Delphi Method Research Articles

Open questions on basal insulin therapy in T2D: a Delphi consensus.

The revolution in the therapeutic approach to type 2 diabetes (T2D) requires a rethinking of the positioning of basal insulin (BI) therapy. Given the considerable number of open questions, a group of experts was convened with the aim of providing, through a Delphi consensus method, practical guidance for doctors. A group of 6 experts developed a series of 29 statements on: the role of metabolic control in light of the most recent guidelines; BI intensification strategies: (1) add-on versus switch; (2) inertia in starting and titrating; (3) free versus fixed ratio combination; basal-bolus intensification and de-intensification strategies; second generation analogues of BI (2BI). A panel of 31 diabetologists, by accessing a dedicated website, assigned each statement a relevance score on a 9-point scale. The RAND/UCLA Appropriateness Method was adopted to assess the existence of disagreement among participants. Panelists showed agreement for all 29 statements, of which 26 were considered relevant, one was considered not relevant and two were of uncertain relevance. Panelists agreed that the availability of new classes of drugs often allows the postponement of BI and the simplification of therapy. It remains essential to promptly initiate and titrate BI when required. BI should always, unless contraindicated, be started in addition to, and not as a replacement, for ongoing treatments with cardiorenal benefits. 2BIs should be preferred for their pharmacological profile, greater ease of self-titration and flexibility of administration. In a continuously evolving scenario, BI therapy still represents an important option in the management of T2D patients.

Teaching Quality Care for Healthcare Professionals: Delphi Consensus on Designing Drama

Purpose: This study aimed to design drama for teaching quality care for healthcare professionals based on the newest evidence for continuous professional development and confront challenges for teaching healthcare professionals through multimedia that shift the trend in education from instructive to constructivist learning. Methodology: This study was conducted through a three-round stepwise Delphi consensus on a judgmental sample of expert panelists. The researchers identified the expert panelists' demographic and professional characteristics, studied the views and expectations of designing drama for teaching quality care, and appraised the designed drama with a self-administered structured questionnaire and a scale, respectively. Findings: Study results revealed that expert panelists achieved consensus on several items concerning the drama's content and design. The expert panelists' appraisals of the internal validity and consistency of the designed drama were (p≤0.05) and (0.767) as measured by the Pearson correlation test and Cronbach α, respectively. Unique Contribution to Theory, Practice, and Policy: The researchers conclude that expert panelists recommend applying drama in teaching, and with in-depth discussion, they verbalize how drama can improve educational outcomes. The researchers recommend adopting and disseminating the designed drama for teaching healthcare professionals’ quality care and instilling drama in teaching curricula to address the gap between theoretical study and what is faced in real fields.

THE INNOVATION OF GOVERNMENT RISK MANAGEMENT MITIGATION FOR DISASTER MANAGEMENT IN INDONESIA

Purpose: The dynamics and complexity of governance in disaster management in Indonesia require disaster management through the implementation of GRC (Governance, Risk, Compliance). integrated. The aim of this research is to assess the readiness of GRC innovation in disaster management through risk management mitigation, supporting infrastructure, and developing an integrated GRC implementation development plan. Theoretical reference and Method: Types of qualitative and quantitative research through surveys, distribution of questionnaires, collection of regulatory documents and GRC system policies in an integrated manner, reinforced by interviews with respondents, use of GRC system infrastructure design through infrastructure preparedness in facing disasters which are formulated in the form of policy proposal frameworks and guidelines that refer to against the ISO Handbook Integrated Use of Management System Standard, an action examination (PDCA) sample of 124 respondents. Results and Conclusion: The research results can be explained: 1) The creation of risk management guidelines resulting from integrated GRC practices in disaster risk mitigation has not been standardized. 2) The infrastructure design resulting from a study regarding readiness to implement integrated GRC in government in disaster management in Indonesia has not been implemented in general. 3) Based on the results of the Delphi method, the implementation of GRC has not been integrated. Implications of research: The implications of the research results can be used as recommendations for risk management stakeholders in making decisions based on the implementation of integrated G/R/C. Measuring the level of effectiveness uses a maturity model approach (Maturity Assessment) according to ISO standards. Originality/value: Originality: This research contributes to the implementation of integrated GRC 1) risk management guidelines resulting from integrated GRC practices 2) Infrastructure design resulting from studies regarding disaster management in Indonesia. 3) Delphi method, GRC implementation is not yet integrated.

