Classical Delphi Method Research Articles

Utilize Fuzzy Delphi Method to Design and Develop T2IG Application for Primary Schools

Education has encountered multiple transformations in tandem with the globalisation of society. Technology is an essential tool for conducting teaching and learning activities. COVID-19 pre- and post-education also emphasize the importance of technology in accessing education. This study aims to develop a Text to Infographic (T2IG) application. T2IG is an application that developed on two platforms, namely in the form of a website and a smartphone application. Users (students) upload text, and the Google Cloud Platform Artificial Intelligence components will translate it into a graphical form containing information. In addition, Google Cloud Platform Artificial Intelligence will quote actual contents from the entire text uploaded by the user. In this study, the process of gathering experts' consensus to identify the application's elements and components that should be used as the application's primary function. The Fuzzy Delphi Method was used to identify the consensus of the experts through a questionnaire. Using the Fuzzy Delphi technique is to get concessions from experts on the development of instructional materials. This method involves the use of fuzzy set theory which has been integrated with the classic Delphi method. The use of this technique helps in determining the requirements of the elements that are important in the development of instructional materials in detail. A total of 12 experts were identified using the expert sampling method. These 12 experts are among lecturers and officials from the fields of education, technology and language who are currently working at the University, Teaching Institutions and the Department of Education. The study identified seven key components and 25 sub-constructs that should be used in the development of the T2IG application. The findings highlight the importance of using technology to enhance teaching and learning activities and the significance of experts' opinions in the development of instructional materials. Twelve study experts accepted a total of six components. The findings of this study have implications for the development of instructional applications that will be developed. This study's findings also emphasise the appropriate components for developing T2IG applications as proposed.

“Supporting our Lost Boys”: A Research on Gender-based Science Education’s Hidden Curriculum in Malaysia

Malaysia has had tremendous success in increasing women participation in science-related fields by diffusing empowering values into the formal school curricula. A subliminal effect of these female empowerment campaigns, however, is that male students are beginning to lag behind in science education, giving rise to the phenomenon known as "The Lost Boys." In light of the potential for a hidden curriculum to support gender-sensitive or gender-responsive science education, this research was aimed at exploring the hidden curriculum in science education and its impact on boys in science education. This research used the classical Delphi method involving 84 experts, whereby two rounds of questionnaires and one round of qualitative commentaries were used to gather information from a group of experts. Gender-biased notions were found in science education’s hidden curriculum, including the proliferation of feminist messages through outside classroom activities, the lack of gender awareness in teaching and training, and the centering of female mentoring in the field. This research further recommends strategies to explicitly address gender-biased issues in science education’s hidden curriculum to benefit both female and male students’ participation in science. It is hoped that this research serves as a guide for policy makers, school leaders and teachers to achieve gender equity in science education.

Improving quality of leisure environment considering youth preferences in Mashhad, Iran

With the industrialization of societies, urban planners are more concerned with the significance of leisure time since it affects individuals’ mental state and wellbeing. Considering the importance of visual quality, this study examined young adults in the Torghabe and Mellat park of the Mashhad to improve the quality of the leisure environment by detecting youth preferences for natural and man-made variables. Accordingly, the classic Delphi method was used to detect research variables. The most common preference priorities were extracted by photo surveys, simulation of the study environment, and conjoint analysis with the full design approach to calculate the relative importance and Part-Worths, or utility values of these variables, according to the results, among the considered attributes, “shape” (32.61%) and “ solid/void patterns” (5.96%) were of the most and the least significance in the youth preferences for leisure spaces combining natural and shopping environment.

Analyzing Green Construction Development Barriers by a Hybrid Decision-Making Method Based on DEMATEL and the ANP

There is a great deal of interest in analyzing construction development barriers to identify and rank them based on sustainability criteria and have less environmental pollution. Due to the importance of construction projects in developing countries such as Iran, this study implements a green construction development paradigm to identify and rank barriers for a case study in Tehran, Iran. The main novelty of this paper is the development of a new decision-making method using the DEMATEL and Delphi techniques and the ANP. In this regard, first of all, data collection is performed through a literature review and survey studies using questionnaires, interviews, and observations. The applied method for experts’ agreement was integrated through brainstorming and the classical Delphi method. By analyzing different economic, environmental, cultural, and social criteria using a hybrid decision-making framework, the results show that the main economic barrier with a weight of 0.2607 is ranked first, while the main feature of economic assessment is connected to the risk of investment. The cultural and social barriers, with a weight of 0.2258, ranked second, and the managerial barrier, with a weight of 0.2052, ranked third. In the social and managerial aspects, the main barriers were related to looking at green construction as luxurious and the uncertainty of green construction performance due to the climate and texture of the local area, respectively. According to the findings and results, the proposed barriers and sub-barriers in this study can be used to develop and create planning at the strategic level for the development of green construction for our case study in Tehran, Iran. With a concentration on the outcomes of the present research, the sustainable green building framework can be implemented by the application of a prioritized knowledge management concept.

