Delphi Method Research Articles

유아기 자녀를 둔 부모공감능력의 의미와 구성요인에 관한 델파이 연구

Objectives This study aims to clarify the meaning of parental empathy ability using the Delphi technique and to derive constituent and sub-factors. Methods To this end, the concept of parental empathy ability was defined through preceding research and liter-ature review, and the structuring factors of the ability were derived. An expert Delphi survey was conducted using the derived data to confirm the exploratory study of deriving the components of parental empathy ability. The data analysis method of the first Delphi survey questionnaire was conducted in order to define the concept of parental empathy and derive the structuring factors. A structured questionnaire, free-choice and open-ended questions were conducted with 13 experts in order to confirm the content validity. Using SPSS 25.0, the average value, standard deviation, skewness, agreement, convergence, and CVR ranges of each variable were calculated, and questions that did not meet each criterion were modified and deleted. Since the number of panels participating in the Delphi survey in this study is 13, if the CVR value is .554 or higher, it can be judged that the content validity is valid. The contents, were revised and supplemented with the experts, used to construct the second Delphi survey. It was used to construct the second questionnaire by reflecting the opinions of experts and revising and supplementing the contents. The second survey tool were gathered from the responses of the first survey. In or-der to clarify the opinions of each panel, structured questions with a 5-point rating scale were presented. Results First, the area of the scale consisted of three areas: ‘emotional empathy ability’, ‘cognitive empathy abil-ity’, and ‘behavioral empathy ability’, ‘emotional empathy ability’ consisted of perspective acceptance, cognitive empathy, and perspective acceptance, ‘cognitive empathy ability’ consisted of emotional response, emotional al-location, and emotional perception, and ‘behavioral empathy ability’ consisted of pseudo-movement, expression consistency, listening, and relationship formation. Conclusions The study is significant in that it derives categories and sub-factors of parental empathy ability that have recently come into focus. Furthermore, the study is significant in that it can be used as basic data for deriving the question composition through focus group interviews in the future.

Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management: Delphi consensus study

BACKGROUND Gastro-esophageal reflux disease (GERD) may affect the upper digestive tract; up to 20% of population in Western nations are affected by GERD. Antacids, histamine H2-receptor antagonists, and Proton Pump Inhibitors (PPIs) are considered the referring medications for GERD. Nevertheless, PPIs must be managed carefully because their use, especially chronic, could be linked with some adverse effects. An effective and safe alternative pharmacological tool for GERD is needed. After the identification of potentially new medications to flank PPIs, it is mandatory to revise and improve good clinical practices even through a consensus process. AIM To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method. METHODS The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel, subject of the consensus, is the basic prerequisite for the consensus itself. A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD. The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations: Gastroenterology, otolaryngology, geriatrics, and general medicine. A scientific committee analyzed the literature, determined areas that required investigation (in agreement with the multiple-choice questionnaire results), and identified two topics of interest: (1) GERD disease; and (2) GERD treatment. Statements for each of these topics were then formulated and validated. The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform. RESULTS According to their routinary GERD practice and current clinical evidence, the panel members provided feedback to each questionnaire statement. The experts evaluated 15 statements and reached consensus on all 15. The statements regarding the GERD disease showed high levels of agreement, with consensus ranging from 70% to 92%. The statements regarding the GERD treatment also showed very high levels of agreement, with consensus ranging from 90% to 100%. This Delphi process was able to reach consensus among physicians in relevant aspects of GERD management, such as the adoption of a new approach to treat patients with GERD based on the overlapping between PPIs and Nux vomica-Heel. The consensus was unanimous among the physicians with different specializations, underlying the uniqueness of the agreement reached to identify in the overlapping approach between PPIs and Nux vomica-Heel a new intervention model for GERD management. The results support that an effective approach to deprescribe PPIs through a progressive decalage timetable (reducing PPIs administration to as-needed use), should be considered. CONCLUSION Nux vomica-Heel appears to be a valid opportunity for GERD treatment to favor the deprescription of PPIs and to maintain low disease activity together with the symptomatology remission.

