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PubMed1984

Natural history of intestinal parasites in asymptomatic adults.

The need to treat asymptomatic adults who have intestinal parasites should be based on considerations of potential pathogenicity and transmission risk, but such data are sparse in general and unavailable for countries such as the United States, where reinfection is rare. Opinions of North American physicians about the natural history and treatment of 12 parasites detectable by stool examination were assessed using the Delphi technique. In response to the first questionnaire, majority agreement on pathogenic potential was achieved for only 3 of 12 parasites. When the more expert group was queried a second time, majority agreement was achieved for 8 of 12 parasites. Nevertheless, the predicted risk of subsequent disease still varied widely, from 1:10 to 1:1,000 for most parasites, and was unrelated to the perceived need for treatment. Almost all respondents thought asymptomatic adults with any intestinal parasites should always be treated. Transmission risk was judged to be low and was generally appropriate to the life cycle of the parasite.

Adult↗

PubMed1981

Quality of life in benefit-cost analyses of rehabilitation research.

Traditionally, benefit-cost (B-C) models have been limited to the consideration of monetary benefits. This approach has been motivated by the fact that nonmonetary benefits are difficult to define and to quantify. Derived from the general theory of B-C analysis, a model is described which includes 3 categories of benefits, identified by a Delphi-like procedure administered to a broad representation of persons involved in the rehabilitation process. Whereas monetary benefits have the dollar readily available as a unit of measurement, scales for nonmonetary benefits must be developed. Methods for estimating the value and the relative importance of the various benefits are analyzed and a procedure for combining monetary and nonmonetary benefits is proposed.

Delphi Technique↗

PubMed1981

A response to the interdisciplinary continuing education dilemma.

The paucity of interdisciplinary continuing education activities and the lack of a mechanism for developing collaborative efforts between and among disciplines are important concerns of continuing health educators. Interested parties in Virginia have established an organization, the Virginia Association for Continuing Education in the Health Professions (VACEHP) to address these concerns. The mission of this association is to meet the needs of planners of continuing education in health fields. The purpose of this article is twofold: to provide background information regarding the origin of VACEHP and to relate the methodology and findings of a Delphi study conducted to assess the needs of the association's membership. The findings of the study are being used by VACEHP to chart a course for developing a statewide interdisciplinary network for continuing education in the health professions.

Delphi Technique↗

PubMed1995

Desired competencies of doctorally prepared allied health faculty.

In 1994, a two-round adaptation of the Delphi method was used to assist deans of the Association of Schools of Allied Health Professions (ASAHP) institutional member schools offering programs at the baccalaureate level or higher to determine important competencies for future doctorally prepared allied health faculty. Thirty-six of the 68 deans invited to participate completed the second questionnaire. Statistical analysis on the frequency of responses and calculated mean responses, including one-sample Z-tests and adjusted p-values, identified 21 important competencies. This information should be considered by universities in the development or modification of graduate program curricula for the preparation of allied health faculty.

Allied Health Personnel↗

PubMed1995

Is consensus reproducible? A study of an algorithmic guidelines development process.

The authors evaluated the reproducibility of a clinical algorithm consensus development process across three different physician panels at a health maintenance organization. Physician groups were composed of primary care internists, who were provided with identical selections from the medical literature and first-draft "seed" algorithms on the management of two common clinical problems: acute sinusitis and dyspepsia. Each panel used nominal group process and a modified Delphi method to create final algorithm drafts. To compare the clinical logic in the final algorithms, the authors applied a new qualitative and quantitative comparison method, the Clinical Algorithm Patient Abstraction (CAPA). Dyspepsia algorithms from all physician groups recommended empiric anti-acid therapy for most patients, favored endoscopy over barium swallow, and had very similar indications for endoscopy. The average CAPA comparison score among final physician algorithms was 6.1 on a scale of 0 (different) to 10 (identical). Sinusitis algorithms from all groups proposed empiric antibiotic therapy for most patients. Indications for sinus radiographs were similar between two algorithms (CAPA = 4.9), but differed significantly in the third, resulting in lower CAPA scores (average CAPA = 1.9, P < 0.03). The clinical similarity of the algorithms produced by these physician panels suggests a high level of reproducibility in this consensus-driven algorithm development process. However, the difference among the sinusitis algorithms suggests that physician consensus groups using a consensus process that a health maintenance organization can do with limited resources will produce some guidelines that vary due to differences in interpretation of evidence and physician experience.

