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PubMed1992

Setting an agenda for clinical nursing research in long-term care.

Twenty nurse experts participated in a four-round Delphi study to identify topics requiring clinical nursing research in long-term care. The Delphi strategy elaborated 265 items grouped in seven categories, with 73 items under the category of clinical practice. After four rounds, participants ranked the top-rated 50 items overall in serial importance. Nineteen of the 50 items were clinical practice items. A weighted rank than identified the top 10 items requiring investigation. Of these 10, the item deemed most important was patient-centered outcomes, an item subsuming all clinical nursing research.

Adult↗

PubMed2006

Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden.

BACKGROUND: Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. METHODS: Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. RESULTS: In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. CONCLUSION: Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

Anticoagulants↗

PubMed2001

Fitting contraceptive diaphragms: can laywomen provide quality training for doctors?

OBJECTIVE: To test the feasibility of training laywomen as professional patients to teach doctors to fit the contraceptive diaphragm. DESIGN: Semi-structured interviews with instructing doctors and questionnaires to DFFP trainees. These documented current teaching practice and the acceptability of professional patients. The Delphi technique was used to establish a curriculum for the professional patients' training programme. RESULTS: The results show that there is currently a lack of standardisation in teaching methods and content with respect to diaphragm fitting. All instructing doctors and DFFP trainees involved had experienced difficulties in recruiting women for training, and the majority would be happy to work with professional patients. After three rounds of the Delphi procedure, consensus was reached and a curriculum developed. Five women were recruited on to a training programme, and four successfully completed it. CONCLUSION: Lack of standardisation and difficulty recruiting patients are current problems when training doctors to fit diaphragms. Our study shows that the use of professional patients would be acceptable to both DFFP trainees and instructing doctors, and that it is possible to recruit and train women for this purpose.

Attitude of Health Personnel↗

PubMed2006

Academic food-supply veterinarians: future demand and likely shortages.

The future demand for and potential shortages of food-supply veterinarians have been the subject of much concern. Using the Delphi forecasting method in a three-phase Web-based survey process, a panel of experts identified the trends and issues shaping the demand for and supply of academic food-animal veterinarians, then forecasted the likely future demand and shortages of food-supply veterinarians employed in academic institutions in the United States and Canada through 2016. The results indicate that there will be increasing future demand and persistent shortages of academic food-supply veterinarians unless current trends are countered with targeted, strategic action. The Delphi panel also evaluated the effectiveness of several strategies for reversing current trends and increasing the number of food-supply veterinarians entering into academic careers. Academic food-supply veterinarians are a key link in the system that produces food-supply veterinarians for all sectors (private practice, government service, etc.); shortages in the academic sector will amplify shortages wherever food-supply veterinarians are needed. Even fairly small shortages have significant public-health, food-safety, animal-welfare, and bio-security implications. Recent events demonstrate that in an increasingly interconnected global economic food supply system, national economies and public health are at risk unless an adequate supply of appropriately trained food-supply veterinarians is available to counter a wide variety of threats ranging from animal and zoonotic diseases to bioterrorism.

Animals↗

PubMed1993

Facilitators and inhibitors of practice: a faculty perspective.

Nurse educators are being encouraged to integrate the role of faculty practice into the role expectations of the educational institution. Schools of nursing are faced with the challenge of facilitating faculty who wish to adopt the practice role. There are limited studies documenting factors that facilitate or inhibit faculty who engage in practice. This article presents the findings of a Delphi procedure used to collect the consensus of practicing faculty concerning organizational and personal facilitators and inhibitors of faculty practice. In this study, 299 faculty representing 170 schools of nursing completed all three rounds of the Delphi. The findings present the top five factors identified by practicing faculty as personal and organizational facilitators and inhibitors of their practice.

Adult↗

PubMed1990

Mastery in clinical occupational therapy.

This study sought to describe the characteristics of mastery in occupational therapy practice. A Delphi survey (i.e., an inquiry technique used to predict and define constructs [Linstone & Turoff, 1975]) of 33 occupational therapy experts was conducted to obtain their conceptions of the characteristics of occupational therapy mastery. Three master clinicians, identified by the expert respondents, were then interviewed to validate and illustrate the concepts of mastery identified in the Delphi survey. The results suggest that mastery is a combination of selected personal traits, creative and flexible judgment, the use of occupation as the foundation for practice decisions, and a strong commitment to occupational therapy practice. Further, mastery is expressed through a personal style that is unique to each clinical master.