Establishing nursing-sensitive quality indicators for pediatric oncology: An international mixed methods Delphi study.

Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings. Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas. Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.

Finding Consensus About the Level of Medication Safety in a Hospital Setting: Development and an Example of Application of a Modified Delphi Method.

A version of the Institute for Safe Medication Practices (ISMP) questionnaire adapted to the Austrian inpatient setting was used to sample the estimates of a group of experts regarding the level of medication safety in a level II hospital. To synthesize expert opinions on a group level reproducibly, classical Delphi method elements were combined with an item weight and performance weight decision-maker. This newly developed information synthesis method was applied to the sample dataset to examine method applicability. Method descriptions and flow diagrams were generated. Applicability was then tested by creating a synthesis of individual questionnaires. An estimate of the level of medication safety in an Austrian level II hospital was, thus, generated. Over the past two decades, initiatives regarding patient safety, in general, and medication safety, in particular, have been gaining momentum. Questionnaires are state of the art for assessing medication practice in healthcare facilities. Acquiring consistent data about medication in the complex setting of a hospital, however, has not been standardized. There are no publicly available benchmark datasets and, in particular, there is no published method to reliably synthesize expertise regarding medication safety on an expert group level. The group-level information synthesis method developed in this study has the potential to synthesize information about the level of medication safety in a hospital setting more reliably than unstructured approaches. A medication safety level estimate for a representative Austrian level II hospital was generated. Further studies are needed to establish convergence characteristics and benchmarks for medication safety on a larger scale.

Implementation of solar energy in smart cities using an integration of artificial neural network, photovoltaic system and classical Delphi methods

Energy supply of megacities is considered as an active research topic in the new aspects of urban management, especially in developing countries like Iran. With an introduction to the sustainable development goals, the smart city concept presents a novel idea for providing energy in a city with the use of Artificial Intelligence (AI), renewable energy, such as Photovoltaic (PV) technologies, and Transformational Participation (TP) based on motivational programs for citizens. This study aims to evaluate the electrical energy consumption in Mashhad, Iran, based on machine learning tools and present the dynamic strategies for promoting citizens’ willingness for renewable energy generation based on the experts’ knowledge. The main novelty of this research is simultaneous application of Artificial Neural Network (ANN) and statistical analysis for creating a Decision Support System (DSS). Then, the solar energy potential is appraised by the PV system simulation tool during one year in our case study in Mashhad, Iran. Furthermore, a Classical Delphi (CD) method is applied for motivational strategies and further TP implementation. In particular, the motivational strategies are suggested by 45 experts and then are prioritized in sequential expert meetings. The outcomes of this research indicate that the ANN model can successfully forecast the electrical energy consumption in summer and winter periods with a 99% accuracy. Then, based on the solar energy computations in the PV system, the peak of electrical energy consumption can be controlled in the hottest and coldest months. Last but not least, the superposition of experts’ and citizens’ opinions reveal A4 (sharing benefits of optimized costs with the citizens by solar energy generation), B2 (reducing the electrical energy cost for solar energy generation, especially in peak times) and C1 (creating the energy coin in the city with credits instead of spending money in urban activities fits to solar energy generation) as the main motivational strategies for solar energy generation in short, middle and long-term planning horizons.

Standardizing the Diagnostic Evaluation of Nonarthritic Hip Pain Through the Delphi Method.

Background:Femoroacetabular impingement and acetabular dysplasia have gained increased attention as nonarthritic sources of pain and dysfunction in young, active patients. To date, no standardized approach to the diagnostic evaluation of nonarthritic hip pain has been identified, as previous work has focused on the diagnostic evaluation and management of patients with femoroacetabular impingement undergoing hip arthroscopy.Purpose:To explore the standard diagnostic evaluation practice of experts in the field of hip preservation surgery and combine their expertise through the Delphi method to form a standardized approach to the diagnostic evaluation of patients with nonarthritic hip pain.Study Design:Consensus statement.Methods:An expert panel made up of 18 orthopaedic surgeons with extensive experience in the treatment of nonarthritic hip disorders participated in this Delphi study. The Delphi panelists were presented with 4 clinical vignettes representing a spectrum of patients with nonarthritic hip pain. Three iterative survey rounds were presented to the panelists based on these clinical vignettes, and a 3-step classic Delphi method was used to establish consensus techniques in the diagnostic evaluation of nonarthritic hip pain.Results:Total (100%) participation was gained, with all 18 experts completing all 3 Delphi survey rounds. Consensus (≥75% support) was achieved for some, if not all, vignettes for each of the following diagnostic domains: historical features, physical examination, radiographic sequences, radiographic interpretation, cross-sectional imaging, and ancillary diagnostics.Conclusion:In this Delphi study, we identified standardized diagnostic treatment approaches as derived from expert opinion for patients with nonarthritic hip pathomorphologies.

