Nominal Process Research Articles

Interpreting Variations in Fugl-Meyer Assessment Protocols: Results and Recommendations from a Nominal Group Consensus Process

ObjectiveTo identify variations among administration and scoring instructions of six upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures. DesignNominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings. SettingClinicians working in clinical practice and research settings participated in virtual meetings via Zoom. ParticipantsTen experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group. Interventionsnot applicable. Main Outcome MeasureQualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (i.e., instructions that could affect the scoring of many individual test items) were discussed and analyzed during a three-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus. ResultsConsensus was attained for 7/10 general administration instructions. Recommendations from our consensus group summarize “best practice” general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between highest and lowest FMA-UE scores, highlights the potential impact of these protocol variations. ConclusionsVariations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidenced-based practice. Results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.

Basic concepts in preserving holistic well-being in interstitial lung diseases: A MIHRA and G-FoRSS collaborative summary

Background: Interstitial lung diseases (ILD) are a heterogenous group of diseases that involve inflammation and/or fibrosis of the lung parenchyma. ILD can exert significant stress on a person’s extrapulmonary systems, eroding organ and physical function. Thus, ILD can accelerate age-related vulnerabilities that lead to early onset frailty, which makes frailty prevalent in ILD at any age. Frailty confers a three-fold increase of, and predicts, mortality in ILD. Objective: To present a feasible approach to understanding and addressing holistic health in ILD to fortify physical and psychological capacity markedly enhances a person’s tolerance of ILD and aging. Methods: From our previous published work that consisted of serial Medline and PubMed scoping reviews (with search terms such as frailty, interstitial lung disease, ILD, idiopathic pulmonary fibrosis, IPF, systemic sclerosis, sarcoidosis, well-being), patient focus groups, ILD outcome measures deconstruction and linking to the World Health Organization’s International Classification of Disability, and nominal group processes, we iteratively isolated factors that seem to accelerate and, importantly, protect against and reverse frailty. These factors were presented at The Eastern Pulmonary Conference in September 2024 and summarized herein. Results: The result is a collective statement that (a) summarizes health-care system responsibilities in providing sustainable, humane environments for patients and clinicians; (b) advocates for early intervention and shared decision-making from the time of diagnosis to fortify well-being when living with ILD; and (c) offers guidance to fortify physical, mental, and social well-being as well as health literacy and strength of patient voice. Conclusion: Proactive measures to protect against frailty begins at the time of diagnosis. Interventions that are incremental and based on patient priorities and preferences introduce a feasible approach to holistic well-being.

A research agenda to advance the study of implementation mechanisms

BackgroundImplementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms—the processes responsible for change—is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution.MethodBuilding on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: “What actions need to be taken to move this research forward?” The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team.ResultsFrom this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms.ConclusionsThis research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.

Intangible cultural heritage in practice Between appreciation and appropriation

This text deals with selected issues related to the use of cultural heritage undertaken from the position of stakeholders. Theoretical considerations are based on selected examples of craft skills used in safeguarding intangible heritage. The lively activity of dissemination and promotion of these skills is largely linked to the implementation of the 2003 UNESCO Convention on the Safeguarding of the Intangible Cultural Heritage and the consequent creation of the National List of Intangible Cultural Heritage. In particular, the text analyses aspects of the nomination process of heritage bearers and the outcomes of such a role. More broadly, the article highlights issues related to the boundary between cultural heritage appreciation and appropriation, as well as heritage management and community empowerment.

Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury.

While it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI, including spina bifida (SB)], the availability of evidence-based follow-up care programs remains limited. Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP), we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps. This guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.). To ensure an evidence-based guidance, we utilized the International Classification of Functioning, Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework. We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments. Subsequently, we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation, while adhering to the criteria outlined in the German guideline development instrument (DELBI). Although there is a fair number of literatures describing prevalence and severity of SHCs after SCI, the amount of literature including recommendations was low (19 for SCI and 6 for SB). Based on the current evidence on prevalence and severity of SHCs and available recommendations, a clinical practice guideline on follow-up care of most relevant SHCs was defined. The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system, vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception, pregnancy, birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy. We could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI. There is however a notable lack of high-quality recommendations for SCI follow-up care.

