Delphi Survey Research Articles

'Towards a conceptualization of nurses' support of hospitalised patients' self-management-A modified Delphi study'.

To determine patients', nurses' and researchers' opinions on the appropriateness and completeness of the proposed conceptualization of nurses' support of hospitalised patients' self-management. A modified Delphi study. We conducted a two-round Delphi survey. The panel group consisted of patients, nurses and researchers. The conceptualization of nurses' support of hospitalised patients' self-management presented in the first Delphi round was based on previous research, including a scoping review of the literature. Data was analysed between both rounds and after the second round. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). In the first round all activities of the proposed conceptualization were considered appropriate to support the patients' self-management. Panel members' comments led to the textual adjustment of 19 activities, the development of 15 new activities, and three general questions related to self-management support during hospitalisation. In the second round the modified and the newly added activities were also deemed appropriate. The clarification statements raised in the first Delphi round were accepted, although questions remained about the wording of the activities and about what is and what is not self-management support. After textual adjustments and the addition of some activities, the proposed conceptualization of nurses' support in patients' self-management while hospitalised have been considered appropriate and complete. Nevertheless, questions about the scope of this concept still remains. The results provide a starting point for further discussion and the development of self-management programs aimed at the hospitalised patient. The results can be considered as a starting point for practice to discuss the concept of nurses' support for hospitalised patients' self-management and develop, implement and research self-management programs specific for their patient population. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Patients were involved as expert panellist in this Delphi study. Impact statement What problem did the study address? Self-management support during hospitalisation is understudied, which undermines the development of evidence-based interventions. What were the main findings? A panel, consisting of patients, nurses and researchers, agreed on the appropriateness of a conceptualization of nurses' support of inpatients' self-management, and identified some points for discussion, mainly related to the boundaries of the concept self-management. Where and on whom will the research have an impact? This study is crucial for generating conceptual understanding of how nurses support patients' self-management during hospitalisation. This is necessary for policy, clinical practice, education, and research on this topic.

Carving out space for co-creation in implementation of evidence-based mental health interventions

Abstract Background Mental health is identified as a pressing public health priority for European countries challenged by societal changes. The ADVANCE project aims to strengthen our understanding of mental health promotion and prevention in seven countries in Europe. In Denmark, the research project sets out to understand how WHO’s stress management intervention Self Help Plus can be embedded within social and integration programmes for adults who have experienced migration. Methods We are using a common methodology across the 7 country projects oriented by co-creation with end users and relevant stakeholders to initially develop implementation scenarios and stigma reduction strategies. We will present findings from this process and reflect on the tension and potential of the co-creation methodology in the implementation of evidence-based mental health interventions. Results In the first project phase of problem analysis and co-creation, the project’s society advisory group discussed 10 tailored intervention scenarios. Then, a Delphi survey and two rounds of scenario-based workshops with additional involvement of 16 end users/actors resulted in a final implementation scenario and stigma reduction strategies. We identified and reflected on questions around ownership of the project, boundaries of the proposed intervention, alignment of expectations, and intervention sustainability within the parameters of the ADVANCE project. Conclusions Even when interventions are pre-selected in response to funding calls, co-creation can facilitate the development of acceptable and sustainable implementation strategies. However, meaningful co-creation requires time, flexibility, and negotiation, which is not always guaranteed. Key messages • Co-creation creates productive tension and potential for the implementation of ADVANCE. • Space for co-creation was negotiated with collaborators to ensure meaningful engagement.

The 1+Million Genomes Maturity Level Model for Genomics in Healthcare

Abstract The 1+Million Genomes Initiative (1+MG) has been fostering reflection in European countries on their national strategies for genomic medicine, and how these can contribute to research development and improved medical practice. For all citizens to truly benefit from genomic medicine, there must be equitable access across Europe. However, European countries are currently at different stages of implementation of genomics in medical practice. To bridge these gaps, health decision-makers need to understand the maturity of genomic medicine practices in their healthcare systems, to make informed decisions about investment, resources, and practices towards optimized adoption of genomics in healthcare systems. This presentation will focus on the 1+MG Maturity Level Model (MLM), developed in the context of the 1+MG Initiative and B1MG project. This MLM was created as a tool for countries to self-assess the maturity of genomic medicine practices in their healthcare systems, and to define a path to optimization. The MLM content was validated through a Delphi survey with international genomics and public health experts, and a pilot in real-life settings was conducted in eight European countries. The 1+MG MLM pilot provided valuable insights regarding common strengths, weaknesses, and asymmetries across Europe, highlighting the need for national and cross-European investments to close existing gaps, and make personalised medicine accessible to all citizens and patients in Europe.