EXTRACTING AND PRIORITIZING THE ATTRACTIVENESS PARAMETERS OF SHOPPING CENTERS UNDER INTUITIONISTIC FUZZY NUMBERS

Shopping center plays an important role in distribution system and marketing. These canters provide an appropriate atmosphere for customers; so that, the customers achieve the best service within a short time. However, there is an intense competition among shopping centers to attract more customers for increasing the profit. Therefore, a powerful model assists authorities in identifying the critical competitive aspects and directing their efforts toward performance improvement. However, a number of strategies have been developed to identify the most relevant components. The Delphi technique under intuitionistic fuzzy environment, called intuitionistic fuzzy Delphi method (IFDM) study, is a group-based technique that can simply formulate the uncertainty imposed by decision making circle. On the other hand, multi criteria decision making (MCDM) method such as analytical network process (ANP) is a mathematical tool for taking into account mutual relationships in order to rank a number of criteria. Nonetheless, the ANP is unable to account for the uncertainty involved in the decision-making process. Similarly, the intuitionistic fuzzy set (IFS) can express ambiguity and vagueness by utilizing the given scale. Because the IFS is robust in dealing with complexity and ambiguity, the IFS-GANP (an integrated model of the IFS and ANP methods under group decision) can result in a more specific description of the situation. As a result, the IFS-GANP approach outperforms both conventional ANP and fuzzy ANP. To demonstrate the model’s feasibility, a case study rating the essential aspects impacting the attractiveness of retail centers is shown. The result demonstrates factor C31 (Location) with value of 0.202 plays the greatest role in attracting customers.

A Delphi study to assess the effect of changes in language between the first and second editions of the WHO’s Joint External Evaluation

IntroductionCountries use the WHO Joint External Evaluation (JEE) tool—part of the WHO International Health Regulations (2005) Monitoring and Evaluation Framework—for voluntary evaluation of global health security (GHS) capacities. After releasing...

Potential of Large Language Models in Health Care: Delphi Study.

A large language model (LLM) is a machine learning model inferred from text data that captures subtle patterns of language use in context. Modern LLMs are based on neural network architectures that incorporate transformer methods. They allow the model to relate words together through attention to multiple words in a text sequence. LLMs have been shown to be highly effective for a range of tasks in natural language processing (NLP), including classification and information extraction tasks and generative applications. The aim of this adapted Delphi study was to collect researchers' opinions on how LLMs might influence health care and on the strengths, weaknesses, opportunities, and threats of LLM use in health care. We invited researchers in the fields of health informatics, nursing informatics, and medical NLP to share their opinions on LLM use in health care. We started the first round with open questions based on our strengths, weaknesses, opportunities, and threats framework. In the second and third round, the participants scored these items. The first, second, and third rounds had 28, 23, and 21 participants, respectively. Almost all participants (26/28, 93% in round 1 and 20/21, 95% in round 3) were affiliated with academic institutions. Agreement was reached on 103 items related to use cases, benefits, risks, reliability, adoption aspects, and the future of LLMs in health care. Participants offered several use cases, including supporting clinical tasks, documentation tasks, and medical research and education, and agreed that LLM-based systems will act as health assistants for patient education. The agreed-upon benefits included increased efficiency in data handling and extraction, improved automation of processes, improved quality of health care services and overall health outcomes, provision of personalized care, accelerated diagnosis and treatment processes, and improved interaction between patients and health care professionals. In total, 5 risks to health care in general were identified: cybersecurity breaches, the potential for patient misinformation, ethical concerns, the likelihood of biased decision-making, and the risk associated with inaccurate communication. Overconfidence in LLM-based systems was recognized as a risk to the medical profession. The 6 agreed-upon privacy risks included the use of unregulated cloud services that compromise data security, exposure of sensitive patient data, breaches of confidentiality, fraudulent use of information, vulnerabilities in data storage and communication, and inappropriate access or use of patient data. Future research related to LLMs should not only focus on testing their possibilities for NLP-related tasks but also consider the workflows the models could contribute to and the requirements regarding quality, integration, and regulations needed for successful implementation in practice.

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process.

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.