Acute Disease↗

PubMed1994

[An index of HIV infection risk in the population].

The paper presents a risk index constructed on the basis of some sexual behaviour-related variables. It is intended for measuring the risk of exposure to HIV infection for the general population. Variables are from a study on Lifestyle and Health conducted on a sample of the population living in the London, Edinburgh, and Glasgow metropolitan area by the Research Unit in Health and Behavioural Change at the Edinburgh University. The construction of the index has been realized through a delphi study which has collected information from a panel of AIDS national experts. Methodological problems in summarising information coming from several variables are discussed. The main task of the study is not to provide a total prediction of HIV infection in the population of Britain, but to assess the component which may stem from sexual behaviours when estimated from self-reports. Major findings are the consistency of the population in the "medium risk" group, that, if a spread of AIDS among the heterosexual population can be hypothesized, gives a rather pessimist scenario. Moreover, a trend analysis (possible because of the continuity in the data collection) shows an increase in this "medium risk" group, although the "high risk" group appears much less consistent (less than two percent) and slowly declining over time.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Development of chiropractic nomenclature through consensus.

OBJECTIVES: The establishment of nomenclature is a sign of maturity in any field. Each discipline formally adopts or sanctions the terminology based by its practitioners. METHODS: Description of the development of chiropractic nomenclature through consensus methodology. A model was designed as an algorithm to outline steps leading to broad geographical and philosophical agreement. RESULTS: Moving through a regional nominal panel to an international Delphi panel, consensus at the 80% level of agreement was obtained for 10 terms and definitions commonly used by the chiropractic profession. CONCLUSIONS: It is recommended that the chiropractic profession adopt the 10 terms and definitions that reached the 80% consensus level as part of chiropractic nomenclature.

Algorithms↗

PubMed1994

Inappropriate medication use in community-residing older persons.

BACKGROUND: Elderly patients taking inappropriate drugs are at increased risk for adverse outcomes. We investigated the prevalence of inappropriate drug use and its predisposing factors in community-residing older persons. METHODS: We conducted in-home interviews with 414 subjects aged 75 years and older living in the community of Santa Monica, Calif. Inappropriate medication use was evaluated using explicit criteria developed through a modified Delphi consensus process. These criteria identified drugs that should generally be avoided in elderly community-residing subjects regardless of dosage, duration of therapy, or clinical circumstances. RESULTS: Based on these conservative criteria, 14.0% of the subjects were using at least one inappropriate drug. The most common examples were long-acting benzodiazepines, persantine, amitriptyline, and chlorpropamide. Subjects using three or more prescription drugs, compared with one or two, were more likely to be taking an inappropriate medication (odds ratio, 3.9; 95% confidence interval, 1.9 to 7.9). Furthermore, subjects with depressive symptoms had a higher risk of receiving inappropriate medications than nondepressive subjects (odds ratio, 2.2; 95% confidence interval, 1.1 to 4.1). CONCLUSIONS: Inappropriate drug use is a common problem in community-residing older persons. The risk of inappropriate drug use is increased in patients taking multiple medications and in patients with depressive symptoms.

Age Factors↗

PubMed1994

Dimensions associated with successful implementation of a hospital based integrated order entry system.

Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.

Attitude of Health Personnel↗

PubMed1994

Consensus development for producing diagnostic procedure guidelines: SPECT brain perfusion imaging with exametazime.

UNLABELLED: A method for developing diagnostic practice guidelines is presented in which a team of experts used a semiquantitative scoring system to reach consensus on a standard procedure for SPECT cerebral perfusion imaging. METHODS: An expert panel generated a list of elements that they thought were important for the optimal performance of cerebral perfusion imaging as the first phase of a modified Delphi panel technique. Panel members then scored each statement to indicate the importance of that statement for the performance of cerebral perfusion imaging. The scores were recorded for each statement and the average score, s.d. and variance for each statement were determined for each successive panel round. A total of three panel rounds were conducted. The change in average s.d. between scoring rounds was analyzed for significance using both parametric and nonparametric tests. RESULTS: The average s.d. decreased by 35% from 2.1 to 1.32 between the first and final panel round. This change in average s.d., which indicated enhanced consensus, was significant at p < 0.0001. Following consensus, all statements were grouped into four categories based on average score: critical elements, important elements, less important elements and elements of uncertain importance. This grouping formed the basis for a guideline summary narrative. Results were generated in 3 mo, at low cost and with clear documentation of rationale. CONCLUSION: Through simple adaptations of this methodology, expert panels that develop practice guidelines can replace informal discussion with systematic scoring methods to rate the quality of evidence, generalizability to practice conditions, appropriate indications and strength of recommendations.

