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PubMed2025

The Clinician-reported Genetic Testing Utility InDEx for Neonatal Intensive Care (C-GUIDE NICU): Quantifying genome-wide sequencing utility in the NICU.

PURPOSE: Use of genomic sequencing (GS) in neonatal intensive care units (NICUs) has increased with improved diagnostic yield. However, uncertainty persists regarding when and for whom GS is most useful. Because a standardized approach to assessing utility is lacking, we developed a novel version of the Clinician-reported Genetic testing Utility InDEx (C-GUIDE) to quantify the utility of GS in NICUs. METHODS: Informed by a scoping review, we developed a draft C-GUIDE NICU tool to quantify utility, which underwent iterative revisions through feedback from clinician interviews and questionnaires on item relevance, comprehensibility, and comprehensiveness. We finalized the expert-informed C-GUIDE NICU using an international Delphi consensus process. RESULTS: Scoping review (n = 25 articles) and interviews (n = 21) revealed key themes of utility. Guided by qualitative feedback and item scoring, C-GUIDE was iteratively reduced to include 21, 18, and 14 items. The Delphi consensus process with 22 experts achieved item consensus and stability, yielding a final 10-item tool. CONCLUSION: Using a rigorous process, we developed a consensus-based standardized method for capturing the clinical utility of GS in NICUs. C-GUIDE NICU can be used by clinicians, researchers, and payers to assess GS value to patient care and will be available for licensed use following reliability and validity testing.

Humans↗

PubMed2004

What do doctors think their caseload should be to maintain their skills for delivery care?

OBJECTIVES: To seek the opinions of doctors on what they thought the minimum, maximum and optimum annual caseload should be for the maintenance of skills and competence in a variety of obstetric procedures. METHODS: An expert panel of respondents from Africa and Asia was asked to give their opinions on what they believed the minimum, maximum and optimum caseload should be for 11 obstetric procedures via a series of structured questionnaires (Delphi exercise). In subsequent questionnaires, participants were asked if they wished to reconsider their opinions in light of the group response. RESULTS: The median values of responses given for the minimum, maximum and optimum caseloads for the 11 obstetric procedures did not change substantially over time, though greater consensus was developed as indicated by reductions in the size of inter-quartile ranges in later rounds. CONCLUSIONS: We encountered several problems associated with using the Delphi technique in this context, which throws doubt on the validity and usefulness of our results. Caseload is just one of many factors, as indicated by our expert panel that need to be considered when planning the delivery of obstetric services in remote areas. High quality training, continued medical education, appropriate quality assurance procedures, and provision of a supportive enabling environment are also important requirements. In addition, the views of clinicians need to be balanced against more objective evidence of quality of care and patient outcome in relation to procedural volume. Such evidence is lacking in the field of obstetrics and requires further investigation.

Africa↗

PubMed2005

Developing terminology for documenting perioperative nursing interventions.

OBJECTIVE: To develop terminology for documenting perioperative nursing interventions. METHOD: Nursing documentation of 250 patients was explored by content analysis. The study was conducted to validate further the Perioperative Nursing Data Set (PNDS) in Finland. The data included 3442 terms that were clustered into 104 nursing interventions. A Delphi-panel (N=5) evaluated the relevance of each term on a scale from 1 to 4. The structure of each nursing intervention was checked to meet the minimum requirements of the ISO reference terminology model for nursing action concepts. Finally, the nursing interventions were compared with the original PNDS-interventions. RESULTS: The Delphi-panel accepted 98 nursing interventions with Content Validity Index from 0.88 to 1.0. Of the 133 nursing interventions in the PNDS, 60% (n=80) were covered by nursing interventions identified in this study. A notable portion of the nursing interventions related to preventive aspects of perioperative care and the patients' coping with perioperative experience. CONCLUSION: The findings supported the need for cross-cultural validation of a nursing language prior to clinical implementation. The ISO reference terminology model is recommended as framework in constructing concepts for nursing interventions in a regular form.

Delphi Technique↗

PubMed2005

A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) was developed using consensus.

