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PubMed2004

Exit learning outcomes for the PRHO year: an evidence base for informed decisions.

OBJECTIVE: To evaluate potential learning outcomes for pre-registration house officer (PRHO) training and develop an evidence base for informed decision making. DESIGN AND SETTING: A 2-stage Delphi process was employed to establish the opinions of Scottish stakeholders with regard to learning outcomes for the PRHO year. PARTICIPANTS: Doctors involved in the provision of PRHO training, including deans, postgraduate tutors and general practitioners (GPs) with trainees, were invited to participate in the study. MAIN OUTCOME MEASURES: Respondents rated a range of outcomes according to which they believed should be included or excluded from the PRHO training year. RESULTS: Learning outcomes identified for PRHOs were grouped under the 12-domain framework of the 3-circle model: 'What the doctor can do', 'How they approach their practice' and 'Their professionalism'. Based on the consensus opinions gained in the Delphi study, the ratings were classified into priority groupings. Priority 1 contained 45 of the original 81 learning outcomes, representing each area of the 3-circle model, with emphasis on the domains of clinical skills, patient investigation/management, communication, appropriate attitudes and personal development. Health promotion and disease prevention was the only domain not represented at priority 1. Priority 2 contained 24 outcomes with emphasis on the understanding of clinical skills, patient management and personal development. Priority 3 contained 12 outcomes indicating a lack of emphasis for some outcomes, particularly the role of the doctor and health promotion. CONCLUSION: Consensus on the learning outcomes for PRHO training has been achieved, providing an evidence base for curriculum planning. The relative priority assigned to these outcomes can facilitate the use of the evidence. This evidence base should be referred to when reviewing any PRHO training programme.

Clinical Competence↗

PubMed2005

Defining professionalism in anaesthesiology.

BACKGROUND: The Royal College of Physicians and Surgeons of Canada, through the CanMEDS 2000 project has identified the role of professional as 1 of 7 roles for which physicians are expected to be accountable when dealing with patients. Each specialty is responsible for defining this role relative to their specialty. METHODS: The qualities of professionalism for anaesthesiology were defined through a Delphi process involving Canadian anaesthesiology educators. The panellists took part in 3 rounds that identified qualities in 3 distinct areas of professionalism - humanistic qualities, personal development qualities and anaesthesiology meta-competences. RESULTS: A total of 23 of 29 anaesthesiologists responded (79%) in round 1, with response rates to rounds 2 and 3 being 72% and 69%, respectively. Of the original 36 qualities, some were combined, definitions were changed in 23, 11 qualities were added and 4 were deleted, leaving a list of 40 qualities. DISCUSSION: There is considerable interest in this issue among the Canadian educators in postgraduate anaesthesiology. Consensus on important professional qualities for anaesthesiologists was obtained through the Delphi technique. These qualities will form the basis of identifiable professional behaviours to which anaesthesiologists should aspire.

Anesthesiology↗

PubMed1996

Nursing-care dependency. Development of an assessment scale for demented and mentally handicapped patients.

This article describing the first phase in the development of an assessment scale of nursing-care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing-care dependency scale. The scale aims to characterize the patients' nursing-care dependency as part of the assessment step in the nursing process, and is based on Henderson's 14 human needs. The Delphi technique, using two panels of experts (n = 44), was applied to reach consensus on significant indicators of nursing-care dependency. The experts' reasoning was used to develop criteria for the assessment of nursing-care dependency. Ultimately, the Delphi rounds generated 15 NCD items with their descriptions and item criteria. There was no fundamental difference between the NCD scales for demented and mentally handicapped patients. Nevertheless, there are two versions of the NCD scale because of the need to apply specific concepts in the nursing care of either population. The original Dutch version of the NCD is also available in English and in Norwegian.

Activities of Daily Living↗

PubMed2006

Development of performance indicators for the primary care management of pediatric epilepsy: expert consensus recommendations based on the available evidence.

