Consensus-seeking Process Research Articles

Creating transformational learning experiences for 21st century healthcare students through preclinical skills training at a South African university.

Creating an inclusive interprofessional teaching and learning community can enhance student engagement and ultimately develop essential graduate attributes (GA) (also known as generic, transferable, core, soft, work-ready or nontechnical skills). The early practical development of GA within a diverse space is essential in health profession education, as students experience the transition to clinical training as challenging. This paper describes the conceptualization and implementation of an inclusive interprofessional curriculum focused on GA development in the preclinical years. A phased multimethod research design was applied. Phase 1 focused on the conceptualization of a preclinical GA development curriculum through a consensus-seeking process among all staff in the School of Health and Rehabilitation Sciences (N = 36). Subsequently, in Phase 2, quantitative and qualitative data were gathered from participating first-year students (N = 135) as an early curricular implementation review. Descriptive statistical analyses for quantitative and thematic analyses for qualitative data were performed. During Phase 1, five themes were identified (Ethics, Professionalism, General principles for interventions, Organizations and institutions, Management) informing preclinical curriculum development. Forty-one first-year students (30%) participated in Phase 2. The majority of participants (87%) indicated that they had a positive learning experience during Phase 2. Students expressed that engagement was encouraged (83%) within a space of mutual respect (83%), with interprofessional groups assisting in building "a trusting environment and a supportive one". Students indicated they "liked that it [module] wasn't just about one topic", as it concretized that "there is more to being a healthcare professional that just treating people". GA development provides an invaluable opportunity for interprofessional engagement. Creating a diverse and inclusive curricular space through multimodal and interprofessional training, GA training was transformed to be more practical and future-focused, creating a positive learning experience. Future research should focus on the longer-term impact of this practical, preclinical GA development during the transition of these students into the clinical training space.

Consensus definition of essential, optimal, and suggested components of a pediatric sickle cell disease center.

Sickle cell disease (SCD) requires coordinated, specialized medical care for optimal outcomes. There are no United States (US) guidelines that define a pediatric comprehensive SCD program. We report a modified Delphi consensus-seeking process to determine essential, optimal, and suggested elements of a comprehensive pediatric SCD center. Nineteen pediatric SCD specialists participated from the US. Consensus was predefined as 2/3 agreement on each element's categorization. Twenty-six elements were considered essential (required for guideline-based SCD care), 10 were optimal (recommended but not required), and five were suggested. This work lays the foundation for a formal recognition process of pediatric comprehensive SCD centers.

Psychological Literacy and Undergraduate Psychology Education: An International Provocation

For over 50 years, psychology leaders have called for fundamental changes in how we undertake research, education, and community interaction. This paper provocatively argues the case for “why now, and how.” The COVID-19 pandemic demonstrated that psychology must contribute more to the wellbeing of local and global communities. We propose that a primary mechanism for doing so is by reinventing the undergraduate psychology program. This paper provides a stimulus to initiate international discussion of interconnected graduate capabilities, which we propose to be: Knowledge, Research Methods, Application of Knowledge to Personal, Professional and Community (Local, National, Global) Domains, Values and Ethics, Critical Thinking, Communication, and Cultural Responsiveness. Focusing on core aspects of psychology (Knowledge, Research Methods, Application) and more generic but evidence-informed capabilities is a unique formulation and should well serve graduates, employers, society, and the psychology discipline and profession in the uncertain “post-pandemic” era. We also propose psychological literacy as a promising unifying approach for psychology. Finally, we provide a “road-map” for curriculum renewal at international, national, and institutional levels, involving a consensus-seeking process (an extensive scholarly overview of the proposed capabilities is provided).

IDQoL, CDLQI and the 45-item CADIS received a sufficient content validity rating during the HOME VII meeting in Japan: a group discussion study.