Mental health promotion research in co-creation: Lessons from a multisite study in six countries

Abstract Background Mounting public health threats associated with climate change, epidemiological and economic crises, digitalisation, rising migration, and population aging have uncovered at-risk groups’ increased vulnerability to mental ill health. Developing mental health promotion interventions tailored to their specific needs and expectations is essential to protect their wellbeing. However, researchers may find it challenging to identify and implement needed adaptations without engaging with end-users, and other stakeholders, to co-create tailor-made interventions. This study aimed to explore co-creators’ views about opportunities and constraints in participatory mental health promotion research. Methods Between September 2023 and July 2024, a qualitative study drawing on participant observation of bimonthly meetings and semi-structured interviews with six co-creation facilitators was conducted in the scope of Horizon Europe’s project ADVANCE. The multi-methods research approach to co-creation entailed desk reviews and online Delphi surveys co-developed with locally-established Society Advisory Groups, and scenario-based workshops held with stakeholders in the six partner countries: Denmark, Germany, Italy, Lithuania, Netherlands, Switzerland. Thematic analysis of the data was carried out. Results Research teams’ epistemic stances impact research planning, resource allocation, partnership nourishing and the unravelling of co-option risks during participatory research implementation. Research co-creation adds pressure onto research teams’ agenda, skillset and performance, but it also encourages power sharing, mutual learning and greater alignment of research design and implementation with end-users’ priorities and aspirations. Conclusions Research co-creation is a partnership-based and resource-intensive endeavour that can provide a valuable pathway to improve the relevance, acceptability and sustainability of public mental health promotion research. Key messages • Research co-creation demands planning, adequate resource allocation, flexibility and continuous investment to sustain academy-society partnerships. • Engaging stakeholders in knowledge co-creation can increase the relevance, acceptability and sustainability of public mental health promotion research.

International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts’ experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

Policy and practice recommendations for services for disabled children during emergencies: Learning from COVID-19.

To seek consensus on recommendations for the delivery of services to disabled children in England during future emergencies. Candidate recommendations were drafted based on our related mapping review and qualitative research related to experiences during the COVID-19 pandemic. Iterative workshops with professionals and parent carers helped to refine the recommendations. A Delphi survey, rating the importance of each recommendation, was conducted with (1) parent carers of disabled children, (2) disabled young people aged 8 to 19 years, and (3) health, education, and social care professionals. A consensus meeting was convened online to discuss the findings and ratify the recommendations. Twenty-eight recommendations were included in the Delphi survey. There were 141 participants in round 1 and 91 in round 2. Seven recommendations reached the agreed consensus criteria for being critical across all stakeholder groups, while 21 recommendations did not reach consensus across all groups. Fourteen participants ratified 23 recommendations, which when aggregated and refined further produced our final 19 recommendations. Reductions in services for disabled children and their families during the COVID-19 pandemic had serious and lasting consequences. This study enabled parent carers, disabled young people, and health, education, and social care professionals to agree recommendations on services for disabled children during future emergencies.

