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PubMed1996

[The clinical significance of metastatic cancer of the larynx to the Delphi node].

Between years 1965-1987, 920 patients with cancer of the larynx were operated on. In this time we identified 9 cases of histologically proven metastasis to the Delphian node. In all patients except one, the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy. Five patients developed metastasis postoperative. Seven of 9 patients have died from their laryngeal cancer. The frequency of neck metastasis and local recurrences is very high in patients with a positive Delphian node.

Adult↗
PubMed2006

A comparison of two consensus methods for classifying morbidities in a single professional group showed the same outcomes.

OBJECTIVE: To investigate whether consensus differs when reached by the Nominal or the Delphi method. STUDY DESIGN AND SETTING: Seventeen general practices from North Staffordshire, England were randomly allocated to Delphi (postal feedback only) or Nominal group (also had group discussion). General practitioners classified 56 morbidities according to four scales of severity (chronicity, time course, health care use, patient impact) in two consensus rounds. Consensus outcomes were assessed by between-group comparison of severity scores at baseline and follow-up rounds, and consensus process by within-group change in the variance of severity scores between the two rounds. RESULTS: Consensus rounds were completed by 21 out of 35 Nominal GPs and 23 out of 43 Delphi GPs. Baseline scores for three of the four severity scales were significantly higher for Nominal compared to Delphi GPs, but there were no differences at follow-up. Between the two rounds, variance reduced within the Nominal and Delphi group, respectively, by 61% and 35% (chronicity), 40% and 62% (time course), 42% and 36% (health care use), and 19% and 38% (patient impact). CONCLUSION: The Nominal and Delphi methods did not result in different outcomes and we conclude that either method can be used in health services research.

Consensus↗
PubMed2006

A comparison of formal consensus methods used for developing clinical guidelines.

OBJECTIVES: To compare two consensus development methods commonly used for developing clinical guidelines in terms of the judgments produced, closeness of consensus, amount of change between rounds, concordance with research evidence and reliability. METHODS: In all, 213 general practitioners and mental health professionals from England participated in four Delphi and four nominal groups. They rated the appropriateness of four treatments (cognitive behavioural therapy [CBT], behavioural therapy [BT], brief psychodynamic interpersonal therapy [BPIT] and antidepressants) for three conditions. First, participants rated the appropriateness of interventions independently, using a postal questionnaire. For nominal groups, the ratings were fed back and discussed at a meeting, and then group members privately completed the questionnaire again. For Delphi groups, there was feedback but no discussion, and the entire process was conducted by postal questionnaire. RESULTS: The effect of consensus method on final ratings varied with therapeutic intervention, with nominal groups rating CBT and antidepressants more favourably than Delphi groups. Consensus was closer in the nominal than in the Delphi groups in both rounds. There was no overall difference between groups in their concordance with research evidence (odds ratio 1.13, 95% confidence interval 0.79-1.61). In this study, the Delphi method was more reliable (kappa coefficients 0.88 and 0.89 compared with 0.41 and 0.65 for nominal groups). CONCLUSIONS: The advantages of nominal groups (more consensus; greater understanding of reasons for disagreement) could be combined with the greater reliability of the Delphi approach by developing a hybrid method.

Chronic Disease↗
PubMed2006

Comparison of body composition measurements obtained by two fan-beam DXA instruments.

Although dual-energy X-ray absorptiometry (DXA) has been widely used for measuring body composition, discrepancies have been reported to exist among results obtained from different instruments. In the course of longitudinal studies lasting for many years, old instruments may be required to be replaced with new ones, necessitating comparison and validation between the values obtained by the old and new instruments. We compared the data obtained by the two fan-beam DXA instruments, QDR-2000 (Hologic, Waltham, MA) and Delphi (Hologic). Body composition was first measured by the Hologic QDR-2000 and next by the Delphi W within 30 days in 99 healthy subjects. Whole-body fat mass (FM), percentage of FM, arm FM, and leg FM measured by the Hologic QDR-2000 were significantly larger than those measured by the Delphi W. Lean tissue mass (LTM), bone mineral content, and bone mineral density of the whole body, trunk FM, arm LTM, and leg LTM measured by the QDR-2000 were significantly smaller than those measured by the Delphi W. After converting the QDR-2000 values by equations developed by multiple regression analysis, they were not significantly different from the corresponding Delphi values. Measurements by the QDR-2000 and the Delphi W were not interchangeable and the conversion equations reduced the discrepancy to a level that enabled direct comparison of the data obtained by the two instruments. However, cautious interpretation is necessary when the conversion equations are applied to other instruments even of the same type or when evaluating data of individual subjects.

Absorptiometry, Photon↗
PubMed2006

Body composition analysis by dual X-ray absorptiometry: in vivo and in vitro comparison of three different fan-beam instruments.

BACKGROUND: Dual X-ray absorptiometry (DXA) is the preferred method for measuring body composition in clinical practice, but interchange between devices may pose problems with the interpretation of results. OBJECTIVE: To establish conversion equations for body composition variables between three fan-beam DXA systems. METHODS: Body composition was assessed in 21 subjects using Lunar Expert (Expert), Lunar Prodigy (Prodigy) and Hologic Delphi W (Delphi). Weekly measurements of Hologic whole body phantom 164 were performed. RESULTS: There were no significant differences between DXA-measured means of body weight, fat mass and lean body mass. Bland-Altman analysis revealed that Lunar Expert increasingly overestimated fat mass with increasing total mass (p<0.001) relative to Delphi and Prodigy, while Delphi produced a constant underestimation of fat mass. Correlations between scale weights and DXA-measured body weights, and between DXA-measured body weights and the sum of fat masses, lean body masses and bone mineral contents (BMC) between the three instruments, were excellent (Rsqr 0.998-0.910; p<0.001). Conversion factors to Prodigy for Expert and Delphi were respectively 1.003 and 1.011 for total body mass, 0.954 and 1.079 for fat mass, 1.018 and 0.967 for lean body mass and 1.049 and 1.136 for BMC (Rsqr 0.999-0.991; p<0.001). Standard error of estimate (SEE) for the slopes ranged from 0.20% to 2.10%. Phantom studies revealed stable instrument function with CV% commonly<2%, except for lean mass for Delphi (5.5%). CONCLUSIONS: Despite the significant differences in measurement of body composition between DXA fan-beam instruments, clinically relevant conversion factors can be established.

Absorptiometry, Photon↗
PubMed1992

Small-group judgment methods for determining resource-based relative values.

National telephone surveys used in the Resource-Based Relative Value Scale Study produce reliable and valid relative values of work, but phone surveys are expensive and time consuming. We evaluated three small-group processes as alternatives. We compared national survey work estimates for 38 surgical services to those generated by panels of 11 and 19 highly qualified general surgeons using 1) single-round mail survey; 2) Delphi multiple-round ratings; and 3) modified Delphi with face-to-face discussion. Single-round mail-survey ratings were closest to the national survey; average differences were 11.0% and 12.6%. Delphi feedback led to increased differences: typical values differed by 14.6% and 15.2%. Face-to-face discussion led to still further divergence (21.0%). Single-round mail survey of a small number of experts provides relative work values that compare more favorably to those of the national survey than those obtained from Delphi multiple-round ratings or modified Delphi with face-to-face discussion.

Data Collection↗