The Future Use of Cloud-based Virtual Technologies to Enhance Project Management in West Coast governments: A Delphi Study

The Future Use of Cloud-based Virtual Technologies to Enhance Project Management in West Coast governments: A Delphi Study

Application of fuzzy Delphi technique to identify analytical lenses for determining the preparation of free and open source software projects for user experience maturity

User eXperience (UX) significantly influences the success of free and open source software (FOSS) projects and is measured using UX capability maturity models (UXCMMs). Every organization desires higher levels of UX maturity; however, it requires upfront preparations and process quality control.Harmonizing processes and analytical lenses for determining preparation for UX maturity are still challenging, and studies to create them are limited. The analysis is ad hoc and based on the actors’ will and experiences. This study proposes and validates analytical lenses.Findings show that UX experts agreed that the lenses could be used with a consensus percentage of 81 %, the threshold value (d) = 0.112, and crisp values greater than α-cut = 0.5. On validation, 47.57 % of stakeholders agreed, and 52.43 % strongly agreed they were relevant. Results help evaluate the status quo and change culture and policies toward ideal preparation. Two areas are suggested for future research.

The Physical Activity Self-Advocacy Inventory for Adolescents with and without Disabilities: A Delphi Study

ABSTRACT Self-advocacy is a critical predictor of actual physical activity participation for children and adolescents with disabilities. Despite its reference within national standards for health and physical education, few practitioners are purported to promote self-advocacy among their students warranting the need for evaluation. However, no self-advocacy inventory exists for children and adolescents with robust psychometrics properties. The purpose of this study was to investigate the content and face validity for the Physical Activity Self-Advocacy Inventory (PASAI) within children and adolescents with and without disabilities. Experts in the fields of health and physical education (N = 12) participated in this Delphi study. Once experts established the content/face validity for the PASAI, children and adolescents (N = 18) provided feedback on the PASAI to further refine the questions and support comprehension/relevance for the target population. After the first round of questions, experts’ average feedback was a 3.99 out of 5.00 across all items. Due to low scores and based upon experts’ suggestions, four questions were deleted, and one question was added. After round two, experts’ average ratings increased to 4.8 out of 5.00. The PASAI appears to have reasonable content/face validity properties per expert- and population-based feedback. Future research should vet additional psychometric properties of PASAI scores.

Real-world use of the updated refractory epilepsy screening tool for Lennox-Gastaut syndrome.

To evaluate the Refractory Epilepsy Screening Tool for Lennox-Gastaut Syndrome (REST-LGS) for real-world identification of LGS in adults and to develop a scoring system for the tool. A retrospective chart review of adults with drug resistant epilepsy (DRE) and intellectual development disorder (IDD) was conducted by 2 primary care providers blinded to diagnosis. The REST-LGS was designed via the Modified Delphi Consensus and was previously validated. This tool consists of 8 criteria (4 major, 4 minor) considered indicative of LGS. To account for missing data in the earlier validation study and to evaluate applicability in a real-world setting, the REST-LGS was refined to include a scoring system in which major criteria were more heavily weighted than minor criteria, producing categories of "likely" (>11 points), "possible" (8-11 points), and "unlikely" (<8 points) LGS. Statistical analyses were descriptive. Of the 100 patients included in the analysis, data for slow spike-waves in electroencephalography and seizure onset age - both major REST-LGS criteria - were missing for 46% and 42% of patients, respectively. The majority of patients met 4 of the 8 REST-LGS criteria (cognitive impairment since childhood, 71%; persistent seizures despite a trial of ≥2 antiseizure medications, 65%; seizure onset before the age of 12 years, 57%; ≥2 seizure types, 56%). All 4 major criteria were met in 22 patients (22%). The percentages of patients considered "likely," "possible," or "unlikely" to have LGS were 26%, 30%, and 44%, respectively. Of the 74 patients without a previous LGS diagnosis, 42 (57%) were identified as "possible" or "likely" to have LGS using REST-LGS. In this analysis, the validated REST-LGS was evaluated in a real-world setting. The majority of previously undiagnosed patients were identified via REST-LGS as "possible" or "likely" to have LGS. Extensive missing data highlights challenges of LGS diagnosis in adults. There is a need to identify adult patients with Lennox-Gastaut syndrome (LGS) so they can receive appropriate treatment. The Refractory Epilepsy Screening Tool for LGS (REST-LGS) questionnaire was designed by experts to identify whether patients with seizures that are not controlled by medications may have LGS. In this study, 2 physicians completed the REST-LGS using charts for 100 patients who experience seizures not controlled by medications. Of the patients who were previously diagnosed as not having LGS, the majority were "likely" or "possible" to have LGS based on the REST-LGS; therefore, the REST-LGS can identify patients for further evaluation.