Exploring essential features for developing a human resource management mobile application: Insights from the middle east

This study aims to investigate the key features necessary for the development of a mobile application for human resource management (HRM). It addresses the shortage of empirical studies on digital HRM in the Middle East and emphasizes the increasing importance of HRM mobile applications in the region. The research utilizes qualitative research methods, including the Delphi method, in-depth interviews, literature review, historical analysis, and critical discussion.A qualitative research strategy is employed, analyzing data from 43 HR experts and mobile app development team members from international and local businesses in the UAE and the Kingdom of Bahrain. NVivo software is used for data analysis, encompassing over 120 transcriptions, notes, and academic papers. The study identifies and explores the logical and practical features required for an HRM mobile app. It uncovers challenges related to the Delphi survey experiences, such as managing heterogeneous information and ensuring compatibility with iOS and Android platforms. This research fills a gap in the literature by investigating the digital HRM landscape and HRM mobile applications in the Middle East. It provides valuable insights from HR and technology experts, contributing to the advancement of digital HRM, mobile applications, and the application of the Delphi method methodology. The study highlights implications for industries to enhance HR operations and productivity through the adoption of mobile HR applications. Theoretical contributions include new insights into the digital HRM literature, specifically regarding the identification and discussion of essential features in HRM mobile applications. Practical implications involve the benefits of transitioning from traditional HRM to digitalized HRM in the professional era, as identified through the analyzed features of the HR app. The study offers practical insights for the development and implementation of mobile HR apps. Organizations can leverage these insights to create effective mobile HR apps that enhance HR operations and employee productivity.

Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure-Process-Outcome Model.

This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model. A Delphi survey. The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts. The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators. The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes. This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training. Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.

Exploring Smart Airports’ Information Service Technology for Sustainability: Integration of the Delphi and Kano Approaches

Airport digitalization has revolutionized service delivery at passenger touchpoints, which leads to sustainable passenger loyalty. However, it is critical to determine whether this rapid transition to digital services genuinely enhances passenger satisfaction with airport services. This study uses a mixed-method approach to identify key traditional and technology-driven information services in smart airports. The specific aim is to determine the optimal balance in which digital technologies can effectively replace human-provided services to establish sustainable passenger loyalty. Two rounds of Delphi surveys were conducted with panels of 23 and 21 experts, followed by an online Kano survey with 401 international passengers. The Delphi analysis identified 16 key information service attributes, while the Kano analysis revealed that the majority of technology-based services were attractive and positively influenced passenger satisfaction. By contrast, human-based services were mostly indifferent, although some were vital for boosting satisfaction and preventing dissatisfaction. These results advance the current airport service research and provide practical insights into optimizing passenger experiences through the strategic integration of technology for sustainable smart airports while maintaining essential human-provided services.

A Study on the Development of Information and Communication Technology-Based Oral Functional Rehabilitation Exercise Program Content for Elderly People.

Background/Objectives: This study was conducted to develop information and communication technology (ICT)-based oral functional rehabilitation exercise (OFRE) program content to effectively improve the oral function of the elderly people. Methods: After selecting evidence-based effective OFRE items through systematic review, the final items were constructed through the validity evaluation of detailed items through an expert Delphi survey. The items were composed in a simple content form that can be performed directly and applied to ICT-based mobile applications. Results: The final content items consisted of an oral functional motor-ability measurement, oral Pilates videos, and games. The first is to measure the maximum opening amount before and after exercise, and the opening amount was designed to be measured by eating the fruit displayed on the screen by opening and closing the lips. The second one consisted of eight exercises in the video, and each exercise was to be performed at least three times a day, with a total of two sets. The third is a salivary secretion function exercise that stimulates the salivary glands to stimulate the user's interest and enable them to perform oral movements on their own. It consists of a lip and respiratory muscle exercise that inflates the cheeks and bursts a balloon, and the image disappears when the word in the image presented on the screen is pronounced correctly. It consists of pronunciation exercises. Conclusions: This content development attempt can be expanded into new convergence research linked to ICT and can be used as basic data when developing related content as part of digital care for the elderly in the future.

