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Scalable near-real-time Bayesian phylogenetics for outbreaks with Delphy.

Pathogen genomic analysis is central to tracking, understanding and containing outbreaks1-13, but the complexity and cost of state-of-the-art phylogenetic tools limit global access and impact. Here we introduce Delphy, an exact reformulation of Bayesian phylogenetics14-17 designed to transform its speed, scalability and accessibility while retaining Bayesian state-of-the-art accuracy. Delphy's central data structure, an explicit mutation-annotated tree, takes advantage of the high sequence similarity of large-scale epidemic datasets18-20 for efficient tree exploration and convergence. By reproducing key analyses from recent major epidemics, including Ebola1,21, Zika2, SARS-CoV-2 (ref. 22), mpox3,4 and H5N1 (refs. 23,24), we demonstrate state-of-the-art accuracy with up to 2-3 orders of magnitude improvements in speed. Assessing Delphy's scalability, we show that a simulated dataset of 100,000 sequences can be analysed within a day. We distribute Delphy as a client-side web application that enables local, interactive analysis of raw data on the user's machine. Delphy automatically identifies key viral lineages and mutations, as well as their emergence and prevalence through time, with quantified uncertainties grounded in Bayesian theory. Delphy establishes Bayesian phylogenetics as a fast, accessible frontline tool for future outbreak response.

Journal Article

Improving diagnostic accuracy: a comparison of interactive and Delphi consultations.

Consultation among physicians on difficult diagnostic problems is commonly used to improve the accuracy of medical decisions. Such consultation is most often informal and interactive. Nevertheless, behavioral studies suggest that non-interactive techniques may be more effective problem solving methods. Of these the Delphi approach, involving pooling and feedback of anonymously contributed information, has generated particular interest. To assess the relative effectiveness of independent decision making, interactive group consultation, and Delphi techniques in a clinical setting we compared the diagnostic accuracy of 17 radiologists interpreting radiologic examinations in these settings. Interactive consultation improved performance by 69% compared to radiologists interpreting the studies individually. In addition, two Delphi strategies each produced an additional 20% mean improvement in accuracy over interactive consultation. Whereas interactive consultation improved the accuracy of the best individual readers by only 6%, a Delphi model improved their performance by 25%. Thus, Delphi was an effective, easily applied method of clinical consultation whose usefulness in other clinical setting should be evaluated.

Decision Making

Delphi survey of priorities in clinical nursing research.

Using the Delphi technique, a panel of 433 nurse and nonnurse experts was surveyed regarding priorities for clinical research in nursing. Of these, 341 completed all four Delphi survey rounds. Three questions were studied: 1) Is this an area in which nursing should assume primary research responsibility? 2) How important is research on this topic for the profession of nursing? 3) What is the likelihood of change in patient welfare because of research on the topic? Although the nature and amount of data produced prohibited interpretation of the data or delineation of succinct conclusions about priorities for clinical nursing research, responses to the three questions supported these statements: The majority of research areas identified in the questionnaire are areas in which nursing should take research leadership. Although there is some overlap, priorities for professional significance and social or patient welfare relevance are different. In terms of professional significance, highest priority was given to items regarding measuring the quality of care, role, nursing process, and the research process. In terms of patient welfare, several programs of research are discernible in the items ranked in the top ten percent; these include nursing interventions related to stress, care of the aged, pain, and patient education. The Delphi technique also is described.

Evaluation Studies as Topic

Solutions for engaging priority populations in HIV cure research: a hybrid Delphi consensus-building process.