Identifying barriers and facilitators of full service nurse-led early medication abortion provision: qualitative findings from a Delphi study

Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia. Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation. Study design and methods: An online threeround classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework. Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion: Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses’ role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria’s under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services. What is already known about the topic? Evidence indicates that appropriately trained primary healthcare nurses can provide early medication abortion and associated tasks as effectively, safely and satisfactorily as physicians. Nurse-led early medication abortion provision is a worldwide recognised strategy to overcome the shortage of early medication abortion providers and to improve equity in access to abortion services. The legal climate of Victoria allows qualified registered nurses to independently administer physician-prescribed early medication abortion drugs to women. What this paper adds: The Delphi panellists of this study all endorsed nurse-led early medication abortion provision in regional and rural Victoria and beyond. The study provides a range of model implementation barriers, which are categorised into the components of the Capability, Opportunity, and Motivation Model of Behaviour. Those barriers need to be challenged and addressed to improve abortion access in underserved regions.

Quantitative development scenario planning of health professional education in Iran: A mixed-method study

Background: The world surrounding human beings perpetually undergoes transformations and the universities are not an exception in this regard. The condition for survival amid this is to identify and control these transformations and the science that can assist human beings in this respect is "Futures Study" whose goal is to eliminate the ambiguity of the future, to establish the opportunities for certain future and, increase human control over the future. This issue is much more tangible than ever in medical universities dealing with the public health of the society and it is required to highly focus on their quantitative development. Methods: The present study is a mixed-method study carried out in the medical universities of Iran in 2018-2019. First, in the qualitative approach, the components and indicators of the health professional education’s quantitative development have been identified by the classical Delphi method according to targeted sampling from ten experts with content analysis that was identified and coded. In the quantitative approach, having analyzed the indicators using Scenario Wizard software, several scenarios have been designed for the quantitative development of education. Results: The study findings suggest that at least 6 components and 32 indicators can be introduced in the quantitative development of medical science education, on which some robust scenarios can be considered for futures including the optimistic, intermediary, and pessimistic ones. Conclusion: This study directs the researchers toward the quantitative development components and the indicators of medical science education in Iran and how they can be exploited to realize promising futures.

Designing a Minimum Data Set for Thyroid Cancer in Iran

Background: Thyroid cancer is one of the most common malignancies related to an endocrine disorder. Due to the widespread increase in thyroid cancer disease all over the world, cancer registries play an important task for improving survival, prevention, and control of cancer plans in developing countries. Objectives: This study aimed at developing a minimum data set (MDS) for thyroid cancer registry to improve care and treatment core indicators and to revise related guidelines for thyroid cancer in Iran. Methods: This research was a descriptive and cross sectional study carried out in 2015. Most of the data were collected from the patient's medical records in public hospitals of Ahvaz province, healthcare medicine centers in Ahvaz, in addition to online databases. The data were collected, using a checklist. The decision-making classic Delphi method was used to make a consensus about the data elements. The construct validity and reliability of the questionnaire were approved by the expert’s opinions in the field of endocrinology. Results: Out of 251 elements of thyroid cancer discussed, 142 and 8 agreed by more than %75 and by 50% to 75% of the experts, respectively. The MDS was divided into 2 categories of identify and clinical data with 1 and 11 sections, respectively. Conclusions: Comprehensive and uniform data elements about thyroid cancer was not available in Iran. This data set in the field of collecting thyroid cancer information can be useful through facilitating the exchange of health information. The determination of MDS for thyroid cancer will be an effective step to integrate and improve the management of patients’ records.