Reducing Disposable Diaper Waste: Protocol for a Behavioural Science Workstream

Disposable diapers contribute to the generation of plastic waste globally, with more than 8 million tonnes of diapers ending up in landfills or incinerated each year. One strategy for reducing this waste while maintaining child and parent health and well-being is to increase reusable diaper use and reduce delays in toilet training. We outline a protocol for applying behavioural science to understand the factors influencing these behaviours and to generate intervention recommendations. The research will be conducted in two stages. Stage 1 involves semi-structured interviews and surveys, guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model, to explore factors influencing reusable diaper use and toilet training at 18–30 months. Data will be analyzed using quantitative (regression and ANOVA) and qualitative (deductive and inductive) methods. Stage 2 involves triangulating findings to identify key barriers and enablers. Intervention frameworks (Behaviour Change Wheel and BCT Taxonomy) will help identify potential behaviour change intervention strategies to target key barriers and enablers identified within COM-B domains. Interventions will be presented to multidisciplinary stakeholders and nominal group technique process will be used to agree on the most promising, feasible, and acceptable options for development and piloting. The findings will help generate recommendations for supporting UK government policy and practice change in this area.

CORPORATE GOVERNANCE REFORM AND SUSTENANCE OF STATE-OWNED ENTERPRISES (SOES) IN ZIMBABWE

The study sought to ascertain corporate governance reforms that foster sustenance of the SOEs in Zimbabwe and how such reforms can be implemented. This study has used a mixed-methods technique and a pragmatist philosophy. A cross-sectional survey design was employed, whereby structured questionnaires and interviews were used to collect data. Top and middle management, board members, board chairpersons, and CEOs of Zimbabwe’s SOEs made up the target population. For quantitative data, a sample size of 351 people was obtained using the sample process created by Krejcie and Morgan (1970). Interviews were done with sixteen (16) people until saturation was achieved. Stratified random sampling was used in the study to choose respondents for the quantitative data collection. To choose interview subjects for the qualitative data, purposeful sampling was applied. The quantitative and qualitative data were analyzed using SPSS version 23 and NVivo version 12, respectively. According to the study, the primary corporate governance reforms for the survival of the SOEs in Zimbabwe included the following: open nomination processes for the SOEs; removal and resignation of directors who did not comply with best corporate governance practices; limitations on board member compensation; and changes to the executive directors’ terms of service. This research has shown that best corporate governance practices in the SOEs are brought about by reforming the Board Appointments Board (RAB). In order to ensure that corporate governance reforms are implemented effectively, the present study has suggested that term limits, with a maximum of ten (10) years, in Chief Executive Officer Employment contracts be strictly enforced.

Identifying and Prioritizing Factors to Improve Implementation of an Evidence-Based Program for Child Maltreatment Prevention in Rural Missouri Communities

AbstractPrevention of child abuse and maltreatment is critical in the Ozark region of Missouri where rates are higher than in other areas of the state. Community-based organizations seeking to address these issues in rural areas face significant challenges both internal and external to the organization. Guided by the Consolidated Framework for Implementation Research (CFIR), Whole Kids Outreach (WKO) utilized a modified concept mapping approach to identify strategies needed to address these challenges and more effectively implement the Healthy Families America (HFA) program in seven counties in the rural Missouri Ozark region. Semi-structured interviews were used to identify barriers and supports to the implementation of HFA. Statements were generated via in-person and telephone interviews with key stakeholders (WKO internal staff and external partners). These stakeholders then sorted statements into like piles and rated them according to importance. Concept mapping systems software, using multidimensional scaling and hierarchical cluster analysis, was used to determine the most salient cluster solution. The resulting cluster map depicted six thematic clusters and provided a visual representation of relationships between clusters. Stakeholders were then guided through a nominal group process to prioritize key issues and begin to develop strategies to address them.

2024 HASTI Award Recipients

Each year at the annual HASTI Conference we have an opportunity to recognize some amazing Science educators. Here, I will introduce the winners and include the words of support their colleagues offered during the nominations process.

A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region.

The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

Reporting guidelines for precision medicine research of clinical relevance: the BePRECISE checklist.