BACKGROUND: To achieve consensus on barriers and strategies to improve the engagement of three priority populations - Black and Latino/a/x individuals, cisgender women, and transgender women in HIV cure research. METHODS: We assembled a panel of 54 experts assigned to six groups in a hybrid Delphi process: (1) HIV community members, (2) biomedical researchers, (3) medical providers, (4) funders and private industry members, (5) bioethicists and regulators, and (6) social scientists. Over 18 months, we conducted four iterative survey rounds and three group discussions to identify barriers and strategies to arrive at a consensus on how to engage these priority populations in HIV cure research. RESULTS: For Black and Latino/a/x populations, the panellists identified inadequate outreach and a lack of accessible educational information as primary barriers and emphasised community-driven engagement and partnerships with trusted leaders as key strategies. For cisgender women, logistical hurdles, caregiving responsibilities and time constraints were identified as major barriers, with flexible trial designs and equitable compensation proposed as solutions. For transgender women, the lack of transgender-focused research design, including misrepresentation and exclusion, was identified as a key barrier, while centring transgender-specific needs in study design achieved consensus as the most effective strategy. CONCLUSION: Among all four priority populations, investment in outreach, engagement along the research process, better integration of health needs with research, and enhanced incentives are not novel ideas, but remain obviously ignored in a way that has led to underrepresentation of people in HIV cure research, who carry the greatest burden of HIV in the U.S. SUMMARY: This paper uses a hybrid Delphi process to identify and reach consensus on key barriers and strategies to engage underrepresented groups: Black and Latino/a/x individuals, cisgender women, and transgender women in HIV cure research across the United States.

Humans

Time to subsequent therapy (TTST) as an endpoint in clinical studies: development of standardized documentation of subsequent therapy through systematic literature review, expert interviews, and Delphi survey.

BACKGROUND: The endpoint Time to Subsequent Therapy (TTST) is an intermediate endpoint used in research and regulatory assessments. TTST denotes initiation of subsequent therapy and is a clearly definable, clinically relevant event for healthcare professionals. However, it has not been systematically established to which extent TTST is subjectively meaningful to patients. The objective of this study was to define TTST as a patient-relevant intermediate endpoint. METHODS: The study examined five oncological indications (breast cancer, prostate cancer, melanoma, multiple myeloma, and non-small cell lung cancer) using a systematic literature review, analysis of case report forms used in international randomized controlled trials, review of German Federal Joint Committee (G-BA) documents, semi-structured interviews and a two-stage Delphi survey with healthcare professionals, patients, and relatives. RESULTS: A total of 35 individuals participated in qualitative interviews. Most of them rated TTST as particularly significant. The Delphi Survey included 264 interviewees in round one, and 117 in round two. Patient-relevance of TTST was confirmed by 81% of respondents (95% confidence interval 76%, 85%). Nine treatment scenarios that justify TTST were identified. To capture patient-relevance, prospective collection of reasons for and consequences of therapy change are required. A checklist with standardized response formats plus free-text fields was developed: a comprehensive master checklist for flexible, complete documentation and a short version focused on therapy change-specific items. CONCLUSIONS: TTST is an intermediate endpoint whose systematic documentation of characteristics demonstrating patient-relevance can be standardized in research and clinical practice using the developed checklists.

Humans

Burn nursing Delphi study: pain management.

In 1989 a Delphi study was undertaken to identify the nursing priorities in burn research. The Delphi technique is a series of questionnaires used to reach consensus. Ninety-four nurses involved in burn care completed four rounds of questionnaires containing 101 research questions. This, the seventh and final report, concerns a significant area of burn research, which is pain management. Eleven (10%) of the 101 questions dealt with pain, whereas five were rated among the top 20 priority questions. As a category the questions concerning pain management had a mean score of 5.91 on a 0 to 7 Likert scale. The questions collectively were cited as having the most impact on the welfare of the patient with burns.

Analgesics

Nursing research priorities for the care of the naval hospital patient: a Delphi survey.

The purpose of this study was to identify priorities for nursing research in a naval hospital using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program at a regional medical treatment facility. Via a three-round Delphi survey, priority research questions were identified for the nursing department of a naval regional medical treatment facility. A serendipitous result was the identification of nursing research priorities within a deployed naval fleet hospital.

Delphi Technique

Complete primary structure of the major component myoglobin of Pacific common dolphin (Delphinus delphis).