PURPOSE: To use available evidence and expert consensus to develop performance indicators for the evaluation and management of pediatric epilepsy. METHODS: We used a three-step process to develop the performance indicators. First, research findings were compiled into evidence tables focusing on different clinical issues. Second, an advisory panel of clinicians, educational and public health experts, and families of children with epilepsy reviewed the evidence. The advisory group used the evidence to draft a preliminary set of performance indicators for pediatric epilepsy management. Third, 13 internationally recognized experts in pediatric neurology or epilepsy rated the value of these indicators on a 5-point scale [1 (essential) to 5 (not necessary)] in a two-round Delphi process. Positive consensus was reached if >or=80% of experts gave an indicator a "1" rating and negative consensus if >80% gave an indicator a "5" rating. Indicators that achieved positive consensus during either round of the Delphi process constituted the final set of indicators. RESULTS: Of the 68 draft performance indicators, the expert panel members achieved positive consensus on 30 performance indicators: eight indicators related to diagnostic strategies and seizure classification, nine related to antiepileptic drug use, six related to cognitive and behavioral issues, six related to quality of life, and three related to specialty referrals. CONCLUSIONS: We identified 30 potential indicators for evaluating the care provided to pediatric patients with epilepsy. The next step is to examine the relation of these performance indicators to clinical outcomes and health care utilization among pediatric patients with epilepsy.

Adult↗

PubMedDate not supplied

Validation of the nursing diagnosis of ineffective breastfeeding.

OBJECTIVE: To test the validity of the definition, related factors, and defining characteristics of the nursing diagnosis of ineffective breastfeeding. Also, to test whether defining characteristics relevant to the interruption of breastfeeding may be included in the diagnosis of ineffective breastfeeding. DESIGN: A methodologic study using a two-stage Delphi process. PARTICIPANTS: Sixty-six nurses in the first round of the Delphi process and 34 nurses in the second round. MAIN OUTCOME MEASURES: A Likert-like scale was used to measure nurse experts' opinions as to how reflective each defining characteristic was of ineffective breastfeeding. RESULTS: The definition of ineffective breastfeeding was simplified, related factors were added, and defining characteristics were clarified. Two characteristics of interruption of breastfeeding were found to be relevant to ineffective breastfeeding, but were considered minor rather than major. CONCLUSION: The definition, related factors, and defining characteristics of ineffective breastfeeding have been clarified and validated by nurse experts, but they need further validation by breastfeeding women.

Breast Feeding↗

PubMed1997

Establishing maternal and child health data collection priorities for state and local oral health programs.

OBJECTIVE: This paper identifies specific data items for use by state and local agencies in a maternal and child oral health needs assessment model. METHODS: A modified Delphi approach was used to develop consensus on items for inclusion in the data set and their relative importance. Initially, 31 data items were chosen from several national sources. All state dental directors, along with other selected administrators and advisory committee members for this process, were asked to categorize each of the data items as core (essential), important but optional, or of lesser importance. Short comments about each data item were accepted, as were additions to the list of data items. Two rounds of comments were held. RESULTS: Eleven data items/types of information were selected as core items to be included in all needs assessments. All but one of these items were determined by the scores of the respondents. The advisory committee strongly recommended that at least one core item relate to the public's perception of oral health. Some differences in perceived importance of several items existed among the state dental directors, local dental directors, and the advisory committee. Twenty-one items were identified as being important, but optional, and seven were considered less than important and not included in the model data set. CONCLUSIONS: A modified Delphi approach facilitated the development of core and optional data items for a model oral health needs assessment. This model has potential for a common reporting mechanism so that states and local dental programs can share data.

Adolescent↗

PubMed2004

EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

OBJECTIVE: To develop evidence based recommendations for the management of hip osteoarthritis (OA). METHODS: The multidisciplinary guideline development group comprised 18 rheumatologists, 4 orthopaedic surgeons, and 1 epidemiologist, representing 14 European countries. Each participant contributed up to 10 propositions describing key clinical aspects of hip OA management. Ten final recommendations were agreed using a Delphi consensus approach. Medline, Embase, CINAHL, Cochrane Library, and HTA reports were searched systematically to obtain research evidence for each proposition. Where possible, outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. Effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation was assessed using the traditional A-D grading scale and a visual analogue scale. RESULTS: Ten key treatment propositions were generated through three Delphi rounds. They included 21 interventions, such as paracetamol, NSAIDs, symptomatic slow acting disease modifying drugs, opioids, intra-articular steroids, non-pharmacological treatment, total hip replacement, osteotomy, and two general propositions. 461 studies were identified from the literature search for the proposed interventions of efficacy, side effects, and cost effectiveness. Research evidence supported 15 interventions in the treatment of hip OA. Evidence specific for the hip was strikingly lacking. Strength of recommendation varied according to category of research evidence and expert opinion. CONCLUSION: Ten key recommendations for the treatment of hip OA were developed based on research evidence and expert consensus. The effectiveness and cost effectiveness of these recommendations were evaluated and the strength of recommendation was scored.

