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There is a major focus in health reform in Australia and internationally on monitoring and reporting organisational performance measures, such as standardised mortality rates, in different clinical areas. Given the increasing reliance on existing data for measuring mortality rates, it is important that the accuracy and validity of data are high. Yet, researchers have demonstrated limitations in measuring in-hospital mortality to evaluate intensive care, as it can lead to skewed measurements depending on the discharge practices of different organisations. In Australia, the intensive care clinical registry does not currently measure survival outcomes of patients after hospital discharge but there is interest in doing so. While administrative data sources have the ability to assess outcomes of intensive care patients after hospital discharge, these data may not have sufficient clinical detail to enable robust risk adjustment. Data linkage can be used to link clinical registry and administrative data to enable the measurement of long-term outcomes while using clinical variables to enhance risk-adjustment. However, linkage must be conducted in a robust fashion so that additional error introduced from sub-optimal linkage processes will not bias results. The main aim of the thesis is to assess the utility of linked administrative and clinical data compared to administrative alone and clinical data alone for monitoring long term survival outcomes of ICU patients. The objectives of the thesis are: 1) to define key attributes of linked data for assessing the quality of study results; and 2) to compare the use of linked data to administrative data alone and clinical data alone for a) predicting survival of intensive care patients at 180 days after discharge and b) assessing systematic variation between observed and expected deaths. There were two projects involved in this thesis to address aims 1 and 2, respectively. The first project involved a Delphi consensus process including Australian experts to develop standardised reporting guidelines for assessing the quality of data linkage studies. The resulting guidelines included a list of fourteen items. The guidelines were then applied by two researchers to a stratified selection of data linkage studies to assess their inter-rater reliability (k=0.6). The second project involved the linkage of the Victorian Admitted Episodes Dataset to the Australian/New Zealand Intensive Care Society clinical database of adult critical care patient episodes in the state of Victoria. The linkage procedure was validated to determine whether sources of bias were introduced into the dataset through linkage processes. The added predictive capabilities of the full linked dataset were compared to a model using the administrative data only (C=0.85 v 0.75), a model using the clinical data only (C=0.85 v. 0.84) and a model using a limited sub-set of linked data (C=0.85 v 0.83). Variable Life Adjusted Display (VLAD) charts were developed using both of the linked, administrative and clinical predictive models to determine whether the linked data enhanced the capacity for detecting systematic variation in mortality ratios. It was found that the use of data linkage can enhance the measurement of long-term mortality indicators in intensive care by improving the accuracy of data, risk prediction models and methods for displaying systematic variation in death ratios. Yet, these benefits must be considered together with the limitations of the data, which can influence the accuracy of the linkage process. Identifying and reporting these issues will help to improve data quality and linkage in the future.

Purpose: The purpose of this study was to develop the adapted standard items of situation, background, assessment, recommendations (SBAR) processing for handover between nursing units in Korean hospitals and evaluate the validity and relevance of the standard items.Methods: A delphi method with 33 experts was used to evaluate content validity of the standard items. Then, 1,175 nurses working in general hospitals of more than 500 beds were recruited to evaluate the validity and relevance of the standard items for clinical implication. Results: Content validity was higher than 0.8. The highest scores for relevance among items in handover standards were state of consciousness in the assessment domain for a ward to a ward transfer (3.82±0.40), for a ward to an ICU (3.85±0.38), an ICU to a ward (3.81±0.39) and an ER to a ward (3.85±0.37). Congenital malformation was the highest relevance score for handover from a delivery room to a neonatal unit (3.91±0.30). Conclusion: This study evaluated validity and relevance of the essential contents for handover standards between units to improve communication quality among nurses. The findings of this study should also be applied in clinical nursing areas and the quality of information and effectiveness of usage of the standard should be evaluated.

Consensus on a Specialist Clinical Learning and Teaching Framework for Australian Nurse Practitioners

Implementing sustainability into global supply chains remains a challenge for companies. Purchasing and Supply Management (PSM) interacts closely with supply network actors, thus influencing how the firm’s value creation is delivered. While previous sustainable PSM (SPSM) research has shed light on how to manage sustainability on an organisational level, the role and impact of individual purchasing professionals on SPSM is less well understood. Their contribution to SPSM depends on both: they must be qualified, and they must be allowed to integrate sustainability in their daily work. Models from organisational psychology consider individual competence as one determinant for behaviour in organisations, together with motivational factors and enablers through the organisation. Transferred to the SPSM context, competences of purchasing professionals contribute to sustainable behaviour in the organisation. This thesis set out to understand individual SPSM competences, with the aim to foster their integration in the daily work of purchasing professionals, finally contributing to the implementation of sustainability in supply chains. It strived for an answer to the central research question: “Which individual competences of PSM professionals are required to implement SPSM?”, with the objectives to develop a SPSM competence model and to design a SPSM training module. A multi-method approach rarely applied so far in the PSM field was used to gather SPSM competences. First, a systematic literature review (SLR) determined the current research coverage of SPSM competences. Second, a Delphi study was conducted with 16 experts in the field of PSM and sustainability, applying the critical incident technique (CIT). A systematic qualitative data analysis led to a set of 26 SPSM competences. These were consolidated in a competence model, highlighting functional, cognition-oriented, social and meta-oriented competences. Familiar denominations of competences were corroborated with specific descriptions in terms of their application in the specific SPSM context. Third, the SPSM competences were transferred into a training module, which was tested in an action research approach with students and purchasing professionals. The findings of this research help companies to better cope with the implementation of sustainability in global supply chains, as individual SPSM competences, being one major determinant of SPSM behaviour, are now much more transparent. Firms may use the competence model and the training module as blueprints and adapt them to the individual organisational context. For Higher Education, the thesis offers inspiration how to integrate sustainability into PSM curricula by focusing on the most important competence areas. In addition, by applying models from educational sciences and organisational psychology in the PSM context, the research intends to foster an interdisciplinary debate on SPSM competences. Finally, future research might look for answers to the hypothesis that SPSM competences point towards a general competence profile for PSM professionals that is necessary to be able to cope with future challenges in the field.