BACKGROUND AND OBJECTIVE: To develop a checklist of items measuring the quality of reports of randomized clinical trials (RCTs) assessing nonpharmacological treatments (NPTs). STUDY DESIGN AND SETTING: The Delphi consensus method was used to select and reduce the number of items in the checklist. A total of 154 individuals were invited to participate: epidemiologists and statisticians involved in the field of methodology of RCTs (n = 55), members of the Cochrane Collaboration (n = 41), and clinicians involved in planning NPT clinical trials (n = 58). Participants ranked on a 10-point Likert scale whether an item should be included in the checklist. RESULTS: Fifty-five experts (36%) participated in the survey. They were experienced in systematic reviews (68% were involved in the Cochrane Collaboration) and in planning RCTs (76%). Three rounds of the Delphi method were conducted to achieve consensus. The final checklist contains 10 items and 5 subitems, with items related to the standardization of the intervention, care provider influence, and additional measures to minimize the potential bias from lack of blinding of participants, care providers, and outcome assessors. CONCLUSIONS: This tool can be used to critically appraise the medical literature, design NPT studies, and assess the quality of trial reports included in systematic reviews.

Consensus↗

PubMed1994

AORN priorities for perioperative nursing research.

The priorities for perioperative nursing research identified by the experts who participated in this Delphi study give direction to future research that can enhance a research-based nursing practice. Patient outcomes, future roles, clinical issues, staffing, and health care delivery topics frame the intricate picture of perioperative nursing research priorities. The results of this Delphi study are consistent with priorities identified in the 1988 "AORN policy, plan, and priority statement on nursing research." Perioperative nurse experts desire a professional practice that is based on scientific knowledge. Future research should generate scientific knowledge for recommended practices and activities that lead to desired patient outcomes by forging a proactive future for perioperative nursing.

Adult↗

PubMed1997

Developing strategic plans for academic general internal medicine.

There is an increasing need to train more primary care physicians. Therefore, it would be advantageous for academic general internal medicine (GIM) to develop strategies to meet these demands. Our GIM division developed a strategic planning process with the participant groups being the division faculty, a pertinent literature review (the surrogate expert), and selected medical administrators. The IDEALS systems design provided the conceptual framework for the strategic planning process. This process used the Delphi technique to develop the theoretically ideal work system based on the division's vision for its future role, and the Nominal Group Process Technique to create the recommended work system, using the Delphi results. The strategic planning process was economical and division faculty agreed that it was useful.

Delphi Technique↗

PubMed2002

Development of a list of consensus-approved clinical indicators of preventable drug-related morbidity in older adults.

BACKGROUND: Older patients (aged >65 years) may experience drug-related problems that, if unrecognized, can result in drug-related morbidities (DRMs). According to the literature, 49% to 76% of all DRMs may be preventable; however, there is little consensus as to which are preventable and which are not. OBJECTIVE: The aim of this study was to develop consensus-approved clinical indicators of preventable DRM (PDRM) in older adults. Geriatricians, clinical pharmacologists, general practitioners, and clinical pharmacists were included in the consensus-building process. METHODS: In 2001, a survey containing potential indicators of PDRM was prepared based on previous research and the input of 2 clinical pharmacists. The survey was administered concurrently via the Delphi technique to 2 separate specialist panels (6 geriatricians and 6 clinical pharmacologists) to generate clinical indicators of PDRMs in older adults. Subsequently, a focus group of 12 general practitioners (GPs) assessed these PDRM indicators in Nova Scotia, Canada. RESULTS: The specialist panels generated 58 consensus-approved clinical indicators of PDRMs in older adults after 2 rounds of the Delphi technique. The GPs agreed with 52 (90%) of these PDRM indicators. CONCLUSIONS: This study generated consensus-approved indicators of PDRMs in older adults, which could be used by health professionals to identify patients at risk for PDRMs. The indicators could also have a role in quality measurement systems and in epidemiologic research. Furthermore, the indicators could complement existing clinical indicators and establish an important link between patterns of care and clinical outcomes.

Adult↗

PubMedDate not supplied

[Hospitalizations due to ambulatory care sensitive conditions: selection of diagnostic codes for Spain].

BACKGROUND: Hospitalisations due to Ambulatory Care Sensitive Conditions (ACSC) are considered an indicator to measure the use of hospital services because of health conditions that could have been prevented and controlled by primary health care. The objective of this study is to select the list of diagnostic codes to assess the performance of primary health care in Spain. METHODS: The five criteria proposed by Weissman and Solberg, to select an appropriate indicator, were applied to a first list of 87 ACSC diagnostic codes identified through bibliographic search. Information on two main criteria-whether care for a health condition was a primary health care role and whether hospitalisation was needed once the health problem occurred was obtained by means of the Delphi technique. A group of 44 experts gathered together for the study. For the remaining criteria, information came from the results of the Pilot study on hospitalisations due to ACSC in Catalonia, Spain. Meeting the five criteria was the criterion selected to evaluate the solving ability of primary health care. RESULTS: a) from the Delphi group: 42 (95.4%) participants completed the three rounds. The question on whether the care of the selected health conditions was responsibility of primary health care reached a high level of consensus (between 86.1 and 100%). The consensus on the need for hospitalisation was lower, from 75.7 to 88.6%, moreover, 5 diagnostic codes did not reach the established consensus, and b) from the ACSC selection process: five diagnostic codes did not meet the criteria and were excluded. Out of the remaining 82, all them were considered as health problems to be cared for at primary level and in 37 cases hospitalisation was considered always as necessary. Thirty-five diagnostic codes, that met the five criteria, represented the set of ACSC diagnostic codes in our setting. CONCLUSIONS: A set of 35 diagnostic codes of ACSC, adapted to our setting, is proposed to evaluate primary health care performance. The selected codes reduce significantly the limitations that stem from hospital admission criteria due to patient clinical characteristics, variations in hospital medical practice, and hospital admission policies.