Qualitative development scenario planning of medical science education in Iran

Background: Futures study is a science that, given changes in society, identifies future trends for making appropriate and practical decisions. Universities benefit from futures study research to improve their efficiency and make effective decisions. This is increasingly seen in medical sciences universities, which are responsible for public and specialized health education, and their quality development should be addressed. The purpose of this study was to identify components and key indicators of the qualitative development of medical sciences education and writing scenarios based on these. Methods: The present study is a mixed methods study carried out in the medical universities of Iran in 2018-2019. In this qualitative approach, the components and indicators of qualitative development of medical sciences education were identified by the classical Delphi method according to targeted sampling from 10 experts with content analysis that was identified and coded. Following the qualitative portion, a quantitative approach using Scenario Wizards software was used to design robust scenarios. Results: In all, 13 components and 48 indicators were identified in the qualitative development of medical sciences education from which robust scenarios can be considered for futures study,including optimistic, intermediary, and pessimistic scenarios. Conclusion: These results indicate how using each of the medical sciences education’s qualitative development components and indicators can lead medical sciences universities to consider favorable and unfavorable futures for planning and direction. Recognizing correct components and drawing scenarios for desired futures is essential.

THE EXPERT OPINION ON QUALITY OF FAMILY FUNCTIONING IN CROATIA

A number of recent studies found the link between the quality of family functioning, welfare and children’s achievement. In the absence of longitudinal studies on the quality of family functioning in Croatia, the expert opinion on family functions and the educational aspects of family life was explored. The data was obtained by classic Delphi method, in three cycles. Anonymous discussion was accepted as a quality manner of idea generating and analysis. Socio-emotional and upbringing functions have been singled out as the most significant permanent family functions, while the educational function is gradually taken over by the society. The expert opinion on family functions and the educational aspects of family life in Croatia was explored. The development of self-esteem and self-respect in children has been identified as the most important aspect of the upbringing function of family. It is assumed that the quality of growing up is related to growing up in families with family functioning. Research participants anticipate further changes in the family structure and the way that family functions. There was no consensus on the unambiguous definition of the family as a concept. There was no statistically significant difference between the opinions of the research participants on the importance of individual family functions in the modern society, and the predictors of the quality of family life. Due to the long-term economic crisis, there is a justified concern about the quality of parenting and, subsequently, the current and long-term welfare of children.

Knowledge transfer in IS offshoring: a Delphi study of the offshore coordinator role

Purpose This paper aims to investigate the main tasks, necessary skills, and the implementation of the offshore coordinator’s role to facilitate knowledge transfer in information systems (IS) offshoring. Design/methodology/approach This empirical exploratory study uses the classical Delphi method that includes one qualitative and two quantitative rounds to collect data on IS experts’ perceptions to seek a consensus among them. Findings The participants agreed, with strong consensus, for a set of 16 tasks and 15 skills. The tasks focused primarily on relationship management and facilitating knowledge transfer on different levels. The set of skills consists of approximately 25 per cent “hard” skills, e.g. professional language skills and project management skills, and approximately 75 per cent “soft” skills, e.g. interpersonal and communication skills and the ability to deal with conflict. Two factors mainly influence implementing the offshore coordinator role: project size and the number of projects to be supported simultaneously. Practical implications The findings provide indications of how to define and fulfill this crucial role in practice to facilitate the knowledge transfer process in a positive way. Originality/value Similarities in previous research findings are aggregated to examine the intermediate role in detail from a consolidated perspective. This results in the first comprehensive set of critical tasks and skills assigned to the competency dimensions of the universal competency framework, demonstrating which and how many competency dimensions are critical.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

The validity of the classical Delphi applications for assessing the industrial sustainability-correction factor: an example study

Purpose The study aims to build up knowledge for collateral exploration of the classical Delphi survey method for assessing the industrial sustainability-related correction factor using a real field study in Nigeria. Design/methodology/approach The paper elicits the character and the operational approaches using an example study to provide a critical review of the method. It estimates the correction factor for appraisal purposes by transforming expert opinion into a valid group consensus. Findings The work considers the specific parameters of the method, design and analysis for interpretation to prove the reliability and the validity for the research results. Moreover, it emphasises that the validity of the traditional Delphi research demands cautious theoretical and practical applications by the coordinating researcher. The paper establishes the current validity and effectiveness of the classical Delphi method of foresight and streamlines their efficient implementation for theory building despite its numerous weaknesses. Originality/value It explores desirable futures for the method while analysing what is possible and probable.

The Delphi method: methodological issues arising from a study examining factors influencing the publication or non-publication of mental health nursing research

Purpose– The purpose of this paper is to describe how the classic Delphi method can be adapted and structured to ensure that specific research questions are clearly addressed.Design/methodology/approach– As part of a larger mixed method project, a modified Delphi study was undertaken to explore factors influencing publication and non-publication of mental health nursing research.Findings– This paper reports brief findings from the Delphi study. However, its main focus is the methodological issues arising from the Delphi method.Research limitations/implications– The paper argues that the classic Delphi method can be adapted and structured to ensure that specific research questions are able to be clearly answered. The adaptations are pragmatic in approach and in keeping with the general principles underpinning the Delphi method, while successfully addressing the problems of attrition and previous criticism of homogenous panels.Originality/value– This paper offers some practical solutions to issue arising from undertaking research using the Delphi method.