Environmental Management Framework for Road Network Demolition Wastes for Construction Industry of Pakistan

Demolition waste from construction industry, especially from road networks, is one of the most voluminous and harmful categories of waste worldwide; therefore, its proper handling is essential for sustainable waste management for environmental, social, and economic benefits. Prolific and unregulated construction activities, conflicts, and defective works are major reasons. The current work aims to address the issue by presenting a framework for an enhanced understanding of sustainable demolition waste management (DWM). A critical analysis of the literature aided to identify major concerns related to different causes, their impacts, and challenges being faced by the construction industry in such management endeavors. The study adopted questionnaire-based methodology to understand the critical relation among the three variables. The Delphi technique supported by industry professionals and pilot study helped to formulate a realistic questionnaire tool. Using the concept of multivariate statistical analysis, structure equation modeling (SEM) helped to assess the structural relationships between the three variables. The research instrument met the reliability, validity and internal consistency criteria required. Each variable achieved a high effect size, f2, with a value of co-efficient of determination of more than the threshold value of 70%. Thus, this supported the fitness criterion of the SEM-based measurement model. Path coefficients yielded the acceptance of all alternate hypotheses, resulting in a strong positive relationship among the three constructs. Therefore, demolition waste impacts are deemed as an effective mediator when explaining the impact between the other two variables. The developed framework presents a coherent and systematic approach and identifies strategies that could be used to address these issues and lead to DWM, including options available for capacity building and implementation and evaluation for supporting sustainability.

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system

ObjectiveTo establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM.MethodsAn executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American.ResultsThe number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM.ConclusionContinuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

The Potential of Cloud-based Virtual Technologies to Enhance Project Management: A Delphi Study of the West Coast Governments

The Potential of Cloud-based Virtual Technologies to Enhance Project Management: A Delphi Study of the West Coast Governments

A core competency evaluation index system for the graded use of clinical nurse specialists: A Delphi study.

To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels. Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession. This research employed the Delphi method. The STROBE checklist for observational cross-sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications. The graded competency evaluation system consisted of five first-level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision-making), 15 second level indicators, and 40 third-level indicators. The authority coefficients (Cr) of the experts were .865 and .901. The Kendall's concordance coefficients of the three-level indicators were .417, .289 and .316 for primary CNSs; .384, .294 and .337 for intermediate CNSs; and .489, .289 and .239 for advanced CNSs. The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral. The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs. Patients participated in the data collection process, during which they shared their health-seeking experience with our research team.

Person-Centred Hepatitis C Virus Treatment In Community Settings

The World Health Organization (WHO) has set a target to eliminate the Hepatitis C virus (HCV) as a public health threat by 2030. To achieve this, HCV treatment needs to be accessible through primary health care providers in community settings. In Australia, general practitioners and nurse practitioners can prescribe nearly free direct-acting antiviral (DAA) medication. However, there are still many barriers to the provision of HCV treatment in community settings. Considering the characteristics of HCV infection, people with HCV, and the Australian primary health system, person-centred HCV treatment is suggested to improve treatment uptake and adherence. Although the provision of person-centred HCV treatment in community settings is emphasised, the characteristics of these models are not well described. This short report describes the characteristics of person-centred HCV treatment in community settings to inform policy and practices in supporting HCV elimination. The characteristics were developed based on the analysis of findings of studies conducted by the author using person-centred care framework. The studies included a mixed methods systematic literature review, a Delphi study, and a mixed methods case study on a community-based model of care for treating HCV.

Performance Evaluation of Railway Infrastructure Managers: A Novel Hybrid Fuzzy MCDM Model

Modern challenges such as the liberalization of the railway sector and growing demands for sustainability, high-quality services, and user satisfaction set new standards in railway operations. In this context, railway infrastructure managers (RIMs) play a crucial role in ensuring innovative approaches that will strengthen the position of railways in the market by enhancing efficiency and competitiveness. Evaluating their performance is essential for assessing the achieved objectives, and it is conducted through a wide range of key performance indicators (KPIs), which encompass various dimensions of operations. Monitoring and analyzing KPIs are crucial for improving service quality, achieving sustainability, and establishing a foundation for research and development of new strategies in the railway sector. This paper provides a detailed overview and evaluation of KPIs for RIMs. This paper creates a framework for RIM evaluation using various scientific methods, from identifying KPIs to applying complex analysis methods. A novel hybrid model, which integrates the fuzzy Delphi method for aggregating expert opinions on the KPIs’ importance, the extended fuzzy analytic hierarchy process (AHP) method for determining the relative weights of these KPIs, and the ADAM method for ranking RIMs, has been developed in this paper. This approach enables a detailed analysis and comparison of RIMs and their performances, providing the basis for informed decision-making and the development of new strategies within the railway sector. The analysis results provide insight into the current state of railway infrastructure and encourage further efforts to improve the railway sector by identifying key areas for enhancement. The main contributions of the research include a detailed overview of KPIs for RIMs and the development of a hybrid multi-criteria decision making (MCDM) model. The hybrid model represents a significant step in RIM performance analysis, providing a basis for future research in this area. The model is universal and, as such, represents a valuable contribution to MCDM theory.