Brain↗

PubMed1994

Research priorities for all phases of postanesthesia nursing: a survey by ASPAN.

This ASPAN survey was conducted by Research Committee members regarding the future of research for postanesthesia nursing and asked this question: What do postanesthesia nurses view as priorities for postanesthesia nursing research in various phases of practice? The design for the study was the Delphi technique, which uses a multiple, sequential survey to reach consensus among a group of experts. Four rounds of questionnaires were used to survey volunteer participants (N = 54). The group of experts remained stable (N = 41) for rounds 2 through 4. Findings from the survey indicated several areas of priorities for postanesthesia nursing. Of the top 10 ranked statements, 4 related to discharge criteria. Another high-priority area identified was pain management, with 5 statements pertaining to this subject being ranked in the top 10. Based on this small sample of postanesthesia nurses, this study provides a beginning step for prioritizing areas of research necessary to expand the body of knowledge for postanesthesia nursing.

Adult↗

PubMed1994

Data needs for decision support of chief nurse executives.

The dynamic changes in healthcare require accurate data on which chief nurse executives can base their decisions. Once these data are available, they must be organized efficiently to assist with decision making. The author presents the results from a national Delphi study, in which data elements for the decision support of chief nurse executives were delineated.

Data Collection↗

PubMed1993

Identifying nursing research priorities in an acute care hospital.

The purpose of this study was to identify nursing research priorities for an acute care hospital. Using the Delphi technique, data were obtained from a panel of 52 nurses who held administrative, staff, or support positions. After three rounds of data collection, a prioritized listing of potential research topics was obtained. The study results have helped motivate and guide research efforts, stimulate formation of research interest groups, and attract local researchers to the facility.

Attitude of Health Personnel↗

PubMed1993

Academic nurse leaders' interpretation of concepts and priorities related to the examination of scientific short papers, dissertations and theses--Part 1.

The purpose of this study was to establish whether there is agreement among academic nurse leaders in their interpretation of aspects and criteria related to the examination of scientific short papers, dissertations and theses. The Delphi technique was selected as the most appropriate method of data-collection for this type of study. The target population identified for this study consisted of the Heads of Nursing Departments or their delegates from the 18 universities of the four provinces of the RSA, self-governing and independent states of Southern Africa and Namibia, which offer nursing degrees. Three rounds of questionnaires were sent to all heads of the 18 identified nursing departments. Participation was poor (nine participated in first round, nine in second the third round, no further rounds of questionnaires were sent due to the waning interest and poor participation. Many divergent responses were received to most of the aspects included in the study. This indicates that with a few exceptions there is little or no agreement among academic nurse leaders in their interpretation of aspects and criteria relating to the examination of post-graduate scientific or academic treatises.

Academic Dissertations as Topic↗

PubMed1994

[Assessment of indications using the RAND method: invasive therapy in coronary sclerosis as an example].

OBJECTIVE: To assess indications for performing medical procedures for their appropriateness, using a method designed by an American research institute, RAND. DESIGN: Delphi investigation SETTING: The Netherlands. METHOD: The RAND method was applied in the 'Dutch inventory of invasive coronary atherosclerosis treatments' study which concerns treatment choices in coronary artery disease: coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA) and conservative treatment. Essential in the RAND method is the construction of a comprehensive matrix of potential indications. Each indication entails a comparison of two or three treatment options. A panel of 12 experts rated each indication in a two-stage process. When the majority of the panelists agreed that treatment option X was strongly to be preferred over Y, it was considered appropriate to perform X and inappropriate to perform Y. RESULTS: The experiences with the RAND method indicated that panelists judged critically and rated many indications for invasive treatment options as inappropriate or uncertain. The method was feasible, although not easy, and produced clinically valid results. CONCLUSION: The RAND method is especially useful when medical literature does not supply sufficient grounds in rating the appropriateness of an indication for medical procedure. However, the verdict 'appropriate' is not eternal. Medical science keeps evolving.

