimulating increased research activities by the nurses. Measurable outcomes of this project included a significant increase in the participants' self-efficacy and implementation of a number of research projects. The Delphi technique proved useful in identifying nursing research priorities as well as in stimulating nurses to initiate and conduct clinical research. Project implementation and evaluation are described to help practicing nurses and their employers in pursuit of the same goal.

Clinical Competence↗

PubMed2006

A Delphi approach to reach consensus on primary care guidelines regarding youth violence prevention.

OBJECTIVE: Anticipatory guidance is a cornerstone of modern pediatric practice. In recognition of its importance for child well being, injury prevention counseling is a standard element of that guidance. Over the last 20 years, there has been growing recognition that intentional injury or violence is one of the leading causes of morbidity and mortality among youth. The US Surgeon General identified youth violence as a major public health issue and a top priority. Yet, only recently has the scope of injury prevention counseling been expanded to include violence. Pediatric health care providers agree that youth violence-prevention counseling should be provided, yet the number of topics available, the already lengthy list of other anticipatory guidance topics to be covered, developmental considerations, and the evidence base make the selection of an agreed-on set a considerable challenge. The purpose of this study was to systematically identify and prioritize specific counseling topics in violence prevention that could be integrated into anticipatory guidance best practice. DESIGN: A modified electronic Delphi process was used to gain consensus among 50 national multidisciplinary violence-prevention experts. Participants were unaware of other participants' identities. METHODS: The process consisted of 4 serial rounds of inquiry beginning with a broad open-ended format for the generation of anticipatory guidance and screening topics across 5 age groups (infant, toddler, school age, adolescent, and all ages). Each subsequent round narrowed the list of topics toward the development of a manageable set of essential topics for screening and counseling about positive youth development and violence prevention. RESULTS: Forty-seven unique topics were identified, spanning birth to age 21 years. Topics cover 4 broad categories (building blocks): physical safety, parent centered, child centered, and community connection. Participants placed topics into their developmentally appropriate visit-based schedule and made suggestions for an appropriate topic reinforcement schedule. The resulting schedule provides topics for introduction and reinforcement at each visit. CONCLUSIONS: The Delphi technique proved a useful approach for accessing expert opinion, for analyzing and synthesizing results, for achieving consensus, and for setting priorities among the numerous anticipatory guidance and assessment topics relevant for raising resilient, violence-free youth.

Adolescent↗

PubMed2006

Development of clinical guidelines for the prescription of orthoses in patients with neurological disorders in The Netherlands.

The objective of this study was to develop guidelines for the prescription of ankle-foot, knee, wrist-hand and elbow orthoses for patients with neurological disorders. The study is part of a more comprehensive study focusing on the development of clinical guidelines for the prescription of these orthoses in a wider patient population. Evidence from literature (reviews, randomized controlled trials with good quality), information from literature with a lower degree of evidence and information from structured interviews with experts in the field of orthotics, form the basis of statements presented in a Delphi procedure. The Delphi technique was used to gain consensus on statements published on the Internet. A group of experts in the field of orthotics and neurological disorders was asked to give their opinion on 41 statements. Statements with a general agreement of at least 75% were accepted. Statements with less general agreement were rewritten and the experts could react in a second and possibly in a third round. Afterwards, an opinion-based workshop was organized in which participants could react on preliminary guidelines and on Delphi-statements with between 65% and 75% agreement. Consensus on 32 statements was gained during the three rounds and the opinion-based workshop. These statements form the basis of the consensus based clinical guidelines for the prescription of orthoses in patients with neurological disorders.

Consensus↗

PubMed2003

Determining generic standards for specialist registrar training.

Requirements for specialist registrar (SpR) training have been developed by adapting standards already determined for senior house officers in the West Midlands. A consensus of views of chairs of higher specialist training committees on generic requirements for SpR training has been reached by using a Delphi technique. There is a large variation between specialties in the extent that they have been able to reach these standards; some have proved easier to establish than others. Acceptance of the new standards should lead to the delivery of a measurable degree of higher quality education, training and experience for SpRs.

Delphi Technique↗

PubMed1998

Streamlining outpatient geriatric assessment: essential social, environmental and economic variables.

There are no known standardized instruments that encompass all of the essential elements of a streamlined outpatient geriatric assessment. A process of arriving at a consensus on essential elements of streamlined geriatric assessment in 3 domains was initiated and described. Two rounds of the Delphi technique were conducted to identify social, environmental and economic variables essential for such an assessment. Consensus among an expert panel was achieved and a list of 27 variables was reduced to 16. This result is discussed in terms of assessment context and standardizing assessment, using case examples.

Aged↗

PubMed1998

[Care for patient and family in a case of traumatic lesion of the spinal cord].

To develop research about nurse's action in rehabilitation, considering specific patients is very rewarding, but it is a challenge as rehabilitation is an emergent area that comes to abolish the focus of the late treatment, that is later than trauma. In order to identify and analyse the nursing interventions to the family, the author chose a methodology that can express the care nurses deliver to patients with spinal cord injury. The author collected data on nursing consultations identifying 14 nursing diagnoses and 183 interventions. Using the Delphi technique, 76 interventions were validated regarding to 8 nursing diagnoses that are more frequent. With reference to all interventions (76), there are 20 prescribed interventions to the family. We believe that it is necessary to keep a communication chanel with the family since the moment of trauma, inserting this support unit in the rehabilitation process.

Delphi Technique↗

PubMed2004

[Evaluation and validation of quality care indicators relative to empowerment in complex chronic disease].

The purpose of the study was to identify, validate and rank, through multi-attribute hierarchical analysis, indicators of quality of care related to the empowerment of patients having a chronic complex illness, or their natural care givers. This methodological study was carried within case management and was theoretically based on the quality model of Donabedian (1980) and the empowerment theory of Zimmerman (1995), while also drawing from values underlying nursing practise described by the health promotion model of Allen (1977). Two groups of professional and one group of non professional were considered. Using the DELPHI technique and interviews, the study has 1) provided an evaluation model for quality of care comprising 239 elements (12 main attributes, 75 secondary attributes and 152 indicators), 2) allowed its validation, and 3) its ranking by experts. The discussion encompasses theoretical, empirical and methodological considerations.

Attitude of Health Personnel↗

PubMed1985

Acceptance of nurse practitioners: patient behavioral indicators.

Using the Delphi Technique, this study investigated the concept of acceptance and sought to identify behavioral indicators of patient acceptance of nurse practitioners. Thirty-four nurse practitioners participated in the study and came to consensus regarding 20 verbal and 16 nonverbal behaviors. This study was a step toward defining objective criteria of NP acceptance.

Behavior↗

PubMed2005

Developing an observational instrument to evaluate personal computer keyboarding style.

While computer use is considered to be a risk factor for musculoskeletal disorders of the upper extremity (MSD-UE), there is currently little information on how the fingers, hand and thumb are used during keyboarding, and no means to document their postures and motions. A computer keyboarding observational instrument, termed the Personal Computer Keyboarding Style (PeCKS), is being developed to meet this need. The goal of this paper is to describe the process by which the PeCKS was developed. Literature on MSD-UE was reviewed and discussions were held with content experts to develop criterion-based items considered to be potential risk factors for MSD-UE during keyboard use. These items were systematically reviewed and rated by seven experts using the Delphi technique. These ratings were used to determine which items to retain and which to discard, resulting in 19 items to define keyboarding style. The PeCKS, when further psychometric testing is completed, will be useful to document and assess keyboarding to identify those individuals who may be at risk for MSD-UE.

Computer Peripherals↗