Reversing the legacies: asset-based discourses for racialized social workers

ABSTRACT Social work has a lengthy history of ignoring and invalidating the assets that racialized practitioners bring to their work. This article seeks to shift the discourse in social work away from invisibility and diminishment toward visibility, positive valuing, and asset-rich perspectives. The rationale is rooted in original research, theory, and experience. We close the article with concrete recommendations for change. Research conducted in [state], USA, partnered with four culturally specific organizations and the university research team. An in-person Delphi study identified a set of 25 assets that these organizations agreed were pronounced within their workforce, and that contributed to the wellbeing of racialized clients. Defined as “staffing assets,” these experiences were then affirmed by a sample of 505 clients. To help organize the 25 assets into more standard constructs, we identify six domains in which to embed the assets: culturally grounded worldview and beliefs, effective advocate, invested in long-term community wellbeing, demonstrated respect and recognition, organic problem solver, and relationally focused. We then theorize these assets, drawing from previously published work. Closing with recommendations for improvements in the field, we prioritize workforce diversification, social work education reprioritizing, supervision improvements, building inclusive workplaces, infusing equity into research, and a shifted discourse within social work that foregrounds practitioners of color as holding essential assets for the wellbeing of racialized clients and communities. This contribution is a mere opening – as a field, we must dedicate scholarship and practice to building out practice frameworks that include social workers of color.

Establishment of in-hospital nutrition support program for middle-aged and elderly patients with acute decompendated heart failure

ObjectiveTo construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization.MethodsBased on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert’s scoring and feedback, and the expert scoring was calculated.ResultsThe response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators.ConclusionThe nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.

An investigation of waqf-based Islamic micro financial institution models to identify the most effective model for Indonesia

Purpose This study aims to determine the best waqf-based Islamic microfinancial institution (IMFI) model by first determining various viable waqf-based IMFI models and then evaluating them based on certain criteria to obtain the best model. Design/methodology/approach A combination of Delphi and analytic network process (ANP) methods was used. The Delphi method was used to determine various waqf-based IMFI models and validate them, whereas the ANP method was used to evaluate those models to prioritize and find the best model. Findings The Delphi results show nine proposed waqf-based IMFI models that have commercial, social or integrated commercial-social orientation, where each could be in the form of a micro bank, micro venture capital (MV) or micro cooperative (MC). Delphi and ANP then determined the strategic, commercial and social criteria to evaluate the models. Finally, the ANP results show that the best waqf-based IMFI models are the integrated waqf-based micro bank, integrated waqf-based MV and integrated waqf-based MC. Integrated waqf-based IMFI provides Islamic microfinance services as well as Islamic social finance services, including waqf, zakat and infaq. Research limitations/implications The adoption of waqf-based IMFI could solve the structural problems of IMFIs, such as funding, low capital, mismatch, liquidity, outreach and sustainability. Practical implications The conceptual framework and method used in this study can be applied to determine and evaluate waqf-based IMFI models in other countries. Originality/value This study begins by determining various viable waqf-based IMFI models and then evaluating them to determine the priority and best waqf-based IMFI model.

Development and Delphi consensus validation of the Medication-Related Fall screening and scoring tool.

Falls are a significant public health problem and constitute a major cause of injuries and mortality. Risk factors for falls are multifactorial and include medication use. To develop and investigate the content validity of the Medication-Related fall (MRF) screening and scoring tool. The MRF tool was developed from clinical practice guidelines addressing medication-related problems, and additional medications identified by specialist pharmacists across a region of the United Kingdom (Northern Ireland). Medication classes were categorised according to their 'potential to cause falls' as: high-risk (three points), moderate-risk (two points) or low-risk (one point). The overall medication-related falls risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of surveys were conducted using SurveyMonkey®. Twenty-two experts from 10 countries determined their agreement with the falls risk associated with each medication on a 5-point Likert scale. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool; ten were classified as high-risk, eight as moderate-risk and one as low-risk. The MRF tool is simple and has the potential to be integrated into medicines optimisation to reduce falls risk and negative fall-related outcomes. The score from the MRF tool can be used as a clinical parameter to assess the need for medication review and clinical interventions.