Angioplasty, Balloon, Coronary↗

PubMed1996

[Computerization and nursing: in search of an ideal!].

The computerized systems that are currently available are frequently incompatible with the specific information needs of nursing practice (Grassert, 1990). It is not currently possible to analyze the computerization requirements of nursing practice, since we do not know towards what ideal situation the process of computerizing nursing should be evolving. This makes it impossible to measure the gap between the status quo and the ideal situation. This methodological study described the desired situation by identifying 43 criteria for ideal management procedures and the handling of data needed in nursing practice. Criteria were validated using the DELPHI technique on a non-probablist sampling of 22 nurses who had developed some expertise in computerization in nursing. The study paves the way for conducting a needs assessment, then measuring the capacity of current systems to meet specific needs in terms of management and handling of nursing data.

Attitude of Health Personnel↗

PubMed1997

Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy. Appropriateness Project Investigators. Academic Medical Center Consortium.

OBJECTIVE: To examine specifically the influence of estimated perioperative mortality and stroke rate on the assessment of appropriateness of carotid endarterectomy. DATA SOURCES/STUDY SETTING: An expert panel convened to rate the appropriateness of a variety of potential indications for carotid endarterectomy based on various rates of perioperative complications. We then applied these ratings to the charts of 1,160 randomly selected patients who had carotid endarterectomy in one of the 12 participating academic medical centers. STUDY DESIGN: An expert panel evaluated indications for carotid endarterectomy using the modified Delphi approach. Charts of patients who received surgery were abstracted, and clinical indications for the procedure as well as perioperative complications were recorded. To examine the impact of surgical risk assessment on the rates of appropriateness, three different definitions of risk strata for combined perioperative death or stroke were used: Definition A, low risk < 3 percent; Definition B, low risk < 5 percent; and Definition C, low risk < 7 percent. PRINCIPAL FINDINGS: Overall hospital-specific mortality ranged from 0 percent to 4.0 percent and major complications, defined as death, stroke, intracranial hemorrhage, or myocardial infarction, varied from 2.0 percent to 11.1 percent. Most patients (72 percent) had surgery for transient ischemic attack or stroke; 24 percent of patients were asymptomatic. Most patients (82 percent) had surgery on the side of a high-grade stenosis (70-99 percent). When the thresholds for operative risk were placed at the values defined by the expert panel (Definition A), only 33.5 percent of 1,160 procedures were classified as "appropriate." When the definition of low risk was shifted upward, the proportion of cases categorized as appropriate increased to 58 percent and 81.5 percent for Definitions B and C, respectively. CONCLUSIONS: Despite the high proportion of procedures performed for symptomatic patients with a high degree of ipsilateral extracranial carotid artery stenosis and generally low rates of surgical complications at the participating institutions, the overall rate of "appropriateness" using a perioperative complication rate of < 3 percent was low. However, the rate of "appropriateness" was extremely sensitive to judgments about a single clinical feature, surgical risk. These data show that before applying such "appropriateness" ratings, it is crucial to perform sensitivity analyses in order to assess the stability of the results. Results that are robust to moderate in variation in surgical risk provide a much sounder basis for policy making than those that are not.

Academic Medical Centers↗

PubMed1997

Moving toward a core curriculum in Schools of the Allied Health Professions: knowledge and skills considered important by department chairs in four disciplines.

An adaptation of the Delphi method was used in four parallel studies to survey chairs of baccalaureate programs in clinical laboratory sciences, health information management, occupational therapy, and physical therapy in schools of the allied health professions which held membership in the Association of Schools of the Allied Health Professions. The purpose was to assist the chairs in coming to consensus regarding requisite knowledge and skills of graduates beyond those required for professional accreditation and credentialing, and prerequisite or cognate courses that may be utilized to develop them. Three rounds of questionnaires were administered to each group. The final round was completed by 45 chairs in clinical laboratory sciences (83% of the population); 18 in health information management (86%); 18 in occupational therapy (56%); and 24 in physical therapy (67%). Statistical analysis of third round responses via one-sample, one-sided Z tests indicated consensus among the chairs in the four disciplines on 16 items of knowledge and skills as most important for graduates. Similar consensus was not evident, however, regarding courses to develop the knowledge and skills, with only two courses considered most important by all four groups of chairs.

Allied Health Personnel↗