Acetaminophen↗

PubMed2006

EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

OBJECTIVE: To develop evidence based recommendations for the diagnosis of gout. METHODS: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert, representing 13 European countries. Ten key propositions regarding diagnosis were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Wherever possible the sensitivity, specificity, likelihood ratio (LR), and incremental cost-effectiveness ratio were calculated for diagnostic tests. Relative risk and odds ratios were estimated for risk factors and co-morbidities associated with gout. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales. RESULTS: 10 key propositions were generated though three Delphi rounds including diagnostic topics in clinical manifestations, urate crystal identification, biochemical tests, radiographs, and risk factors/co-morbidities. Urate crystal identification varies according to symptoms and observer skill but is very likely to be positive in symptomatic gout (LR = 567 (95% confidence interval (CI), 35.5 to 9053)). Classic podagra and presence of tophi have the highest clinical diagnostic value for gout (LR = 30.64 (95% CI, 20.51 to 45.77), and LR = 39.95 (21.06 to 75.79), respectively). Hyperuricaemia is a major risk factor for gout and may be a useful diagnostic marker when defined by the normal range of the local population (LR = 9.74 (7.45 to 12.72)), although some gouty patients may have normal serum uric acid concentrations at the time of investigation. Radiographs have little role in diagnosis, though in late or severe gout radiographic changes of asymmetrical swelling (LR = 4.13 (2.97 to 5.74)) and subcortical cysts without erosion (LR = 6.39 (3.00 to 13.57)) may be useful to differentiate chronic gout from other joint conditions. In addition, risk factors (sex, diuretics, purine-rich foods, alcohol, lead) and co-morbidities (cardiovascular diseases, hypertension, diabetes, obesity, and chronic renal failure) are associated with gout. SOR for each proposition varied according to both the research evidence and expert opinion. CONCLUSIONS: 10 key recommendations for diagnosis of gout were developed using a combination of research based evidence and expert consensus. The evidence for diagnostic tests, risk factors, and co-morbidities was evaluated and the strength of recommendation was provided.

Advisory Committees↗

PubMed2006

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

OBJECTIVE: To develop evidence based recommendations for the management of gout. METHODS: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert representing 13 European countries. Key propositions on management were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Where possible, effect size (ES), number needed to treat, relative risk, odds ratio, and incremental cost-effectiveness ratio were calculated. The quality of evidence was categorised according to the level of evidence. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales. RESULTS: 12 key propositions were generated after three Delphi rounds. Propositions included both non-pharmacological and pharmacological treatments and addressed symptomatic control of acute gout, urate lowering therapy (ULT), and prophylaxis of acute attacks. The importance of patient education, modification of adverse lifestyle (weight loss if obese; reduced alcohol consumption; low animal purine diet) and treatment of associated comorbidity and risk factors were emphasised. Recommended drugs for acute attacks were oral non-steroidal anti-inflammatory drugs (NSAIDs), oral colchicine (ES = 0.87 (95% confidence interval, 0.25 to 1.50)), or joint aspiration and injection of corticosteroid. ULT is indicated in patients with recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout. Allopurinol was confirmed as effective long term ULT (ES = 1.39 (0.78 to 2.01)). If allopurinol toxicity occurs, options include other xanthine oxidase inhibitors, allopurinol desensitisation, or a uricosuric. The uricosuric benzbromarone is more effective than allopurinol (ES = 1.50 (0.76 to 2.24)) and can be used in patients with mild to moderate renal insufficiency but may be hepatotoxic. When gout is associated with the use of diuretics, the diuretic should be stopped if possible. For prophylaxis against acute attacks, either colchicine 0.5-1 mg daily or an NSAID (with gastroprotection if indicated) are recommended. CONCLUSIONS: 12 key recommendations for management of gout were developed, using a combination of research based evidence and expert consensus. The evidence was evaluated and the SOR provided for each proposition.

Acute Disease↗

PubMed2006

EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

OBJECTIVES: To develop evidence based recommendations for the management of hand osteoarthritis (OA). METHODS: The multidisciplinary guideline development group comprised 16 rheumatologists, one physiatrist, one orthopaedic surgeon, two allied health professionals, and one evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points for management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of Medline, Embase, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA, and NICE reports was used to identify the best available research evidence to support each proposition. Where possible, the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety, and incremental cost effectiveness ratio was used for cost effectiveness. The strength of recommendation was provided according to research evidence, clinical expertise, and perceived patient preference. RESULTS: Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (for example, clinical features, risk factors, comorbidities), non-pharmacological (for example, education plus exercise, local heat, and splint), pharmacological (for example, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX-2 inhibitors, systemic slow acting disease modifying drugs, intra-articular corticosteroids), and surgery. Of 17 treatment modalities, only six were supported by research evidence (education plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs, topical capsaicin, and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of the treatment, and clinical expertise. CONCLUSION: Eleven key recommendations for treatment of hand OA were developed using a combination of research based evidence and expert consensus. The evidence was evaluated and the strength of recommendation was provided.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2003

Comparison of statistically derived ASAS improvement criteria for ankylosing spondylitis with clinically relevant improvement according to an expert panel.