행동기준 평정척도(BARS)를 적용한 대학생 핵심역량 측정도구 개발 및 타당화 연구: D대학의 의사소통역량을 중심으로

Objectives This study attempted to develop the core competency’s measurement tool and secure its validity by focusing on the D University’s communication capabilities and applying the behaviorally anchored rating scale based on experiences or behaviors closely related to students’ university education and life. Methods This study applied appropriate research methods according to a six-step’s systematic research procedure, including core competency analysis and competency modeling, analysis of behavioral characteristics of excellent students through FGI for professors and BEI for students, development of core competency’s measurement tool through expert council, validation through expert delphi survey, pilot test and analysis, and finalizations stage of system, definition, and measurement tool. Results The research results are as follows. First, the core competency’s system and definition with a high consistent were derived through a systematic competency modeling process. Second, the behavioral characteristics of hyperformers(high-performing students) were analyzed through interview with professors and students and reflected in the behaviorally anchored rating scale. Third, the core competency’s measurement tool(draft) with a high consistent were confirmed. Fourth, a core competency measurement tool(revised version) was tentatively derived by verifying its validity through two expert delphi surveys. Fifth, a pilot test was conducted to improve effectiveness of the core competency’s measurement tool, and reliability and validity were secured. Sixth, the finalizations stage was completed, and the system, definition, and measurement tool of core competencies were confirmed. Conclusions By developing a core competency’s measurement tool based on the behaviorally anchored rating scale focusing on D University’s communication capabilities and then revealing the process of securing reliability and validity, It could play a significant role in suggesting alternative methods to objectively measure the core competencies of each university.

Referral pathway and competency profiles of primary care physiotherapists and kinesiologists for physical activity interventions for diabetes: a modified Delphi study

BackgroundHigh quality diabetes care is an essential service in primary care settings since the prevalence and associated complications of diabetes is increasing. Physical activity is effective for the prevention and management of diabetes yet is underutilized in diabetes care. Exercise professionals have specialized skills to deliver physical activity interventions, but effective interprofessional collaboration for diabetes care requires role clarity. This study established the competencies of entry-level physiotherapists and kinesiologists for physical activity interventions for diabetes care in primary care settings and used these competencies to develop clinical tools to promote role clarity in interprofessional care teams.MethodsWe used a modified Delphi process. Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft competency profiles and a referral pathway tool. Eleven of the participants then participated in a focus group for member-checking of the tools. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively.ResultsThe modified Delphi process resulted in 38 physiotherapy and 27 kinesiology competencies that identify the distinct roles of physiotherapists and kinesiologists in delivering physical activity interventions for diabetes care. The physiotherapy competencies describes their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. The kinesiology competencies indicate where these professionals may require additional training, especially when working with people living with type 1 diabetes or who are pregnant. All developed tools had good face validity and were seen to be potentially useful tools by the subject matter experts.ConclusionsThe findings highlight that both physiotherapists and kinesiologists have fundamental skills and abilities to deliver physical activity interventions to people living with diabetes, but that different exercise professionals may be needed depending on the complexity of the clinical profile. The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in delivering physical activity interventions for diabetes care and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care.

Multiple negative impacts of marine plastic pollution on tropical coastal ecosystem services, and human health and well-being

There is limited empirical evidence showing the impacts of marine plastic pollution on ecosystem services or on human health and well-being in Global South countries. We aimed to estimate these impacts in the tropical archipelago of Indonesia, one of the top emitters of marine plastics globally, through an iterative Delphi survey, with an expert panel (n = 42) consisting of equal numbers of Indonesian scientists, policymakers, and practitioners. After two rounds of the survey, the analysis of interquartile ranges indicated that the experts reached a consensus in their predictions. The experts agreed that, over the next 10 years, plastics would be mainly accumulated in the coastal area of Java, the most densely populated island, and mostly in mangrove ecosystems. While all ecosystem services were harmed by plastic pollution, the most vulnerable services were food provisioning, genetic materials, nursery habitat, and recreation supplied by the highly vulnerable coastal ecosystems of, in descending order, mangrove, coral reef, seagrass, and sandy beach. These impacts on ecosystem services influenced different dimensions of human health and well-being and were dependent on the ecosystem types, as indicated in several statistically significant positive correlations (Spearman's rank), including those between the decline of mangrove ecosystem services and reduced household income, and between the decrease of coral reef ecosystem services and both deteriorating mental health and reduced household income. Overall, this study provides the first indication of Indonesian coastal ecosystems and ecosystem services to be prioritized for mitigation and monitoring efforts. The focus on impacts on human health and well-being also incentivizes ongoing efforts by policymakers, industry and commerce, the third sector, and the public in the country to address the contribution to global marine plastic pollution.