MASCC 2023 Patient-Centered Antiemetic Guidelines and Education Statements: an evidence-based and consensus resource for patients.

The Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) Patient Antiemetic Guideline Committee aimed to (1) adapt the updated evidence-based, clinical guidelines to patient-centered antiemetic guidelines and (2) develop patient education materials and statements. The MASCC 2023 Patient Antiemetic Guidelines were created and reviewed by antiemetic experts and patient advocates by incorporating the 2023 MASCC/ESMO antiemetic guidelines into patient-friendly language. Patient Education Statements were developed based on current literature and by utilizing an expert modified Delphi consensus (≥ 75% agreement). Patient advocate/focus group input and patient survey results were further integrated into Patient-Centered Antiemetic Guidelines and Education Statements. Patient-Centered Antiemetic Guidelines were created using patient-friendly language and visual slides. Patient-friendly language was also utilized to communicate the Educational Statements. Key content categories identified for the Educational Statements included the following: nausea/vomiting definitions, causes, risk factors, categories, complications, accompanying symptoms, prophylactic antiemetic treatment, general management, when to call/what to ask the healthcare team, what caregivers can do, and available resources. All identified content met the ≥ 75% expert agreement threshold. Fifteen (15) items demonstrated 100% agreement, 11 items achieved ≥ 90% agreement, and three content items demonstrated 80 ~ 82% agreement. The inaugural MASCC 2023 Patient Antiemetic Guidelines can help patients and caregivers understand the prevention of nausea and vomiting related to their cancer treatment. Educational Statements provide further patient information. Educating patients on how to utilize guideline antiemetics and the education statements can contribute improvements in the control of anticancer treatment-related nausea and vomiting.

Palliative Care Research and Clinical Practice Priorities in the United States as Identified by an Interdisciplinary Modified Delphi Approach.

Background: Palliative care demands in the United States are growing amid a comparatively small workforce of palliative care clinicians and researchers. Therefore, determining research and clinical practice priorities is essential for streamlining initiatives to advance palliative care science and practice. Objectives: To identify and rank palliative care research and clinical practice priority areas through expert consensus. Design: Using a modified Delphi method, U.S. palliative care experts identified and ranked priority areas in palliative care research and clinical practice. Priorities were thematically grouped and analyzed for topic content and frequency; univariate analysis used the median of each priority item ranking, with a cutoff median of ≤8 indicating >76% agreement for an item's ranking. Results: In total, 27 interdisciplinary pediatric and adult palliative care experts representing 19 different academic institutions and medical centers participated in the preliminary survey and the first Delphi round, and 22 participated in the second Delphi round. The preliminary survey generated 78 initial topics, which were developed into 22 priority areas during the consensus meeting. The top five priorities were (1) access to palliative care, (2) equity in palliative care, (3) adequate financing of palliative care, (4) provision of palliative care in primary care settings, and (5) palliative care workforce challenges. Conclusions: These expert-identified priority areas provide guidance for researchers and practitioners to develop innovative models, policies, and interventions, thereby enriching the quality of life for those requiring palliative care services.

Luteinizing hormone supplementation in controlled ovarian stimulation: the Iran Delphi consensus

IntroductionNumerous consensus documents worldwide address luteinizing hormone (LH) supplementation in controlled ovarian stimulation, yet to the best of our knowledge, only one consensus paper has been published in the Arab region. This study presents a Delphi consensus by seven Iranian infertility experts, offering real-world clinical perspectives. The aim was to develop evidence-based opinions on LH's role alongside FSH in various aspects of assisted reproductive technology (ART), including LH levels, monitoring, r-hLH use, and suggested activity.MethodsEmploying the Delphi consensus approach, the Iran consensus unfolded in three steps. In Step 1, eight out of 10 statements gained approval, while two unclear statements were removed. In Step 2, the 20-member extended panel voted on the remaining eight statements.ResultsOnly one (statement 3) lacked consensus (55% agreement), prompting a modification. The revised statement (noted as statement 3′) obtained an 83% agreement.DiscussionThe clinical perspectives included in this consensus complement clinical guidelines and policies that help further improve treatment outcomes, especially for patients with FSH and LH deficiencies.