Precision medicine should aspire to reduce error and improve accuracy in medical and health recommendations by comparison with contemporary practice, while maintaining safety and cost-effectiveness. The etiology, clinical manifestation and prognosis of diseases such as obesity, diabetes, cardiovascular disease, kidney disease and fatty liver disease are heterogeneous. Without standardized reporting, this heterogeneity, combined with the diversity of research tools used in precision medicine studies, makes comparisons across studies and implementation of the findings challenging. Specific recommendations for reporting precision medicine research do not currently exist. The BePRECISE (Better Precision-data Reporting of Evidence from Clinical Intervention Studies & Epidemiology) consortium, comprising 23 experts in precision medicine, cardiometabolic diseases, statistics, editorial and lived experience, conducted a scoping review and participated in a modified Delphi and nominal group technique process to develop guidelines for reporting precision medicine research. The BePRECISE checklist comprises 23 items organized into 5 sections that align with typical sections of a scientific publication. A specific section about health equity serves to encourage precision medicine research to be inclusive of individuals and communities that are traditionally under-represented in clinical research and/or underserved by health systems. Adoption of BePRECISE by investigators, reviewers and editors will facilitate and accelerate equitable clinical implementation of precision medicine.

Controversy as Currency: An Investigation into the Economy and Politics of Literary Prizes

Literary prizes, while providing legitimacy of artistic excellence to authors, are delicately poised in modern prize culture. They must maintain a balance between the artistic merit of literature and the health of the economic capital of the publishing industry and sponsors. This paper meticulously examines the myriad proliferation of literary prizes and the convergence of its intricacies— the process of nomination and selection, sponsorships, promotion, media coverage of the award ceremony, celebratory nature of the occasion, the climactic drama of acceptance speech, and controversy— to characterize the centrality of economic force at play. It reflects the dependency of art form’s flourishing and sustenance on the logic of the economic marketplace. Through a close analysis of the controversial selection of certain authors and particular books, the paper looks at the epiphenomena of prestigious literary prizes to demonstrate a classic working of the neoliberal market outcome of controversy as publicity/currency, which not only brings about manufacturing of aura for controversial writers as celebrities but simultaneously radiates its effect on the demand value of their literary products and investing participants. It concludes that centrifugal dissemination and consumption of mediatised controversy events across national and international borders generates a centripetal concentration of socio-economic capital for writers, publishers and sponsors.

Is all the UNESCO´s Qhapaq Ñan really Inca? Problems with the incorporation of sections and sites from San Juan (Argentina)

The nomination and acceptance of the Qhapaq Ñan as World Heritage took more than a decade of work in the six countries involved. In Argentina, a centralized coordination system in charge of articulating the proposals of the provinces that were part of the national program was implemented. Some people expressed certain inconveniences in the program’s development, mainly related to the participation of native communities. Furthermore, the presentation approved by UNESCO shows some shortcomings associated with the identification of some of the proposed elements. In this sense, and in order to provide relevant information to better understand the Argentinean nomination process and its outcome, this article shows the divergences between the Inca Road system known in San Juan and the one accepted in the project, the nomination of a section and associated sites without the corresponding evidence of their Inca character and a failed previous proposal to incorporate historical sites to the project. Also, to help explain this situation, some aspects related to the actions of different agents and the possible incidence of political power are discussed.

Qhapaq Ñan as World Heritage Site. New Tourist Destinations and Inherited Tensions in Argentina

Summary Qhapaq Ñan, or the Andean Road System, was inscribed on UNESCO’s World Heritage List in 2014. This inclusion was the result of a process initiated by six South American countries (Peru, Bolivia, Ecuador, Colombia, Chile, and Argentina). The process identified the selection of features that distinguished the road and justified the inscription. How was this selection made? Was tourism involved in it? This case study analyzes the details of the Qhapaq Ñan nomination process in Argentina. It especially focuses on the northwestern region of the country, an area with a long (and controversial) history of tourist valorization of Andean heritage. It is argued that tourism was involved in the heritage selection processes in Argentina by two means. Firstly, tourism interests have oriented the choosing of some archeological sites that could be tourist attractions. Secondly, the definition of heritage sections and sites has sought to avoid previous heritage areas where the presence of tourism has been highly conflictive. Avoiding potential conflicts is also at the core of recent tourist projects designed for Qhapaq Ñan in Northwestern Argentina that aim to encourage “off the beaten track” (and supposedly non-controversial) forms of tourism. Information © The Author 2024

"Reflecting back" on public participation in the judicial appointment of the South African Chief Justice?