The complete amino acid sequence of the major component myoglobin from Pacific common dolphin, Delphinus delphis, was determined by the automatic Edman degradation of several large peptides obtained by specific cleavages of the protein. More than 80% of the covalent structure was established by the degradation of the apomyoglobin and five peptides from: (1) cyanogen bromide cleavage at the two methionine residues, (2) trypsin cleavage of the acetimidated apomyoglobin at the three arginine residues, and (3) 2-p-nitrophenylsulfenyl-3-methyl-3'-bromoindolenine cleavage at the two tryptophan residues. The rest of the sequence was determined by use of the peptides prepared from further digestion of the central cyanogen bromide peptide with staphylococcal protease and trypsin. The primary structure of this myoglobin proved identical with that from the Atlantic bottlenosed dolphin, Tursiops truncatus, but showed four substitutions with respect to the sequence reported for the Black Sea dolphin which has also been given the designation Delphinus delphis.

Amino Acid Sequence

Using Delphi to achieve congruent objectives and activities in a pediatrics department.

This study demonstrated the use of the Delphi technique in conjunction with activity analysis to obtain consensus on and clarity of objectives and activities of full-time members of an academic medical department. The results indicated that the Delphi technique is an effective method not only for obtaining a consensus on objectives but also for elucidating areas where there is no apparent consensus. The results also revealed which activities contributed to the objectives of the department and in which areas there was a divergence of objectives from the actual activities being carried out.

British Columbia

Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network.

INTRODUCTION: The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption. This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. METHODS: A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall's W coefficient was used to assess concordance. RESULTS: High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. CONCLUSIONS: This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre's context, case volume, and available resources.

Cirugía Asistida por Robot

The musculoskeletal pain literacy questionnaire (MSK-PLq) - Part 1: Development of a preliminary version through a systematic review and Delphi consensus.

OBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq). METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (≥70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity. RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity. CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.

Humans

The future of hypnosis through the remainder of the decade: a Delphi poll.

We predicted the future of hypnosis for the next 10 years using the Delphi method--the best available forecasting tool. A panel of 89 experts in the field of hypnosis completed a 44-item questionnaire that addressed future developments in these areas: (1) training and preparation, (2) general applications of hypnosis, (3) theory, and (4) research. Also predicted was the likelihood of occurrence of certain cogent events in the field. Results indicated probable increases in emphasis in nearly all areas surveyed. We also solicited nominations for major contributors to the field of hypnosis, major books on hypnosis, and journals most likely to publish articles on hypnosis.

Adult

Developing a certificate course for hospice nurses: a Delphi survey of subject areas.

A Delphi survey of 16 national experts in hospice nursing was conducted to address which subject areas were the most important to include in a certification course for hospice nurses. The three-round survey elicited 70 subject areas which were ranked in order of importance according to the group opinion of the panel of experts. The means, average deviations, standard deviations, and variances for each rank were calculated. The panel showed a high degree of consensus and there was little change in ranking after the second round. The survey produced results that should be of interest to organizations concerned with developing certification courses and examination procedures for hospice nurses.

Adult

Organizational factors to consider when developing a certification program for hospice nurses: a Delphi survey.

A Delphi survey of 16 national experts in hospice nursing was conducted to address the question of which organizational factors should be considered when developing a certification program for hospice nurses. The three-round survey elicited many factors to consider which were arranged by category and ranked in order of importance according to the group opinion of the panel. The means, average deviations, standard deviations, and variances for each factor were calculated. The panel showed a high degree of consensus and there was little change in ranking after the second round. The survey produced results that should be of interest to organizations concerned with developing a certification program for hospice nurses.

Certification

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel.

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.

Humans

Research priorities of VA nurses: a Delphi study.

The purpose of this study was to conduct a Delphi survey of a sample of Gainesville Veterans Affairs Medical Center staff and head nurses. The study consisted of three rounds of questionnaires completed by the nurses as they identified and narrowed the most pressing nursing research questions. Results indicated that in five of the six clinical settings, despite investigators' instructions to identify clinical nursing research questions, administrative research questions were identified and ranked consistently higher in priority than clinical research questions. The single exception was in home care, where clinical questions received the highest priority. This phenomena may suggest that institutional constraints interfere with nurses' full expression of their clinical practice.

Attitude of Health Personnel

Developing criteria for quality of assessment: effect of the Delphi technique.

We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The second round of criteria selection, with the first-round summary available, produced few and relatively minor changes in the items chosen by group consensus.

Ambulatory Care