OBJECTIVE: To investigate whether the recently developed (statistically derived) "ASsessment in Ankylosing Spondylitis Working Group" improvement criteria (ASAS-IC) for ankylosing spondylitis (AS) reflect clinically relevant improvement according to the opinion of an expert panel. METHODS: The ASAS-IC consist of four domains: physical function, spinal pain, patient global assessment, and inflammation. Scores on these four domains of 55 patients with AS, who had participated in a non-steroidal anti-inflammatory drug efficacy trial, were presented to an international expert panel (consisting of patients with AS and members of the ASAS Working Group) in a three round Delphi exercise. The number of (non-)responders according to the ASAS-IC was compared with the final consensus of the experts. The most important domains in the opinion of the experts were identified, and also selected with discriminant analysis. A number of provisional criteria sets that best represented the consensus of the experts were defined. Using other datasets, these clinically derived criteria sets as well as the statistically derived ASAS-IC were then tested for discriminative properties and for agreement with the end of trial efficacy by patient and doctor. RESULTS: Forty experts completed the three Delphi rounds. The experts considered twice as many patients to be responders than the ASAS-IC (42 v 21). Overall agreement between experts and ASAS-IC was 62%. Spinal pain was considered the most important domain by most experts and was also selected as such by discriminant analysis. Provisional criteria sets with an agreement of >or=80% compared with the consensus of the experts showed high placebo response rates (27-42%), in contrast with the ASAS-IC with a predefined placebo response rate of 25%. All criteria sets and the ASAS-IC discriminated well between active and placebo treatment (chi(2)=36-45; p<0.001). Compared with the end of trial efficacy assessment, the provisional criteria sets showed an agreement of 71-82%, sensitivity of 67-83%, and specificity of 81-88%. The ASAS-IC showed an agreement of 70%, sensitivity of 62%, and specificity of 89%. CONCLUSION: The ASAS-IC are strict in defining response, are highly specific, and consequently show lower sensitivity than the clinically derived criteria sets. However, those patients who are considered as responders by applying the ASAS-IC are acknowledged as such by the expert panel as well as by patients' and doctors' judgments, and are therefore likely to be true responders.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

Research on injury prevention: topics for systematic review.

BACKGROUND: Duplication should be avoided in research and only effective intervention programs should be implemented. OBJECTIVE: To arrive at a consensus among injury control investigators and practitioners on the most important research questions for systematic review in the area of injury prevention. DESIGN: Delphi survey. METHODS: A total of 34 injury prevention experts were asked to submit questions for systematic review. These were then collated; experts then ranked these on importance and availability of research. RESULTS: Twenty one experts generated 79 questions. The prevention areas with the most number of questions generated were fires and burns, motor vehicle, and violence (other than intimate partner), and the least were other interventions (which included Safe Communities), and risk compensation. These were ranked by mean score. There was good agreement between the mean score and the proportion of experts rating questions as important or very important. Nine of the top 24 questions were rated as having some to a substantial amount of research available, and 15 as having little research available. CONCLUSIONS: The Delphi technique provided a useful means to develop consensus on injury prevention research needs and questions for systematic review.

Humans↗

PubMed2001

Expert consensus on the desirable characteristics of review criteria for improvement of health care quality.

OBJECTIVES: To identify the desirable characteristics of review criteria for quality improvement and to determine how they should be selected. BACKGROUND: Review criteria are the elements against which quality of care is assessed in quality improvement. Use of inappropriate criteria may impair the effectiveness of quality improvement activities and resources may be wasted in activities that fail to facilitate improved care. METHODS: A two round modified Delphi process was used to generate consensus amongst an international panel of 38 experts. A list of 40 characteristics of review criteria, identified from literature searches, was distributed to the experts who were asked to rate the importance and feasibility of each characteristic. Comments and suggestions for characteristics not included in the list were also invited. RESULTS: The Delphi process refined a comprehensive literature based list of 40 desirable characteristics of review criteria into a more precise list of 26 items. The expert consensus view is that review criteria should be developed through a well documented process involving consideration of valid research evidence, possibly combined with expert opinion, prioritisation according to health outcomes and strength of evidence, and pilot testing. Review criteria should also be accompanied by full clear information on how they might be used and how data might be collected and interpreted. CONCLUSION: The desirable characteristics for review criteria have been identified and will be of use in the development, evaluation, and selection of review criteria, thus improving the cost effectiveness of quality improvement activities in healthcare settings.