Research Designs and Methodologies Related to Pharmacy Practice

In this research, we have tried to find out what pre-service teachers’ geography competences are required who were graduated from social science teaching program. Delphi technique was used in order to reach to the defined aim. In this technique we try to come to an agreement on a common opinion by implementing consecutive questionnaires to the related area experts. In this research how geography area competence for social studies teaching is defined by Delphi technique is explained step by step. For this research, initially rate definition of Geography Bu calismanin bir kismi doktora tezinden yararlanilarak olusturulmustur.courses that included in 1998 and 2006 years Social Studies Teaching Program and Primary Social Studies Teaching Curriculum (2005) and American Social Studies National Council’s geography standards were examined. Info form created after these examinations were reached to 70 academicians who are studying at Geography, Geography Teaching and Social Studies Teaching Programs in 22 different universities. After getting feedbacks from these participants, nd questionnaire form was created by analyzing 35 questionnaires and sent back to the participants. After the second round it was defined that agreement on questionnaire items were provided and results were presented.

İlköğretim Sosyal Bilgiler ve Fen Bilgisi Öğretiminde Öğretmenlerin Dersin Geliştirme Bölümü Etkinliklerine İlişkin Öğrenci Görüşleri

The aims of this development research is to produce entrepreneurship learning model based onthe valid contextual, practical and effective.The research follows the design of model of the Branch (2009). There are five steps from the design model of the Branch (2009), namely; analysis, design, development, implementation and evaluation (ADDIE). To collect the data, the instrument that writer used are the observation, instrument validation and test sheets. To validate instrument products, expert assessment of the strategies are chosen by using the delphi technique and continued with exploration of the feasibility which is applied by using focus group discussions technique. The data will be analyzed through qualitative and quantitative techniques. In order to get the book of entrepreneurship learning model and the guidebook based on the contextual, the data were analyzed by using qualitative and quantitative methods. The validity of the product are tested by expert, the practical test by the user, and the effectiveness test trought the students learning outcomes. The results of the development consists of (1) book-entrepreneurship learning model based on contextual, (2) the lecturers’ guidebook of entrepreneurship learningmodel based on contextual, (3) Student Handbook learning model based on contextual is valid, practical and effective.

Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation

This study aims to identify and propose the most appropriate risk management tools for automotive suppliers, considering the tools listed in ISO 31010 and the risk assessment steps in ISO 31000. A bibliometric analysis was performed on 223 articles published in the Web Of Science (WoS) scientific research base on Supply Chain Risk Management (SCRM) and “Suppliers”. Subsequently, a systematic literature review was prepared for the topics associated with risk management, supply chain, supplier risk, ISO 31000 and ISO 31010, as well as Delphi and AHP research methods. For the execution of this study, a multinational company located in the city of Porto Real / RJ was selected, which is the supplier of parts for the car makers PSA Peugeot Citroen, Nissan, Volkswagen and FIAT. It was used as methodology for this research the Delphi and AHP tools. The AHP method was applied with the help of 7 experts working in the selected industry for this research, and the Delphi tool was executed with the participation of 20 suppliers from this same organization. For both methods, experts with knowledge in the area of risk management and supply chain were selected. The last step of this research is to apply the prioritized SCRM tool FMEA to one of the model company suppliers. As a result of this study, the definition and prioritization of the most suitable tools for use in the SCRM of automotive supply chain suppliers is expected, under the assumption that ISO 31000 can be used as a systematic process for risk management. supply chain and the more than 30 tools listed in ISO 31010 will be evaluated. This result should be proven through the analysis, evaluation, selection and application of this tool, using the proposed methodology.