Optimizing Spatial Layout of Campsites for Self-Driving Tours in Xinjiang: A Study Based on Online Travel Blog Data

Within the economic and cultural context of Xinjiang, the tourism industry has rapidly developed as a strategic pillar of the national economy, with the self-driving tour market emerging prominently. However, the uneven spatial layout and insufficient service facilities of self-driving camps limit their development potential. This study aims to enhance the attractiveness of tourism in Xinjiang and improve the visitor service experience by constructing an evaluation system for the layout of self-driving camps based on online travel blog data, utilizing methods such as literature review, surveys, ArcGIS spatial analysis, and web text analysis. The Delphi method and entropy weight method were applied to determine the weights of the influencing factors. The findings reveal spatial imbalances in the layout of Xinjiang’s self-driving camps and propose eight preferred scenic areas for camp location. This study also suggests sustainable development strategies. These insights and recommendations aim to optimize the layout of self-driving camps, enhance the tourism experience, and promote the sustainable development of Xinjiang’s tourism industry.

Development of a minimum clinical dataset for preoperative comprehensive geriatric assessment using a modified Delphi technique.

To construct a standardised, consensus-guided minimum clinical dataset (MCDS) for preoperative comprehensive geriatric assessment and optimisation (CGA) in Australia and Aotearoa New Zealand. We conducted a review of the international perioperative literature to identify CGA domains and tools for potential inclusion in the MCDS. We invited members of the Australian and New Zealand Society for Geriatric Medicine to participate in a Delphi study to obtain consensus on MCDS tools. Participants were asked to rate proposed tools using Likert scales (when >2 tools) or make a binary choice between two proposed tools. Consensus was considered to be achieved when there was at least 75% concordance between the two rounds amongst the participants, and at least one variable attaining over 50% of participants' votes. Domains that did not achieve consensus in Round 1 were carried over to Round 2. There were 73 participants in Round 1 of the Delphi study and 47 participants in Round 2. Consensus was achieved on tool/s recommended for every MCDS domain: Clinical Frailty Scale (frailty); sMMSE, RUDAS, MoCA (cognition); 4AT (delirium); timed-up-and-go (physical function); GDS-15 (mood); Barthel Index (functional status); and MUST (malnutrition). We recommend clinicians delivering preoperative CGA consider the use of the MCDS we have constructed when assessing older people contemplating surgery, as part of a multicomponent and multidisciplinary approach to optimising perioperative outcomes.

Refining the CRiSPHe (checklist for reporting research using a simulated patient methodology in Health): a Delphi study.

A recent applicability study highlighted the need for the existing checklist for reporting research using a simulated patient methodology (CRiSP) to be clearer and user-friendly. The aim of this study was to update the checklist to address these concerns. A fourth round of the Delphi consensus study, used in the original checklist development work, was conducted. Previous participants, who had expertise in SP methodology, were invited to complete a questionnaire including a list of 13 checklist items developed in the previous study and revised following applicability testing. Closed questions were analysed for frequency. Consensus was predefined as >80% agreement. All items were discussed in a roundtable meeting and further modified as necessary. Responses to open questions were content analysed. Twenty-one authors participated. There was a statistical consensus in 12 out of 13 modified checklist items. A final reporting checklist for studies in health research using SP methodology has been developed using a consensus approach. Further refinements may be needed to increase the generalizability of the checklist in different contexts.

Infective Native Aortic Aneurysms: A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards

Abstract Background There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. Aims The aim of this study was to establish this by performing a consensus study. Methods The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two-week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five-point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting “strongly agree” or “agree” on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient &amp;gt; .80. Results All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 = .84, round 2 = .87, round 3 = .90, and round 4 = .92). Thus, consensus was reached for all statements and reporting items. Conclusion This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge.

Development of a national maternity early warning score: centile based score development and Delphi informed escalation pathways

ObjectiveTo derive a new maternity early warning score (MEWS) from prospectively collected data on maternity vital signs and to design clinical response pathways with a Delphi consensus exercise.DesignCentile based score...

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.