Consensus Statements as Topic↗

PubMed2000

What is a prescribing error?

OBJECTIVE: To develop a practitioner led definition of a prescribing error for use in quantitative studies of their incidence. DESIGN: Two stage Delphi technique. SUBJECTS: A panel of 34 UK judges, which included physicians, surgeons, pharmacists, nurses and risk managers. MAIN OUTCOME MEASURES: The extent to which judges agreed with a general definition of a prescribing error, and the extent to which they agreed that each of 42 scenarios represented a prescribing error. RESULTS: Responses were obtained from 30 (88%) of 34 judges in the first Delphi round, and from 26 (87%) of 30 in the second round. The general definition of a prescribing error was accepted. The panel reached consensus that 24 of the 42 scenarios should be included as prescribing errors and that five should be excluded. In general, transcription errors, failure to communicate essential information, and the use of drugs or doses inappropriate for the individual patient were considered prescribing errors; deviations from policies or guidelines were not. CONCLUSIONS: Health care professionals are in broad agreement about the types of events that should be included and excluded as prescribing errors. A general definition of a prescribing error has been developed, together with more detailed guidance regarding the types of events that should be included. This definition allows the comparison of prescribing error rates among different prescribing systems and different hospitals, and is suitable for use in both research and clinical governance initiatives.

Attitude of Health Personnel↗

PubMed2005

What constitutes a prescribing error in paediatrics?

OBJECTIVE: To develop a practitioner led definition of a prescribing error for use in prevalence/incidence studies in paediatric practice. DESIGN: A two stage Delphi technique was used to obtain the views of a panel of expert health professionals working in the hospital paediatric setting. The extent of their agreement on a definition of a prescribing error, and on 40 scenarios that might be classified as prescribing errors in paediatric practice, was obtained. RESULTS: Response rates were 84% (n = 42) in the first Delphi round and 95% (n = 40) in the second. Consensus was to accept the general definition of a prescribing error. In addition, there was consensus that 27 of the 40 scenarios should be included as prescribing errors, 10 should be excluded, and three may be considered prescribing errors depending on the individual clinical situation. Failure to communicate essential information, transcription errors and the use of drugs, formulations, or doses inappropriate for the individual patient were considered prescribing errors. Deviations from policies or guidelines, use of unlicensed and off-label drugs, and omission of non-essential information were not considered prescribing errors. CONCLUSION: A general definition of a prescribing error has been developed that is applicable to the paediatric setting, together with more detailed guidance regarding the types of events that should be included. These findings are suitable for use in future research into the incidence and nature of prescribing errors in paediatrics.

Age Factors↗

PubMed2001

The teaching of health care ethics to students of nursing in the UK: a pilot study.

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the 'four principles' approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students.

Adult↗

PubMed2000

Identifying nursing research priorities in a pediatric clinical trials cooperative group: the Pediatric Oncology Group experience.

If nurses involved in pediatric oncology clinical trials are to use resources and manpower most effectively, nursing research priorities must be set that meet the nursing care issues of nurses at the bedside. Using a Delphi technique, nurses from the Pediatric Oncology Group (POG) were surveyed in Round 1 to discover patient care concerns or other issues in pediatric oncology nursing related to clinical trials. The 87 research ideas generated were reviewed by a panel of nurse experts, and a total of 57 unique research topics were delineated. These topics were then used for Round 2 of the Delphi study, which identified the top 10 nursing research priorities of the POG nurses participating in the study.

Clinical Trials as Topic↗

PubMed2002

Identifying individual competency in emerging areas of practice: an applied approach.

Competency designation is important for any discipline to define individual performance expectations. Although public health (PH) agencies have always responded to emergencies, individual expectations have not been specified. The authors identified individual competencies necessary for organizations to meet performance standards. In the first stage, a Delphi survey served to identify competencies needed by staff to respond to any emergency, including bio-terrorism, yielding competency sets for four levels of workers. In the second stage, focus groups were used to assess the competencies with public health agencies. This feedback validated the Delphi-identified competencies as accurate and necessary for emergency response. The authors demonstrate the feasibility of using these methods to arrive at statements of value to PH practice at a reasonable investment of resources.

Bioterrorism↗