After more than two decades of South Africa's democracy, the significance of the reform of the judiciary is grounded in the process of judicial appointments to restore its public credibility from South Africa's tainted past. Such reform is now constitutionalised through the establishment of the Judicial Services Commission (JSC) which serves as a focal point in the restoration of such confidence in the judiciary. The JSC's processes seek to ensure the rebuilding of public confidence which entails, amongst others the legitimacy of judicial appointments that should be reflective of gender and racial composition as envisaged in the Constitution 1996. However, the public has since weighed heavily on the criteria and discretion exercised by the JSC on its judicial appointment processes. The debates were intensified by President Ramaphosa's unprecedented reform to involve public participation and establishment of the advisory panel in his constitutional role of the nomination process of the Chief Justice. The President opened an opportunity for a pool of eligible candidates to be recommended for his consideration after they were determined and sifted by the advisory panel. The last four candidates were recommended by the panel and after their interviews, the JSC recommended Justice Mandisa Maya as Chief Justice for appointment by the President. Instead, the President appointed Justice Raymond Zondo as Chief Justice and Justice Maya as Deputy Chief Justice which raised debates and questions on the exercise of this constitutional discretion. The purpose of this article and its focus and limitation is to examine the role of public participation and the establishment of the advisory panel in the nomination process of the Chief Justice. It raises questions about whether public participation does not amount to the representative form of democracy in judicial appointments. In addition, it will restore trust, credibility, and confidence and extend the protection of the judiciary from unjustified attacks from the members of the public. In turn, the value of the credibility of the recommendations of the JSC as a constitutional structure in the judicial appointment processes. Therefore, the paper argues that public participation in the nomination of the Chief Justice is an indirect intrusion of the representative form of democracy in judicial appointments. Public participation is also unlikely to make a significant contribution to the protection accorded to the judiciary by the Constitution. If the President could "water down" the JSC's recommendation, there is uncertainty towards the strive for the attainment of transformative ideals of the new democracy.

Crouching the tiger, or hiding the dragon? scale in China’s heritage production

In the built heritage studies, the intricate web of social and selective processes that define heritage is evident. These processes are, in many cases, intertwined with the notion of scale, examplified through the production of heritage sites at the local, national, and transnational scales. While heritage and geography scholars have articulated the role played by scale in heritage-making and argue against a rigid, fixed, and hierarchical understanding of scale, they highlight the constant reproduction of scale. There is, so far, limited explanation of how the perception of scale gets reproduced and how crucial actors manipulate scalar power and resources for heritage making and the reproduction of scale. To fill this gap, this paper delves into mainland China’s heritage-making, using the southern Anhui historical villages as an example. Based on intensive 5-month field research, this paper has three findings: 1) The nomination process for a World Heritage Site is notably influenced by politics and selectivity; 2) Diverse stakeholders are pivotal in shaping heritage narratives; 3) Individual contributions to heritage creation directly interact with, and subsequently reshape, ‘scale’, an entity that is simultaneously discursive and tangible. By integrating the notion of ‘scale’ into heritage discussions, we illuminate two concurrent processes: creating hierarchies through rule assimilation by interpreting the UNESCO standard internally and evolving socio-spatial dynamics via the manifestation of individual agency with resource manipulation, scale jumping, and reproduction of scale. This approach aligns with the material orientation in human geography and repositions ‘scale’. Here, it’s not just an epistemological framework but also a tangible force that steers individual perceptions and actions and yields measurable material impacts.

Acting(s) without consequence: The (lack of) public costs for vacancies and acting officials

AbstractWhile acting officials in federal agencies have become more common in recent years, presidents still utilize the traditional nomination process, which constrains presidents' choices, for most executive branch appointments. Recent work emphasizes presidents' incentives for using acting officials, but few scholars have considered what keeps presidents from using them even more often. We argue presidents' use of acting officials, like other forms of unilateral action, is constrained by public opinion; while actings may be expeditious policy tools for presidents, the public perceives them to undermine the executive branch's legitimacy and competence and punishes presidents accordingly. Through three survey experiments leveraging real‐world instances of President Joe Biden's usage of acting officials, we find little evidence the public reacts negatively to acting officials in agency leadership. While some institutional forces must encourage presidents to seek senatorial advice and consent for their nominees, our evidence does not indicate public opinion provides that constraint.

