SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The Delphi Technique is gaining popularity in the health care field, although no model has been presented to capture its sequential process. An attempt was made to trace its characteristics and to design such a model in order to clarify the process and to assist users of this technique.
PURPOSE: To develop current treatment recommendations for dry eye disease from consensus of expert advice. METHODS: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. RESULTS: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. CONCLUSION: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.
Evidence-based reviews of research literature are useful in determining the efficacy of specific clinical practices, but the review process is frequently time-consuming and costly. The purpose of this study was to identify important research questions in rehabilitation that are appropriate for evidence-based reviews. The focus of this study was rehabilitation after traumatic injuries. Topics were identified using the Delphi method, which utilized a panel of 24 researchers and clinicians with expertise in rehabilitation of traumatic injuries. The experts identified 71 topics, predominantly in the areas of spinal cord injury and traumatic brain injury rehabilitation. The most commonly suggested intervention topics involved assessment of pharmacologic agents, the timing or intensity of interventions, or specific nonpharmacologic therapies and exercises. Topics were ranked by mean importance score. Ten of 24 questions in the top tertile were considered to have some or a substantial amount of available research and thus may be appropriate for structured evidence-based reviews. Similar methods could be used to identify appropriate topics in other areas of rehabilitation.
BACKGROUND: Systematic reviews of controlled clinical trials in the form of meta-analyses can serve as an important guide to direct clinical practice. This study identifies the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve consensus of expert opinion. METHODS: Experts in trauma care from the United States and Canada (n = 68) were asked to generate structured research questions and were then required to rank these questions in order of importance and estimate the amount of research currently published. RESULTS: The questions ranking in the highest tertile are presented along with an estimate of their importance and the amount of research published using an ordinal scale. Only 9 of 16 (56%) questions had some or a substantial amount of research available on which to perform a systematic review. CONCLUSION: This study identifies the areas of trauma care in which research efforts might best be directed. In the absence of sufficient data for systematic reviews, these research topics represent important areas for the design and implementation of clinical trials.
HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.
PURPOSE: To reach a broad consensus on case definitions, outcomes, and outcome measures that will ease future study design and facilitate comparison of data from different studies of infantile spasms and West syndrome. METHODS: Persons who had recently presented or published first-author original research in this field were invited to participate in an e-mail Delphi process and to invite other investigators or clinicians who they thought might participate. RESULTS: The process consisted of six rounds, anonymous except to the facilitator. In total, responses were received from 46 participants. The final statement was approved by 31 participants from 15 countries. It concluded that the primary clinical outcome, cessation of spasms, should denote absence of witnessed spasms from within 14 days of commencement of treatment, and for > or =28 consecutive days from the last witnessed spasm. Primary electroclinical outcome denotes cessation of spasms with resolution of hypsarrhythmia. West syndrome should be a defined subset of the syndrome of infantile spasms. An infantile spasms single-spasm variant should be recognized. Ways are suggested of handling subtle spasms in the context of clinical studies. It proposes a standard for reporting modifying and atypical features of hypsarrhythmia, a minimal set of baseline characteristics and outcomes that should be reported in trials of infantile spasms, and suggests a standard definition of relapse. Consensus was not reached on a definition of hypsarrhythmia. CONCLUSIONS: We reached a clear consensus on many aspects of study design for the investigation of infantile spasms, although incomplete consensus was found on how to define EEG criteria.
Although good communications are generally agreed to be an essential component of effective nursing care of cancer patients, little research has been done on nurses' perception of communication problems, and less on their suggestions for resolving them. A Delphi-type survey among nurses in the North of England revealed that the main areas of comment were: dealing with patients' questions and fears; the communication implications of pain control; and relationships with other professional groups both inside and outside the hospitals. Numerous suggestions were made for improving communications.
The development of the Delphi technique, as a survey method of research, and examples of its use are described. The technique's key characteristics, anonymity, use of experts and controlled feedback, are examined. The method's usefulness in structuring group communication for the discussion of specific issues and as an aid to policy making is discussed in the light of the technique's perceived drawbacks and limitations.
AIM: This paper reports a study to develop further the existing assessment form and to capture new aspects of assessment for the nursing profession of the future for inclusion in the form. BACKGROUND: Since nursing education became part of the higher education system, the assessment of clinical periods of the programme has become more complicated and requirements are more demanding. Changes in the health care sector, such as demographic changes and shorter hospitalization, create demands upon the independent nursing role of the future. Many educational documents, such as an assessment form, must continuously be up-dated and adapted to changes in society. METHOD: A Delphi study concerning the content of this assessment form was carried out using two rounds. Through this process, an expert panel gave their opinions about the form and possible changes to it. RESULTS: There was general acceptance of the content in the current assessment form. Suggested changes were the addition of two factors concerning collaboration with the family and society, and development of the student's independence. Two new area headings were suggested: one about ability to use the nursing process, and the other about development of a professional stance. CONCLUSIONS: The suggested changes in the assessment form match expected changes in the health care sector and the demands of an academic nursing education.