Consensus recommendations for the assessment and management of idiopathic intracranial hypertension in children and young people

BackgroundIdiopathic intracranial hypertension (IIH) is a potentially disabling condition. There is a lack of evidence and national guidance on how to diagnose and treat paediatric IIH, leading to variation in...

Ventral hernia repair in India: a Delphi consensus

Abstract Purpose While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes. Methods Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence. Results Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia &lt; 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI &gt; 40 kg/m2, and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width &lt; 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia &lt; 4 cm; midline hernias &lt; 4 cm with diastasis; and M5 hernia. Conclusion The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

Informational Modeling of Cities: Method and Challenges for Institutional Implementation

ABSTRACT Although cities are increasingly permeated by information and communication technologies (ICTs), these urban centers still face theoretical and practical obstacles regarding the application of 3D technologies as a tool for urban planning and management. This study aims to ontologically structure an informational model as an urban management tool and assess the perceived challenges for implementing this model in the municipal public management of Curitiba, Brazil. The study was carried out through the collective subject discourse, the interviews’ thematic saturation, and Delphi techniques. The results indicate that the technical capacity, technological infrastructure, and financial resources for the development of a city information modeling (CIM) exist, although its activation for such development depends on a more significant political and managerial entrepreneurship in the decision-making in arrangements of multilevel governance, and, consequently, there is a need to develop public policies for staff training to stimulate and promote advanced technological innovations for urban management and planning. Implementing a CIM in large cities seems to face more management and planning problems due to the lack of institutional ontologies than technological, infrastructural, or knowledge limitations.

Guía para el manejo de los trastornos del desarrollo sexual en la infancia, Medellín 2020-2021

Objective: to present a local guide for the management of disorders of sexual development (DSD) in childhood. Disorders of sexual development are situations in which a newborn has congenital incoherence between chromosomal, gonadal and / or genital development. Materials and methods: the Guide for action on anomalies of sexual differentiation (ADS) / different sexual development (DSD) of the Spanish Pediatric Association published in 2018 was adapted, according to the guidelines of the Guide for Adoption-Adaptation of Guides of the Ministry of Health and Social Protection and the Institute of Technological Evaluation in Health in Colombia 2017. The GRADE system was used for the global qualification of the evidence and this guide was evaluated with the AGREE II-Global Rating Scale (AGREE II-GRS) tool. Through the Delphi method, a consensus was made with national experts who contributed their opinions about the diagnosis, management and follow-up of these disorders, which were included. Results: a guide was developed with 15 evidence-based recommendations for the diagnosis, treatment and follow-up of TDS in childhood. Conclusions: the management of TDS in childhood requires the participation of an interdisciplinary group that, in accordance with the recommendations in the light of current knowledge, guarantees to advance and improve technologies for both its diagnosis, as well as for its various therapies and the follow-up that implies the complexity of these disorders.

Supportive and palliative care needs in advanced non-malignant liver disease: systematic review

Advanced cirrhosis confers a significant symptom burden and has a 50% 2-year mortality rate in those with decompensated disease. There is increasing demand for supportive and palliative care (SAPC) for...

Challenging the profanity of management of higher education

Management and managerialism in higher education have become increasingly synonymous with the corruption of self-regulating institutions, with the disbandment of collegial governance, and with a general devaluation of traditional academic norms and values; they have become profane concepts. In this paper, this profanity is challenged, through an exploration of its reach into the actual practices of higher education. We conceptualise two versions of profane management: management as discursively profane and as practically profane. Using data from a Delphi study on perceptions of quality and quality management, we explore the usefulness of these concepts and discuss their value.

Developing consensus to enhance perinatal mental health through a model of integrated care: Delphi study.

Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.