Attitude of Health Personnel↗

PubMed2026

Strengthening the Reporting of Observational Studies in Epidemiology Enhanced Prevalence and Incidence Criteria (STROBE EPIC): An Extension of the STROBE Statement.

Prevalence and incidence are fundamental metrics with numerous applications in epidemiology. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline lacks specific items for reporting studies of disease prevalence or incidence. To address this gap, the STROBE Enhanced Prevalence and Incidence Criteria (STROBE EPIC) extension was developed in accordance with established methods for reporting guideline development. The authors generated an initial list of reporting items, conducted a modified Delphi process, and convened a face-to-face consensus meeting to confirm the need for a STROBE extension and to generate an early version of the checklist. They conducted 2 further Delphi surveys, first extending from typhoid and other invasive salmonelloses to all infectious diseases, and then to noncommunicable diseases and injuries. Finally, experts piloted the checklist on relevant manuscripts to critically assess if it was clear, concise, complete, and free of errors. An executive group curated the checklist after every survey round. The STROBE EPIC checklist comprises 47 items in the domains of title (1 item), abstract (2 items), introduction (1 item), methods (25 items), results (6 items), discussion (7 items), and other information (5 items). STROBE EPIC items address reporting of study design, adjustment factors for underreporting and underdiagnosis, denominator population estimation, case ascertainment methods, factors producing artefactual changes to observed disease prevalence or incidence, limitations of incomplete surveillance coverage, generalizability of short-duration studies, and data availability. The authors anticipate that the STROBE EPIC extension will be used by researchers, authors, modelers, burden-of-disease researchers, peer reviewers, and journal editors to optimize the presentation of epidemiologic evidence to support diverse health policy decisions.

Humans↗

PubMed1993

Health care administration in the year 2000: practitioners' views of future issues and job requirements.

This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.

Attitude of Health Personnel↗

PubMed1997

Management competencies for medical practice executives: skills, knowledge and abilities required for the future.

The purpose of this study was to obtain a consensus of opinion from a large and diverse population of experienced ambulatory health care administrators regarding the essential ambulatory health care management competencies, and their related skills, knowledge and abilities (SKA) requirements, that will be required for successful management performance in ambulatory health care delivery settings in the next five years. A literature review suggests limited research in this essential and rapidly developing area for the health care community. The research design and methods employed the Delphi technique. Three hundred and twenty (320) Fellows of the American College of Medical Practice Executives (ACMPE) were asked to respond to two rounds of a Delphi mail survey. The results indicate that the essential ambulatory management competencies could be discretely grouped into six Management Domains, each with related SKAs. The respondents rated leadership and strategic management as the most important Management Domains. The highest rated SKA emphasized interpersonal skills with the next highest SKA relating to ethical and moral dimensions. Patient care management, as well as two SKAs relating to computer skills, were rated lowest.

Ambulatory Care↗

PubMed2000

Membership by Assessment of Performance: developing a method for assessing established general practitioners.

Over 200 general practitioners (GPs) and others have contributed to the development of Membership by Assessment of Performance (MAP): a new scheme for assessing established GPs. By means of a Delphi consultation with a broad cross-section of the profession, a working conference, piloting with potential candidates, and repeated checking with reference panels, the assessment was developed within two years. We report the development of MAP, including the results of the Delphi consultation, which asked 'Which aspects of a general practitioners performance are important to assess?'.

Delphi Technique↗

PubMed2001

Development of a standardized, comprehensive "ideal drug detail".