Ambulatory Care↗

PubMed2003

Developing a framework for assessment of the environmental determinants of walking and cycling.

The focus for interventions and research on physical activity has moved away from vigorous activity to moderate-intensity activities, such as walking. In addition, a social ecological approach to physical activity research and practice is recommended. This approach considers the influence of the environment and policies on physical activity. Although there is limited empirical published evidence related to the features of the physical environment that influence physical activity, urban planning and transport agencies have developed policies and strategies that have the potential to influence whether people walk or cycle in their neighbourhood. This paper presents the development of a framework of the potential environmental influences on walking and cycling based on published evidence and policy literature, interviews with experts and a Delphi study. The framework includes four features: functional, safety, aesthetic and destination; as well as the hypothesised factors that contribute to each of these features of the environment. In addition, the Delphi experts determined the perceived relative importance of these factors. Based on these factors, a data collection tool will be developed and the frameworks will be tested through the collection of environmental information on neighbourhoods, where data on the walking and cycling patterns have been collected previously. Identifying the environmental factors that influence walking and cycling will allow the inclusion of a public health perspective as well as those of urban planning and transport in the design of built environments.

Adult↗

PubMed2003

Reproductive health indicators for China's rural areas.

We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.

Adult↗

PubMed1995

The development of the Australian Basic Intensive Care Knowledge Test.

The Basic knowledge Assessment Tool (BKAT), a test developed in the United States, has been presented as a valid and reliable test of basic knowledge for critical care nursing. However, it was necessary to determine the BKAT's validity and reliability in the Australian intensive care (IC) context. The Delphi technique, utilising a panel of eleven experts, was used to determine the content validity of the BKAT. The Delphi process resulted in the development of a test with 105 questions. These questions consist of 49 original BKAT questions, 25 original BKAT questions slightly modified, 3 original BKAT questions with major modifications and 28 new questions. A criterion group design was used to establish the modified test's reliability and decision validity. Item analysis was undertaken using item difficulty and item discrimination indexes. The modified test was completed by 14 registered nurses with no IC experience, 18 registered nurses with intermediate IC experience and 25 registered nurses qualified as intensive care specialists. The mean score (and standard deviation) for the test for each of the respective groups was 41(9), 69(9) and 86(7). These results were significantly different (p < 0001). The reliability was established with a Cronbach Alpha coefficient of .96. The modified test is a reliable and valid measure of IC basic knowledge and can be used as a valuable adjunct in the assessment of IC orientation programs.

Australia↗

PubMed1998

Study to validate the outcome goal, competencies and educational objectives for use in intensive care orientation programs.

Intensive care orientation programs have become an accepted component of intensive care education. To date, however, there have been no Australian-based standards defining the appropriate level of competence to be attained upon completion of orientation. The aim of this study was to validate a set of aims, competencies and educational objectives that could form the basis of intensive care orientation and which would ensure an outcome standard of safe and effective practice. An initial document containing a statement of the desired outcome goal, six competency statements and 182 educational objectives was developed through a review of the orientation programs developed by the investigators. The Delphi technique was used to gain consensus among 13 nurses recognised for their expertise in intensive care education. The expert group rated the acceptability of each of the study items and provided suggestions for objectives to be included. An approval rating of 80 per cent was required to retain each of the study items, with the document refined through three Delphi rounds. The final document contains a validated statement of outcome goal, competencies and educational objectives for intensive care orientation programs.

Australia↗

PubMed1997

Indications for arterial reconstruction and major amputation in the management of chronic critical lower limb ischaemia. The Scottish and Northern Vascular Audit Groups.