The Harmonising Outcome Measures for Eczema (HOME) initiative has agreed that quality of life should be measured in all atopic eczema clinical trials. Various candidate instruments exist for this domain but their content validity in atopic eczema is largely unclear. To assess the content validity of quality-of-life candidate instruments for atopic eczema in infants, children and adults in order to aid the decision on what instrument to include in the core outcome set for the quality-of-life domain. Six group discussions were conducted at the HOME VII Meeting in Tokyo. Each group was composed of 8-12 patients or parents of patients, clinicians, methodologists and pharmaceutical industry delegates and discussed one or two candidate instruments. The COSMIN criteria on relevance, comprehensiveness and comprehensibility were used to determine the overall content validity rating per instrument. Content validity of the Infant's Dermatitis Quality of Life Index, Children's Dermatology Life Quality Index and the Childhood Atopic Dermatitis Impact Scale (CADIS) long-form was rated as sufficient (+). Results for the CADIS short-form, DLQI and Skindex were inconsistent (±). DISABKIDS, Infants and Toddlers Dermatology Quality of Life and ABS-A were classified as having insufficient content validity. The content validity rating allowed for a comparison of all candidate instruments and informed the consensus-seeking process regarding the core instrument for the quality-of-life domain.

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings - Results of an expert consensus and feasibility field test.

There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale - revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).

Home therapy for inherited bleeding disorders in South Africa: Results of a modified Delphi consensus process.

Optimal care of patients with inherited bleeding disorders requires that bleeding episodes are treated early, or still better prevented, through extension of patient care beyond hospital-based treatment to home-based therapy. In South Africa (SA), adoption of home therapy is variable, in part owing to lack of consensus among healthcare providers on what constitutes home therapy, which patients should be candidates for it, how it should be monitored, and what the barriers to home therapy are. To conduct a modified Delphi process in order to establish consensus on home therapy among haemophilia healthcare providers in SA. Treaters experienced in haemophilia care were invited to participate in a consensus-seeking process conducted in three rounds. In round 1, provisional statements around home therapy were formulated as questions and collated in a structured list. In rounds 2 and 3, evolving versions of the questionnaire were administered to participants. Consensus was defined as ≥70% agreement among the participants. The panel composition included an equal number of physicians and non-physicians. The participation rate was 100% through all three consensus rounds. The group reached consensus for 92% of the statements. Consensus of 100% was reached on starting home therapy in paediatric patients, requiring all patients on home therapy to sign informed consent and indemnity, and providing round-the-clock support for patients on home therapy. The home therapy consensus statements in this report have the potential to translate to policy on home therapy and to guide the initiation, practice and evaluation of home therapy programmes in SA.

Integrating promotive, preventive, and curative health care services at hospitals and health centers in Addis Ababa, Ethiopia.

BackgroundThe current trend in patients’ disease management is mostly aimed at addressing their present health complaints; the focus is thus purely curative. As the limits of curative medicine become apparent and the cost of medical care escalates, disease prevention is gaining prominence. Factors that contribute to unreliable delivery of an integrated health care service are worth investigation. This study explores the extent to which health promotion and disease prevention services are integrated to curative health care and identifies the factors associated with not reliably providing the services.MethodsA cross-sectional quantitative study using an exploratory and descriptive design was used to explore and describe the extent of health promotion, preventive, and curative health care services provision, and investigated factors related to low performance. Phase I of the study examined the degree of promotive and preventive health care provision at hospitals and health centers while investigating the staffing and equipment and supply status of the facilities. Phase II, using the Delphi consensus-seeking process, focused on the validation of the findings from Phase I.ResultsOf all patients who attended health facilities, only 2.4% (n=20) received optimal health promotion services. Disease prevention services were optimally provided to only 3.6% (n=30) patients. Integrated health promotion and disease prevention services were provided to only 0.8% (n=7) patients. The main reasons for not providing an integrated health care service were shortage of skilled health staff, equipment, medication, protocols, and guidelines, and high service cost, poor patient awareness, and health professionals’ focus on curative health care.ConclusionHealth service providers were not routinely conducting patient-specific health promotion, disease prevention, and integrated health care services, losing the opportunities of patient’s presence for health promotion and diseases prevention purposes. Addressing barriers can help with integrating health promotion and disease prevention services to the curative health care services.