OBJECTIVES: To develop a standardized, comprehensive ideal drug detail for use in face-to-face education about individual drugs. METHODS: A random sample of 603 physicians and pharmacists was selected and stratified to include input from each of the following specialties: family practice, internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, geriatric medicine and clinical pharmacology. Thirty-one potential items were generated by the investigators from a preliminary survey of a local convenience sample of physicians and pharmacists. A modified Delphi consensus process was used in the large sample to determine which items should be included in the ideal drug detail. In each round of the Delphi process, respondents rated each item on a seven-point scale of importance and were then given feedback of the cumulative ratings for each item. Rounds were continued until consensus was obtained on all items. RESULTS: The response rate to the first round was 55.3%; 85.5% of these respondents responded to the second round. Response rates varied between specialties from 44% to 70%. Attempts to contact nonresponders to measure potential nonrespondent bias were unsuccessful. Consensus was obtained on 19 items after the first round, and on the remaining 12 items after the second round. Four items were dropped because they were unimportant. There was variation in modal response between specialties on eight items. CONCLUSIONS: Consensus was obtained among a sizable and interested sample of Canadian physicians and pharmacists on the items of information needed to prescribe a drug appropriately. Subsequent work will refine this list into a usable template to develop ideal drug details for specific drugs, to develop an assessment process to measure quality of information, and to assess the impact of this program on prescribing and patient outcomes.

Adult↗

PubMed2001

[Evaluation of a leadership education at the Rigshospitalet. How an evaluation design can support organizational learning].

INTRODUCTION: The aim of the present study was to evaluate a Management & Leadership Education and Training Programme at the hospital before, during, and after implementation, allowing stakeholders to qualify alteration of the Programme as a process by using for instance formative evaluation. MATERIAL AND METHODS: The Delphi method is used for pre-evaluation of the concept of the Programme. Pre- and post-questionnaires were employed to measure the participants' adaptation of the hospital's "Management Fundamentals" before and after the Programme. RESULTS: The Expert panel stated that the Programme concept was pertinent and applicable. One hundred per cent recommended the Programme to be interdisciplinary. Eighty-two per cent stated that it would probably be difficult to acquire organisational learning. The results of the pre- and post-questionnaires showed that the participants and their superiors found that they adapted the hospital's "Management Fundamentals" better after having followed the Programme. DISCUSSION: With the use of the Delphi method (formative evaluation), the Programme concept could be altered already before implementation. The experts stated that they were not sure that the Programme would support organisational learning. Having this knowledge, it has been possible to work with activities supporting organisational learning already during implementation. In future, the experience with pre- and post-measurements will be used in a concrete way to support the learning environment in the organisation.

Decision Making↗

PubMed1992

Outcome measures for primary health care: what are the research priorities?

A Delphi technique was used to ask general practitioners for their opinions as to which clinical problems and types of measure they thought most appropriate for the development of outcome measures for use in primary health care. The study comprised two rounds of postal questionnaires, targeted at general practitioners in academic departments throughout the United Kingdom and at trainers in the northern region, with the second questionnaire feeding back opinions from the first. Ninety eight participants suggested one or more areas in which outcome measures could be developed, giving a total of 451 suggestions. Consensus produced in the second round indicated that three clinical conditions were preferred for the development of outcome measures: asthma, diabetes and hypertension. Six categories of outcome measures were developed from the responses given in the first round--level of function, level of clinical control, incidence of complications, iatrogenic problems, patient understanding of a condition, and quality of life. Participants gave these measures different levels of importance according to the clinical problem in question. This Delphi study of doctors' opinions is a first step in the development process of appropriate, practicable measures of outcome for use in primary care and has achieved a degree of consensus among general practitioners.

Attitude of Health Personnel↗

PubMed2004

A suggested fourth-year curriculum for medical students planning on entering family medicine.

BACKGROUND: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency. METHODS: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority. RESULTS: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency. CONCLUSIONS: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.

Clinical Clerkship↗

PubMedDate not supplied

Clinical skills for nurses in medical assessment units.

AIM: To identify the skills possessed by nurses working in medical assessment units (MAUs) and those that are needed to enable them to undertake a detailed, holistic assessment of the patient. METHOD: A qualitative study was undertaken using mixed methods to obtain data. A postal survey using Delphi methodology was sent to a group of advanced nurse practitioners educated at master's degree level. Four focus groups were conducted with 38 qualified nurses working in a MAU. FINDINGS: The first round of the Delphi survey identified 27 skills deemed pertinent to nurses working in this setting. A second round resulted in 11 skills and a further five skills for the most senior nurses were identified by the postal survey participants. Focus groups also identified skills that nurses working in MAUs should possess. There was widespread agreement between participants that the degree of expertise pertaining to each skill would be dependent on their experience in the clinical area and would reflect their seniority. CONCLUSION: There is broad agreement between a body of expert opinion and staff working in a MAU that there are core skills nurses working in MAUs should possess. The author plans to use the results of the study to develop future training in the MAU.