AIMS AND OBJECTIVES: The research outlined in this paper aimed to establish a consensus view amongst primary healthcare professionals about the competencies that district nurses need in order to fulfil an effective role in health promotion. BACKGROUND: In recent years there has been a growing emphasis on health promotion in primary care in the United Kingdom and health promotion is becoming increasingly important to nurses who work in the community. However, consideration of the role of the district nurse in health promotion is rather restricted and consequently district nurses have limited access to empirical evidence, from which they can develop their work in health promotion. DESIGN AND METHODS: The Delphi technique was used for this study. Seventy-two primary healthcare professionals were mailed a series of three questionnaires, which achieved response rates of 86, 87.5 and 78.9%. RESULTS: There was a consensus amongst the panellists that district nurses require a range of competencies to engage effectively in health promotion. These were categorized to produce a definitive list of eight knowledge-, seven attitude- and eight skill-related competencies. CONCLUSIONS: For the first time, this study achieves a consensus on the competencies needed by district nurses to engage in health promotion. RELEVANCE TO CLINICAL PRACTICE: District nurses should feel encouraged to develop their health promotion role in light of the fact that many of the competencies that they require for this activity have been identified as essential for their day-to-day nursing practice. The research highlights the fact that new paradigm health promotion is a concept that has moved beyond the academic arena and is recognized as significant by practising health professionals.
This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on 'the postnatal experience' was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was 'examining the professional issues that impact on midwives' clinical practice' (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area.
The purpose of this study was to identify research questions and priorities in public health nursing based on the perceived needs of practicing public health nurses, and to assess whether the respondents believed that the profession should provide leadership in the study of the identified questions. Using a modified Delphi survey, 76 research priorities were ranked and produced three factors or categories of questions during the two rounds: outcomes in maternal-child and family planning, outcomes in home health services, and public health nurse recruitment, retention, job satisfaction, and image. Forty-seven (62%) of the 76 priorities were deemed appropriate for nursing to assume leadership in seeking answers. Results reveal a consensus of research priorities generated by front-line nurses consistent with year 2000 health objectives for the nation.
PURPOSE: To identify competencies needed by nurse leaders in public health programs. DESIGN: Five-round national Delphi. SAMPLE: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. METHODS: Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. FINDINGS: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. CONCLUSIONS: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.
PURPOSE: This project evolved from a partnership between an advanced practice nurse (APN) graduate program and a care management insurer. The purpose of this Delphi survey was to identify (a) role components germane to the practice of APNs in managed care and (b) topics reflecting these components in the curriculum. DATA SOURCES: Data were gathered from two expert panels, clinician preceptors and faculty members. Each panel had 11 members: 11.3% and 100%, respectively, of the target populations of clinicians and faculty in the partnering agencies. CONCLUSIONS: There was considerable congruence between the panels on the survey. IMPLICATIONS FOR PRACTICE: Case vignettes could be used as a vehicle for discussion of the broader issues of population approaches to specific problems. Faculty could partner with clinicians to develop cases for discussion of evidence-based practice. Faculty and clinicians could create preceptorships focused on business management, postgraduate fellowships within managed care systems, and regular opportunities to dialogue about curriculum and essential attributes of APN graduates.
The Delphi methodology was used to explore common factors across theories of marriage and family therapy (MFT). Leading clinicians and researchers from the American Family Therapy Academy and select faculty members from MFT training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across the various MFT theories, as well as what they personally considered to be the core ingredients of change. A final profile of items was created from the responses. Qualitative interviews were conducted with selected panelists to clarify discrepancies as well as to add meaning to the data. Implications for the training and practice of MFTs as well as direction for future research are discussed.
This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.
The purpose of this study was to determine the knowledge, experiences, and values that therapists should possess to provide quality therapy services to lesbian, gay, and bisexual (LGB) persons and their families. Using the Delphi method, consensus from a panel of experts on LGB topics was obtained on the components that training curricula should ideally include to prepare therapists adequately to work with this population. Panelists provide suggestions for important therapist values and qualities, key theoretical orientations, common issues of LGB clients and their support persons, key components of assessment and interventions, ethical and legal issues, and recommended materials. The panelists stress self-of-the-therapist work and development of a systemic perspective as critical aspects of training. The role of sexuality was deemphasized. Recommendations to training programs based on these findings are provided.
This study developed a list of target outcomes for long-term oral health care in persons with dementia. A three-round Delphi study was used to develop a list of target outcomes. Participants included 99 staff and 171 family members associated with the Dementia Special Care Unit in Bedford, MA. In Round 1 participants were asked to list five outcomes for long-term oral health care. Items were grouped, redundancies removed, and fed back in Round 2, when participants scored the items from 1 (least important) to 10 (most important). Round 2 responses were tabulated and the top 20 were fed back for scoring in Round 3. The top 10 target outcomes in decreasing order of importance were: patient will be free from oral pain, patient will not be at risk for aspiration, emergency dental treatment will be available when needed, prevent mouth infections, daily mouth care is as much a part of daily care as shaving or brushing hair, prevent discomfort from loose teeth or sore gums, teeth will be brushed thoroughly once a day, staff will be able to provide oral hygiene care as needed, provide dental care to prevent problems eating, and recognize oral problems early. Family and professional caregivers were remarkably consistent in their identification of the top 10 outcomes. Further work is needed to ensure broad international and interdisciplinary acceptance (including families and the long-term care residents themselves) of target outcomes for long-term oral health care in persons with dementia.