Establishing Outcome Parameters for Helicopter Emergency Medical Services Research in The Netherlands: Results of a Mixed-Methods Delphi Consensus Study

Objectives Physician staffed Helicopter Emergency Medical Services (P-HEMS) care in the Netherlands has transitioned from predominantly trauma management to handling a variety of medical conditions. Relevant outcome parameters for Dutch P-HEMS research have not been previously defined. National consensus was sought to identify relevant long term patient outcome parameters, process outcome parameters and performance outcome parameters for Dutch P-HEMS care. Methods This was a mixed methods Delphi consensus study. A list of potentially relevant outcome parameters was identified using a systematic literature review. These parameters were subsequently surveyed in a Delphi consensus study. Helicopter Emergency Medical Services physicians and relevant stakeholders were invited to participate in this Delphi survey, where they were allowed to suggest additional outcome parameters. Descriptive analysis was performed on all data sets. Results Forty-nine potential outcome parameters for Dutch P-HEMS care were surveyed. Of 71 invited participants, 53 (75%), 40 (56%), and 20 (28%) participated in the first, second, and third round of the Delphi study, respectively. Consensus was reached on 25 (51%) of 49 outcome parameters as being important. These consisted of seven long term patient related outcome parameters, four short term patient related outcome parameters, five process outcome parameters and nine performance outcome parameters. Conclusions In conclusion, this study identified 25 outcome parameters relevant for Dutch physician staffed HEMS care. These parameters should be considered when designing future studies and should be routinely collected for each dispatch if possible.

Construction and validation of the Emergency Oncology Scale (EMOnco), a risk rating protocol for the triage of cancer patients in acute care settings.

Manfredini et al. demonstrate that the new rating protocol, EMOnco, can triage of cancer patients in acute care settings safely, considering their cancer type, stage and treatment histories and oncological emergencies, enabling the appropriate classification from high-risk patients to non-urgent patients. ■ EMOnco considers variables related to the cancer history and treatment. ■ Triages patients in the emergency care in less than three minutes. ■ Cancer patients need priority care regarding infection, and this protocol consider it. ■ EMOnco has shown to be a valid and reliable scale for the triage of oncological patients in the emergency room or acute care clinics. To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition. This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit. We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p<0.001 for all). EMOnco in Portuguese considers variables related to the cancer history and treatment and has proven to be a valid and reliable for the risk classification of oncological patients in emergency care services.

Delphi Recommendations for Diagnosis and Treatment of Sexual Interest in Children in Non-Mandated Community Settings

ABSTRACT This study sought to reach an international expert consensus regarding the diagnosis and treatment of adults with a sexual interest in children in cases where treatment is non-mandated. An expert panel of 27 participants (19 professionals and eight individuals with sexual interest in children) completed at least one of three rounds of an online Delphi survey. In the first round, participants responded to open-ended questions about assessment approaches, treatment goals, treatment approaches, and adapting assessment and treatment for sexual exclusivity. In rounds two and three, participants rated their level of agreement with each of the recommendations derived from Round 1. Consensus was reached for 48 practice guidelines, particularly for recommendations that relate to general clinical practice, such as assessing for other mental health conditions. There was more contention for the inclusion of forensic practices. The present recommendations can serve as a set of tentative guidelines that may guide assessment and treatment of sexual interest in children in non-mandated settings.

A new performance evaluation indicator for the LEE Jong-wook Fellowship Program of Korea Foundation for International Healthcare to better assess its long-term educational impacts: a Delphi study.