“I see absolutely nothing wrong with that in fact I think …”: Functions of modifiers in shaping dynamic relationships in dissertation defenses

This study examines the distribution and cumulative effects resulting from the interplay of diverse salient modifiers in question-response sessions in dissertation defenses. The quantitative results of the study show a high prevalence of modifiers used in the defense corpus. These results are consistent with findings observed in other native and non-native corpora of various academic spoken genres, confirming their crucial importance across generic, cultural and disciplinary boundaries. Statistical comparison of modifiers between the committee and candidate sub-corpora reveals a high degree of homogeneity in type and frequency, except for certain modifiers prefacing disagreement, involvement and intrusion of a subjective stance. Significant numerical discrepancies can be attributed to committees’ institutional obligations to question, challenge candidates by introducing conflicting opinions and evoke common ground in the consensus-seeking process. However, qualitative analysis of the majority of common modifiers reveals that their genre-bound functions are largely shared by the opposing groups as strategic elements for securing their original contributions to disciplinary knowledge in the rhetorical encounter. These modifiers contribute to the construction of dynamic relationships between participating academics via their distinctive patterns in the dynamics of interaction.

Consensus seeking of multi-agent systems from an iterative learning perspective

The consensus seeking problems for both discrete and continuous multi-agent networks are discussed from an iterative learning perspective. It is shown that the consensus seeking process can be viewed as an iterative learning process for agents under directed networks to improve their performances from time to time in order to achieve consensus. If a desired consensus state is specified, then the multi-agent system can be guaranteed to reach consensus through reducing the tracking error between each agent’s state and the desired consensus state monotonically to zero with respect to the increasing of time. If there is no desired consensus state, then the agents can achieve consensus through reducing their states monotonically to the minimum quantity with increasing time. Simulations illustrate the observed results.

Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)

PurposeManagement of giant cell arteritis (GCA, Horton's disease) involves many uncertainties. This work was undertaken to establish French recommendations for GCA management. MethodsRecommendations were developed by a multidisciplinary panel of 33 physicians, members of the French Study Group for Large Vessel Vasculitis (Groupe d’étude français des artérites des gros vaisseaux [GEFA]). The topics to be addressed, selected from proposals by group members, were assigned to subgroups to summarize the available literature and draft recommendations. Following an iterative consensus-seeking process that yielded consensus recommendations, the degree of agreement among panel members was evaluated with a 5-point Likert scale. A recommendation was approved when ≥ 80% of the voters agreed or strongly agreed. ResultsThe 15 retained topics resulted in 31 consensus recommendations focusing on GCA nomenclature and classification, the role of temporal artery biopsy and medical imaging in the diagnosis, indications and search modalities for involvement of the aorta and its branches, the glucocorticoid regimen to prescribe, treatment of complicated GCA, indications for use of immunosuppressants or targeted biologic therapies, adjunctive treatment measures, and management of relapse and recurrence. ConclusionsThe recommendations, which will be updated regularly, are intended to guide and harmonize the standards of GCA management.

Pursuing a corporate understanding of service-learning in nursing education: A case study

A corporate definition of service-learning (SL) could help to mainstream SL in higher education institutions (HEIs). Concepts like ‘service-learning’, ‘community engagement’ and ‘community service’ tend to be used interchangeably. It is thus imperative to start from a common understanding of these related concepts. Therefore, this article discusses the development of a definition of SL for a school of nursing. The democratic process of the nominal group technique (NGT) allowed the academics to discuss conflicting points openly during the consensus-seeking process. The thematic analysis, based on frequency scores, identified ‘equal tri-partnership’; ‘teaching and learning process’; ‘reflective practitioners’; ‘community needs’; ‘community development’; ‘shared values’; and ‘community engagement’ as the essential concepts to be included in the definition of SL. It can be concluded that the final SL concept list was formulated due to the academics’ willingness to examine their individual practice theories with the purpose of developing a shared understanding of these concepts.