DECISION SUPPORT MODEL FOR SELECTING PROJECT DELIVERY METHODS IN SUSTAINABLE CONSTRUCTION PROJECTS

Selecting the appropriate delivery approach holds a huge significance level, especially in sustainable construction projects, which exhibit unparalleled attributes compared to traditional counterparts. This paper introduces a novel decision support model aimed at assisting owners in this crucial nomination process. Critical review analysis was used to identify 36 important nomination factors for project delivery methods and categorized into traditional and sustainability-specific factors. In order to determine how well typical delivery methods—Design-Bid-Build (DBB), Design-Build (DB), and Construction Management at Risk (CMR)—meet the nomination factors, a poll was subsequently sent to construction experts in the United Arab Emirates. Paired analyses of the three delivery systems were performed using the Analytical Hierarchy Process. The results showed that DBB, the traditional delivery technique, is not up to the increased needs for integration and collaboration in sustainable construction projects. Alternative delivery techniques, like CMR and DB better meet these needs. Three functions make up the suggested decision support model: screening of nomination factors, evaluation of project delivery methods, and strategic alignment of project goals and project delivery methods nomination factors. Users of this model can alter the weights assigned to the nomination factors that are essential to accomplishing the objectives of their green construction projects. It also offers an extensive set of nomination factors, enabling choice determiners to formulate a convincing argument for pinpointing the best delivery method for their green construction project.

DECISION SUPPORT MODEL FOR SELECTING PROJECT DELIVERY METHODS IN SUSTAINABLE CONSTRUCTION PROJECTS

Selecting the appropriate delivery approach holds a huge significance level, especially in sustainable construction projects, which exhibit unparalleled attributes compared to traditional counterparts. This paper introduces a novel decision support model aimed at assisting owners in this crucial nomination process. Critical review analysis was used to identify 36 important nomination factors for project delivery methods and categorized into traditional and sustainability-specific factors. In order to determine how well typical delivery methods—Design-Bid-Build (DBB), Design-Build (DB), and Construction Management at Risk (CMR)—meet the nomination factors, a poll was subsequently sent to construction experts in the United Arab Emirates. Paired analyses of the three delivery systems were performed using the Analytical Hierarchy Process. The results showed that DBB, the traditional delivery technique, is not up to the increased needs for integration and collaboration in sustainable construction projects. Alternative delivery techniques, like CMR and DB better meet these needs. Three functions make up the suggested decision support model: screening of nomination factors, evaluation of project delivery methods, and strategic alignment of project goals and project delivery methods nomination factors. Users of this model can alter the weights assigned to the nomination factors that are essential to accomplishing the objectives of their green construction projects. It also offers an extensive set of nomination factors, enabling choice determiners to formulate a convincing argument for pinpointing the best delivery method for their green construction project.

A mixed-methods review and adaptation of a novel clinical pharmacy tool: The MA2VER2ICK Tool Study

Abstract Introduction The MA2VER2ICK Tool[1] (see Figure 1) is a clinical pharmacy mnemonic developed in 2016 by the pharmacy department of Tallaght University Hospital, through a combination of literature searching and local expert consensus opinion. The intended purpose of the tool was to guide clinical pharmacists in pharmaceutical care planning. Since inception, the tool has not been formally evaluated. Locally, users report the tool as useful; although, there is scope for improvement, to better support clinical pharmacists. Aim Identify and gain consensus on suggestions to adapt the existing tool. Methods A two-stage mixed-methods approach was adopted. This comprised focus groups to facilitate idea generation and appraise contents of the existing tool, followed by a nominal group technique process[2] to agree the content and structure of the final tool. A purposive sample of clinical pharmacists were selected to participate in the focus groups and nominal group technique panel, based on responses to a screening questionnaire pre-circulated to all clinical pharmacists employed at the study site. Thematic analysis of the focus group transcripts was conducted by two independent researchers, with key themes and related recommendations to improve the tool identified. These recommendations were presented to the nominal group technique panel via an anonymous survey, where numerical rating scores were assigned over two rounds, with an intervening panel discussion. An increase in the mean rating score and convergence of the standard deviation indicated consensus for a recommendation. Results Two focus groups (5 participants each) of 45 minutes duration took place. Both focus groups resulted in similar findings, with seven major themes identified relating to adapting the tool. Overall, eight recommendations were formulated, with suggestions to adapt the content, structure, usability and application of the tool. Consensus agreement was reached on seven recommendations, each receiving a panel rating score > 90%. One recommendation was rejected, receiving a panel rating score < 30%. Conclusion This study demonstrates that the MA2VER2ICK Tool is a comprehensive clinical pharmacy resource. Few amendments were required to the original tool, indicating user satisfaction with and the utility of the tool, together with a high degree of consensus for the adaptations made. VTE: venous thromboembolism; Rx: prescription; CRP: C-reactive protein.