The Dr. LEE Jong-wook Fellowship Program, established by the Korea Foundation for International Healthcare (KOFIH), aims to strengthen healthcare capacity in partner countries. The aim of the study was to develop new performance evaluation indicators for the program to better assess long-term educational impact across various courses and professional roles. A 3-stage process was employed. First, a literature review of established evaluation models (Kirkpatrick's 4 levels, CIPP model, OECD DAC criteria) was conducted to devise evaluation criteria. Second, these criteria were validated via a 2-round Delphi survey with 18 experts in training projects from May 2021 to June 2021. Third, the relative importance of the evaluation criteria was determined using the analytic hierarchy process (AHP), calculating weights and ensuring consistency through the consistency index (CI) and consistency ratio (CR), with CR values below 0.1 indicating acceptable consistency. The literature review led to a combined evaluation model, resulting in 4 evaluation areas, 20 items, and 92 indicators. The Delphi surveys confirmed the validity of these indicators, with content validity ratio values exceeding 0.444. The AHP analysis assigned weights to each indicator, and CR values below 0.1 indicated consistency. The final set of evaluation indicators was confirmed through a workshop with KFIH and adopted as the new evaluation tool. The developed evaluation framework provides a comprehensive tool for assessing the long-term outcomes of the Dr. LEE Jong-wook Fellowship Program. It enhances evaluation capabilities and supports improvements in the training program's effectiveness and international healthcare collaboration.

The management of idiopathic toe walking.

The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care. An established Delphi approach with predetermined steps and degree of agreement based on a standardized protocol was used to determine consensus. The steering group members and Delphi survey participants included members from the British Society of Children's Orthopaedic Surgery (BSCOS) and the Association of Paediatric Chartered Physiotherapists (APCP). The statements included definition, assessment, treatment indications, nonoperative and operative interventions, and outcomes. Descriptive statistics were used for analysis of the Delphi survey results. The AGREE checklist was followed for reporting the results. A total of 227 participants (54% APCP and 46% BSCOS members) completed the first round, and 222 participants (98%) completed the second round. Out of 54 proposed statements included in the first round Delphi, 17 reached 'consensus in', no statements reached 'consensus out', and 37 reached 'no consensus'. These 37 statements were then discussed, reworded, amalgamated, or deleted before the second round Delphi of 29 statements. A total of 12 statements reached 'consensus in', four 'consensus out', and 13 'no consensus'. In the final consensus meeting, 13 statements were voted upon. Five were accepted, resulting in a total of 31 approved statements. In the aspects of practice where sufficient evidence is not available, a consensus statement can provide a strong body of opinion that acts as a benchmark for excellence in clinical care. This statement can assist clinicians managing children with ITW to ensure consistent and reliable practice, and reduce geographical variability in practice and outcomes. It will enable those treating ITW to share the published consensus document with both carers and patient groups.

Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method.

Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

Proposed categories for reporting of service organization in rehabilitation in clinical trials: a discussion paper.

The lack of standardized reporting for crucial organizational factors in rehabilitation poses a significant barrier to understanding their impact on patient outcomes in clinical trials and meta-analyses. Based on the categories in the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), we aimed to develop reporting standards specifically for organizational factors in clinical trials. A comprehensive two-step process was conducted. In Step 1, important categories were identified. The identification was based on previous results from a Delphi survey with international stakeholder participation, two systematic literature reviews and results from focus groups with users in Germany, Indonesia and Norway. Step 2 involved the necessary reduction of categories and the proposal of reporting specifications, achieved through two voting rounds among key researchers, stakeholders and users. The suggested minimum reporting set comprises Context and Setting as well as Quality assurance and management. The Context and Setting is proposed to include whether the intervention is delivered by Hospital, Community or Other service providers. The Mode of delivery is proposed to be specified as Inpatient, Outpatient, In-home, or Tele-rehabilitation. Furthermore, the Level of specialization (Primary/Secondary) and the Phase of service delivery Acute, Subacute or Long-term rehabilitation services should be reported. The Quality assurance and management should be reported as Yes or No, with the option Yes requiring description of the quality assurance applied in the methods section. This study proposed a compulsory and standardized reporting of organizational factors in clinical trials to facilitate the generation of scientific evidence regarding effective service provision and delivery in rehabilitation medicine. Authors are encouraged to consider the proposed reporting set to testing, criticism, and modification to enhance its applicability and robustness.