Medical centers (that is, hospitals and clinics) in metropolitan areas produce substantial amounts of hazardous waste in both solid and liquid (wastewater) forms. Unless medical centers manage their waste with appropriate care, the significant hazards posed to urban residents and areas far outweigh the benefits of their services. Therefore, comprehensive environmental management programs need to be developed in order to minimize the associated impacts and improve environmental performance. In addition to identifying the environmental consequences, developing a comprehensive performance assessment program requires a deep understanding of the factors involved and their corresponding shares. Thus, the aim of this paper is to model environmental performance assessment in urban medical centers. Firstly, relevant criteria, sub-criteria and indicators were identified using the Delphi method. Next, Fuzzy Analytical Hierarchy Process (AHP) was applied to rank the factors and a balanced scoring was established to model the environmental performance assessment in medical centers. The adequate consistency index confirms Fuzzy AHP accuracy and consequently, the scores. The model was applied in Sarem Specialized Hospital in Tehran, Iran. The results indicate that the hospital has good environmental performance. The results show that the waste disinfection indicator, was rated the highest and most important index with a score of 84.The other indicators were ranked in terms of treated sewage and source separation of waste and application of mechanisms to control water consumption respectively with scores of 38, 26.5 and 25.

The Delphi method is a combination of qualitative and quantitative forecasting evaluation method. It draws the results from the experts by several rounds of anonymous consultations. Combining with the real case of constructing integrated medicine curriculum evaluation index system the author introduces the concept of the Delphi method, its implementation steps, the statistical analysis and the application, the focus on principle of the Delphi method and to implementation technology and to optimize the application of the Delphi method in medical education research. Key words: The Delphi method; Integrated medicine curriculum; Evaluation index system

Complexity is the characteristic of systems or situations that prevents the observer from predicting their behaviour or evolution while having full knowledge of the properties and behaviour of all the elements that constitute them. Complexity is usually caused by the individual components, people or other systems, which can evaluate situations and make decisions. Complexity nowadays is a characteristic of every aspect of human organizations and entrepreneurship. As expected, it also appears in Project Management, and it is considered one of the most severe factors in not meeting the project's success criteria. Systemic approaches deal with organized social or business systems in which complexity is an inherent property. This thesis aims to investigate how Systems Thinking can contribute to Project Management in addressing complexity issues. To this end, it examines the basic principles of Systems Thinking along with feedback loops and system dynamics, some specific systemic methodologies and some conceptual tools on whether they contribute to the Project Management knowledge areas. The systemic methodologies presented and examined here are the following: Soft systems methodology, Design Thinking, Delphi Method and Theory of Change. The conceptual/diagram tools list consist of Systems Map, Context Diagram, Input-Output Diagram, Affinity Diagram, Functional Modelling, Influence Diagram, Sequence Diagram and Quad of Aims. In the end, an overview of publications including proposals or case studies which employ systemic methodologies in Project Management is presented. The final result is a table that shows the correlation of the methodologies and tools studied with each Project Management knowledge area. The study shows that project management can apply these methodologies and tools in many of these knowledge areas to manage difficult situations that arise due to complexity.

Objective To construct health education path of nucleoside antiviral treatment on pregnant & maternal women with HBV, so as to make the health education with complete content and standard procedure. Methods On the basis of literature review and health education demand investigation and research, framework and content of the health education path was preliminarily constructed of nucleoside antiviral treatment on pregnant & maternal women with HBV. 20 medical and nursing specialists with rich working experience in infectious department of obstetrics and gynecology were selected by purposeful sampling as consulting object. Final structure and the evaluation indexes of the health education path were established by using Delphi method. Reliability and representativeness of the consultation were tested by indexes like active coefficient of expert opinion, coordination degree, authoritative coefficient, etc. Results In the two rounds of expert letter-enquiry, positive coefficient was both 100%, authority degree coefficient of experts was 0.900, and coordination coefficient of expert opinion was 0.167. In the finally decided health education path, five first level indexes, 28 secondary indexes and 134 tertiary indicators were included. Conclusions The health education path constructed basing on Delphi method perfected and standardized content and process of the whole health education of nucleoside antiviral treatment on pregnant & maternal women with HBV, with the indexes having high degree of expert approval and consistency. Key words: Delphi method; Pregnant m Nucleoside antiviral treatment; Health education path

The aim of this study is to assess the risk factors of pipelines and prioritize their severity in order to prevent their effects in Shadegan International wetland, Iran. Due to the participatory nature of the managerial affairs, the study employs an integrated approach that combines Analytic Hierarchy Process (AHP) and Delphi Method. Also, Likret Scale has been applied to quantify the qualitative (verbal) data, thus reducing the uncertainty of oil pipelines' risk evaluation. In order to evaluate potential risk factors, Failure Mode Effects Analysis (FMEA) method has been applied. According to the study results, in terms of the likelihood of environmental impacts on the main considered criteria of natural and man-made environments, the former's effect is a priority risk, weighing 0.670 and primarily important. On the other hand, environmental hazards caused by oil pipes of water quality in Shadegan wetland has been ranked first, with a relative weight of 0.389 to contain the highest level of risk. The risk degree for diversity and density of benthos is 12.6 and 6.3for fish, both higher than other parameters of water systems in Shadegan wetland. Considering the recognized factors that lead to probable risks of pipelines along with their most notable outcomes, the paper suggests environmental management plans on how to control and reduce the potential impacts, with an emphasis on elimination of the most likely causes.