A conceptual framework for educational design at modular level to promote transfer of learning

Students bridge the theory–practice gap when they apply in practice what they have learned in class. A conceptual framework was developed that can serve as foundation to design for learning transfer at modular level. The framework is based on an adopted and adapted systemic model of transfer of learning, existing learning theories, constructive alignment and the elements of effective learning opportunities. A convergent consensus-seeking process, which is typical of a qualitative approach, was used for expert review. The final conceptual framework consists of two principles: establishing a community of learning and the primacy of a learning outcome. The four steps entail the following: (1) activation of existing knowledge; (2) engaging with new information; (3) demonstrating competence; and (4) application in the real world. It is envisaged that by applying the framework educators in health care will design for transfer of learning, resulting in quality of care and optimal patient outcomes.

Setting Up an Ethics of Ecosystem Research Structure Based on the Precautionary Principle

Ethical practices in ecological field research differ from those in laboratory research in more than the technical setting and the important distinction between population-level and individual-based concerns. The number of stakeholders affected by the conduct of field research is far larger; private landholders, public water utilities, public land managers, local industries, and communities large and small are only some of those who may be impacted. As research review boards move to establish specific ethical practices for field biologists, the process of identifying appropriate standards will affect the degree to which research will ultimately be disrupted. Standards that lead to research protocols that alienate key interests are not likely to be sustainable. Already, standards that have conflicted with the primary values of a key interest have resulted in disruptions to research and scientific progress. One way to manage this problem of deeply competing interests is to avoid the deepest offenses to any relevant interest group in the design of a proposed study. This is an application of the precautionary principle and is likely to generate a more sustainable balance among competing interests. Unfortunately, this process is also likely to be a never-ending, consensus-seeking process. Fortunately, scientists can have enormous influence on the process if they choose to engage in it early. If scientists use their expertise to function as honest brokers among affected interests, their own interest in scientific research progress is likely to be better met.

Ethical regulation of the Internet: the challenges of global governance

Multiregulation, a central support system for the ethical regulation of the Internet, provides a solution which is both complex and difficult to realize. It gives another vision of the methods of law production, as the characteristics of the internet imply an almost instantaneous and largely harmonized law. It also gives another vision of the application of the law since priority will be given to the means of making the players responsible in the context of promoting self-regulation tools. Accordingly, the harmonization of international law must make the progressive creation of a global public order system possible, to which all states will be likely to commit themselves. This harmonization aims at a progressive reconciliation of the rules, particularly those applicable within cyberspace. Agreement on a common denominator of rules can only come about through an ethical consensus-seeking process. Regulation and ethics must join forces to give the digital universe a framework of rules responding to a double imperative: to protect the rights and liberties of individuals and ensure the security of goods, without creating new abuses which themselves are destructive of freedom and dangerous for the security of people. Instituting an International Internet Committee or an equivalent body at the global level can be the means of achieving such a reform and important changes in present-day geopolitical and legal structures. Defining rules of such a planetary nature means asking ourselves questions about the shape of an international society and the form such a global governance could take. Clearly, the question implies major upheavals as the present balances are fragile, being based on excessively great inequalities. The coming of the information society could, in fact, cause these inequalities to increase even further. For the network of networks is a luxury which only a privileged minority of the population of the world can afford. This last point will certainly be one of the upcoming major issues of information technologies. The democratization of the Internet, by means of generalized facilitated access, could no doubt provide an element of reconciliation for the societies of the globe, many of which do not even know of the existence of these networks. The Internet therefore cannot continued to be thought of today as a simple means of communication to be added to the others. Using and regulating the Internet to include rather than just exclude a little more would also make it possible for cultural, philosophical and religious traditions to understand each other while continuing to be different, and to participate in the construction of a more equitable global society.

A Delphi Study of Young Children’s Readiness in Korea: Challenges and Implications for Early Childhood Schooling

This paper reports the results of a Delphi study investigating young children’s readiness in Korea. Twenty-two (22) Korean experts in early childhood education participated in a 4-stage Delphi consensus-seeking process. Results indicate that behaviors related to social adjustment to school were considered the most important components of school readiness. Academic abilities such as understanding simple math and science concepts were of moderate or low importance. The results suggest the need for a continuous conversation between the experts and parents, more in-depth research about the young children’s readiness, and development of a new readiness assessment system for Korea.