OBJECTIVES: The aim of this study was to derive specific clinical indications for surgery in patients with chronic critical lower limb ischaemia and to determine the extent to which practice in Scotland conformed to these indications. DESIGN, MATERIALS AND METHODS: Consensus on indications was achieved using a modified Delphi method in which a postal questionnaire was completed by 29 vascular surgeons on two occasions, with feedback between the rounds. Respondents indicated the appropriateness of arterial reconstruction and primary major amputation for 218 case scenarios comprising all possible combinations of clinical and angiographic findings. RESULTS: Agreement was reached on 31 appropriate indications for major amputation and 65 for arterial reconstruction. In 10 hospitals in Scotland, 400 primary amputation and arterial reconstruction operations were reviewed retrospectively and compared with the indications. The clinical findings for 7 (4%) arterial reconstructions and 48 (24%) major amputations did not conform to the indications agreed by the Delphi method. The proportion of operations conforming to the agreed indications differed significantly by size of unit (p < 0.025). CONCLUSIONS: This study shows that consensus can be reached on indications for surgery. However, in practice some operations performed do not conform with these indications. This discrepancy may be due to inappropriate practice.

Amputation, Surgical↗

PubMed2003

Establishing nursing research priorities on a paediatric haematology, oncology, immunology and infectious diseases unit: involving doctors and parents.

Following a Delphi survey undertaken with nurses on a specialist children's unit to identify priorities for nursing research, this paper outlines the results of a survey to ascertain the views of doctors and parents regarding the results of the Delphi. This approach was in keeping with national guidance on multi-professional working in paediatric oncology and the importance of service-user involvement in planning and evaluating care. Convenience samples of doctors (n=16) and parents (n=10) were asked to rank the priorities previously identified by nurses. Results highlighted that in the main, nurses, doctors and parents agreed on the key areas that should take priority for research. Nurse's knowledge of day-to-day symptom management, children's quality of life, negotiation and communication in relation to care provision were identified by all three groups as high priorities. There were some areas where the views varied: this was generally in relation to the different primary focus of the individual groups-parents being very concerned with the effect of daily ward routines and procedures and their child's overall hospital experience, nurses with issues such as staff retention and morale, whereas doctors were more concerned with issues around information giving and consent to treatment. Limitations of the study, including sample selection and the transient nature of the population involved are discussed within the paper. The paper concludes that all three groups shared similar views, being focused on issues directly related to patient care. Consensus between the groups should result in future research initiatives reflecting a shared focus and responding to an identified need.

Attitude of Health Personnel↗

PubMed2001

A clinical minimum data set for primary dental care.

OBJECTIVE: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status. DESIGN: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set. RESULTS: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear. CONCLUSIONS: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.

Community Dentistry↗

PubMed1999

Impact of guidelines implemented in a paris university hospital: application to the use of antiemetics by cancer patients.

AIMS: To assess the impact with time of guidelines on antiemetic use in an 850-bed Paris university hospital with a high proportion of cancer patients. METHODS: Guidelines on the use of antiemetics available in cancer chemotherapy were drafted according to the Delphi technique. Their implementation was based upon a patient-specific antiemetic prescription form. To assess the impact of guideline implementation over time, discrepancies between current practice and the guidelines were compared before guideline implementation (between March and August 1995) and after implementation (between March and August 1997, and March and August 1998). RESULTS: Before the Delphi panel's guidelines were implemented, 5-HT3 antagonists were inappropriately administered in 70% of cases. After guideline implementation, this proportion dropped significantly (P<0.0001, Fisher's exact test) to 22% between March and August 1997 and 28% between March and August 1998. CONCLUSIONS: Implementation of guidelines seems to have resulted in significant changes with time, although a causal relationship has not been demonstrated. The development of guidelines by our hospital's multidisciplinary working group helped the various consultants to adjust medical practices to take account of these changes.

Academic Medical Centers↗

PubMed1993

Clinical role activities of nurse teachers in Project 2000 programmes.

This paper presents the findings related to the clinical role activities of nurse teachers in Project 2000 programmes. Data were collected by a Delphi survey of 25 colleges of nursing that had implemented Project 2000 between September 1989 and April 1991. The findings from the Delphi survey were explored more fully through in-depth interviews with a sample of the respondents. The findings identified a very strong commitment of the respondents to a clinical liaison role. But they did not perceive their role to be one of teaching students through 'hands on care'; they felt this was the role of the qualified staff in the clinical areas. The respondents considered it important to maintain their clinical credibility through theoretical updating rather than being able to perform as an expert practitioner.

Clinical Competence↗

PubMed2001

Achieving consensus about pain content for child branch curricula.

AIM: The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. RATIONALE: Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. METHODOLOGY: A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. RESULTS: Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. CONCLUSIONS: The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.

Curriculum↗