Clinical Competence↗

PubMed2005

Fibromyalgia syndrome.

The objectives of the first OMERACT Fibromyalgia Syndrome (FM) Workshop were to identify and prioritize symptom domains that should be consistently evaluated in FM clinical trials, and to identify aspects of domains and outcome measures that should be part of a concerted research agenda of FM researchers. Such an effort will help standardize and improve the quality of outcomes research in FM. A principal assumption in this workshop has been that there exists a clinical syndrome, generally known as FM, characterized by chronic widespread pain typically associated with fatigue, sleep disturbance, mood disturbance, and other symptoms and signs, and considered to be related to central neuromodulatory dysregulation. FM can be diagnosed using 1990 American College of Rheumatology criteria. In preparation for the workshop a Delphi exercise involving 23 FM researchers was conducted to establish a preliminary prioritization of domains of inquiry. At the OMERACT meeting, the workshop included presentation of the Delphi results; a review of placebo-controlled trials of FM treatment, with a focus on the outcome measures used and their performance; a panel discussion of the key issues in FM trials, from both an investigator and regulatory agency perspective; and a voting process by the workshop attendees. The results of the workshop were presented in the plenary session on the final day of the meeting. A prioritized list of domains of FM to be investigated was thus developed, key issues and controversies in the field were debated, and consensus on a research agenda on outcome measure development was reached.

Delphi Technique↗

PubMed2005

[A qualitative study for identifying determinants of the quality of stroke patient referral].

BACKGROUND: Referral of patients from acute to rehabilitation care is a key stage in the overall quality of stroke care. The aim is to choose the most appropriate care pathway taking into account patient needs and preferences, as well as constraints such as bed availability. The objective of the project was to identify factors contributing to the quality of transfer decisions. METHODS: Semi-directive interviews were conducted among health care professionals, patients and their relatives. From this work, a preliminary list of factors contributing to the quality of the referral decision was issued. In order to identify their pertinence and feasibility, these factors were re-phrased into criteria, and introduced into a Delphi questionnaire which was circulated twice among a panel of 39 health care professionals. RESULTS: At the end of the Delphi survey there was consensus about: the importance of the mutual knowledge between acute and rehabilitation teams, the possibility to call on rehabilitation competencies in order to define rehabilitation objectives while the patient is hospitalised in acute care, the attention given to patient preferences, and reliability of information exchange between teams. A consensus was reached for one of the six criteria regarding feasibility, specifically the awareness of admission procedures in rehabilitation wards. CONCLUSION: Establishing a list of selected criteria is a first step in the development of an evaluation tools which could be used within a network of health care structures involved in the care of stroke patients.

Critical Pathways↗

PubMed2006

Innovative approaches to obtaining community feedback in the Witness for Wellness experience.

BACKGROUND: Awareness of the need for innovative approaches to obtaining feedback in community-based participatory research (CBPR) is increasing. These innovative approaches should incorporate the core principles of CBPR, including equity and co-learning. Additionally, the methods should be culturally appropriate and inclusive of the community and academic partners. OBJECTIVE: To develop and implement two separate methods of obtaining community feedback for two activities in a CBPR initiative: 1) discussion of three work-group plans during a leadership council meeting; and 2) feedback from the work groups to the target community in a public setting. METHODS: In order to facilitate a feedback process for the discussion of 3 separate group action plans, an adapted version of the modified Delphi technique was used during which 42 community and academic partners voted and evaluated each plan both before and after group discussion. Results were immediately posted on a projection screen for the group to process. The second community feedback method incorporated the use of an audience response system (ARS) in order to obtain responses from 187 community participants after hearing summaries of the Witness for Wellness work-group action plans. More than 60% of the respondents added that the use of the handheld device made research seem more relevant and less intimidating. CONCLUSIONS: Both the use of the adapted modified Delphi process and ARS were effective in capturing community feedback related to two group activities in the Witness for Wellness initiative. Both methods also allowed participants to understand the role of research in a community setting.

Black or African American↗