Consensus about cardiac patients and families’ competencies in emergency situations: use of a multi-partite Delphi method

Background: Cardiovascular diseases (CVD) are a real public health issue in France. CVDs are generally chronic diseases, punctuated by emergency situation. When a cardiac crisis occurs, the patient and his family are confronted with complex situations that they must manage in priority. The primary aim of this pilot study was to characterise the decision-making competencies that the patient and his close relations must mobilise in such situations, by clarifying diverging and converging opinions among a panel of experts. The objective is to obtain a unique and convergent final opinion of a group of experts. Methods: We conducted a Classical Delphi method during 18-month with 196 members of “Heart and Health” clubs and 82 CVD specialists in one area of France. The Delphi process consist of five rounds of questionnaires (Q) administrated by post to an expert panel. The first questionnaire asks the experts about their opinions on a topic in an open-ended manner: Q1 defined the concept of crisis. These responses are then analysed by the researchers and sent back to the expert panel in the form of statements or new questions. The expert panel rate or rank the questions within the second questionnaire according to their expert opinion on the subject: Q2 identified the emergency situations (frequency and severity); Round continue until a consensus is reached on some or all of the items as required: Q3 ranked the competencies required and the actions likely to be implemented in those situations (feasibility and limitations); and Q4 determined the conditions in which they are mobilised. The Wilcoxon-test was used to compare how the choices regarding these competencies in emergency situations changed from before (Q3) to after (Q4) the responses were submitted to the entire panel (p The panellists reported, clarified and prioritised 20 competencies. Competencies C2 (Recognising the warning signs) and C3 (Calling emergency medical) services ) got a very strong consensus immediately (agreement ≥ 90%) and acquiring them is a high priority. The decision-making competencies C20 (Making emergency decisions ) and organisational competencies C10 (Preparing the medical record ) take precedence over the emotional competencies C14 (Articulating one’s experience) and C15 (Articulating one’s emotions) . Sharing opinions among the panellists led to a significant change in scores for 16 competencies between Q3 and Q4. Conclusions: Using a formal approach, our study produced a solid expert consensus on the competencies needed by CVD patients (and their families) for managing crises, which can help guide clinicians in their practice. Our study helps shift the balance in the care relationship, where, traditionally, health care professionals (HCP) develop the educational programsand define the competencies to be acquired by patients.

Barriers and Facilitators to Palliative Care of Patients with Chronic Heart Failure in Germany: A Study Protocol.

BackgroundDespite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany.Design and MethodsTripartite study. First part of this study evaluates health care providers’ (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients.Expected Impact for Public HealthThe results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.Significance for public healthPatients with chronic heart failure suffer from similar symptoms and symptom burden than patients with malignant diseases. However, palliative care differs between these groups in a quantitative and qualitative way. This study will help to understand why patients with chronic heart failure receive less palliative care than patients with malignant disease. In addition, measures to overcome barriers and to promote facilitators of palliative care in patients with chronic heart failure will be developed. These recommendations could provide a basis for quality improvement projects or studies aiming at improving symptoms and symptom burden of heart failure patients. The recommended measures could also be used to reduce caregiver burden.

Sustainable business models for wind and solar energy in Romania

Abstract Renewable energy has become a crucial element for the business environment as the need for new energy resources and the degree of climate change are increasing. As developed economies strive towards greater progress, sustainable business models are of the essence in order to maintain a balance between the triple bottom line: people, planet and profit. In recent years, European Union countries have installed important capacities of renewable energy, especially wind and solar energy to achieve this purpose. The objective of this article is to make a comparative study between the current sustainable business models implemented in companies that are active in the wind and solar energy sector in Romania. Both sectors underwent tremendous changes in the last two years due to changing support schemes which have had a significant influence on the mechanism of the renewable energy market, as well as on its development. Using the classical Delphi method, based on questionnaires and interviews with experts in the fields of wind and solar energy, this paper offers an overview of the sustainable business models of wind and solar energy companies, both sectors opting for the alternative of selling electricity to trading companies as a main source of revenue until 2013 and as the main future trend until 2020. Furthermore, the participating wind energy companies noted a pessimistic outlook of future investments due to legal instability that made them to reduce their projects in comparison to PV investments, which are expected to continue. The subject of the article is of interest to scientific literature because sustainable business models in wind and photovoltaic energy have been scarcely researched in previous articles and are essential in understanding the activity of the companies in these two fields of renewable energy.