Two-round Delphi Process Research Articles

Development of a global health bachelor curriculum in China: a Delphi study

ObjectiveThis study aimed to establish the first global health bachelor curriculum in China.DesignThe Delphi methodology was used to determine expert consensus on which courses should be included in the global...

Equine de-worming: a consensus on current best practice

Despite increasing awareness within the veterinary profession and equine industry of the potential implications of anthelmintic resistance (AHR), there is a concern that insufficient measures are being taken to reduce its development and spread. This document was commissioned to provide veterinary surgeons with up to date information on worm control plans that will prevent clinical disease while minimising selection pressure for resistance. Recommendations were developed using an informal two-round Delphi process, considering published and unpublished research relating to equine parasite control using a roundtable forum and online discussion. Where research evidence was conflicting or absent, collective expert opinion, based on the experience of the group, was applied. The opinions expressed are the consensus of views expressed by the authors. Where agreement was not reached opposing views are presented such that readers can understand the arguments. The document is focused on the management of horses and ponies; while much of the information herein applies to donkeys, it is important to recognise that donkeys face major challenges with AHR, and further research is required before specific recommendations can be made with respect to this species. The expert group was organised by UK-Vet Equine and hosted by Moredun Research Institute with sponsorship from Virbac and additional support from The Horse Trust and vetPartners.

Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study.

BackgroundAn increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.ObjectiveTo critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.MethodsA two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60–69% for moderate consensus as measured on a 5-point Likert type scale.ResultsTwenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient’s preferences.ConclusionsThe selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.

Equine obesity: current perspectives

ForewordEquine obesity is now so common that is has become accepted by many as the norm ( Owers and Chubbock, 2012 ). Rates of obesity may be as high as 70% in some populations and obesity is often associated with morbidities that may ultimately result in mortality. Obesity is a common feature in animals diagnosed with equine metabolic syndrome, a conflation of metabolic disturbances including insulin dysregulation, which may lead to laminitis. Obesity is a risk factor for insulin dysregulation and is therefore implicated in laminitis risk. In addition to laminitis, adverse consequences of obesity include orthopaedic disease, hyperlipaemia, hyperthermia, infertility and poor performance. Over time, perception of what constitutes a healthy body condition in horses has shifted, with the result that potentially harmful excess adiposity may not be recognised by owners or those working in the equine industry ( Owers and Chubbock, 2012 ). In addition, increasing numbers of equines are kept as companions rather than athletes and live relatively inactive lifestyles favouring the development of obesity. Finally, owners of leisure horses often think their horses are working hard when, in reality, their exertions have minimal impact on their energy requirements. Despite increasing awareness within the veterinary profession and equine industry of the impact of obesity on equine welfare, little progress seems to have been made in tackling it. This document was commissioned in order to provide veterinary surgeons with up-to-date information on equine obesity and to equip them to tackle it within their own practices. Recommendations were developed using an informal two-round Delphi process, considering published and unpublished research relating to equine obesity using a round table forum and online discussion. Where research evidence was conflicting or absent, collective expert opinion based on the clinical experience of the group was applied. The opinions expressed are the consensus of views expressed by the authors. Where agreement was not reached, opposing views are presented such that readers can understand the arguments fully. The document is focused on the management of horses and ponies; while much of the information herein is applicable to donkeys it is important to recognise that the metabolism and management of donkeys are different and further research is required before specific recommendations can be made. The expert group was organised by UK-Vet Equine with sponsorship from Baileys Horse Feeds.

Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.

BackgroundUrinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care.MethodsCriteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores.ResultsThe first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections.ConclusionThis study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.

A consensus exercise identifying priorities for research into clinical effectiveness among children's orthopaedic surgeons in the United Kingdom.

High-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. A modified Delphi technique was used, which involved an initial scoping survey, a two-round Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. A total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). This consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials. Cite this article: Bone Joint J 2018;100-B:680-4.

Terms, concepts and definitions in clinical artificial nutrition. The ConT-SEEN Project

BackgroundImprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. ObjectiveFor this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. MethodsForty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57 were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. ResultsFifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.

Recommendations for the management of equine glandular gastric disease

ForewordThe European College of Equine Internal Medicine (ECEIM) consensus statement recently made the distinction between disease of the squamous mucosa (Equine Squamous Gastric Disease; ESGD) and of the glandular mucosa (Equine Glandular Gastric Disease; EGGD) ( Sykes et al, 2015a ). Since its publication, a number of reports have furthered understanding of the pathology and management of EGGD, such that new clinical guidelines for the management of this condition were considered necessary. The following guidelines are the consensus views of subject specialist representing authors of the ECEIM consensus statement, authors of recent clinical research, and clinical specialists active in the management of horses with this condition. The recommendations were developed using an informal two-round Delphi process, considering published and unpublished research relating to EGGD using a round table forum and online discussion. Where research evidence was conflicting or absent, collective expert opinion based on the clinical experience of the group was applied. The opinions expressed are the consensus of views expressed by the authors. The expert group was organised by UK-Vet Equine with sponsorship from Luoda Pharma.

Términos, conceptos y definiciones en nutrición clínica artificial. Proyecto ConT-SEEN

BackgroundImprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. ObjectiveFor this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. MethodsForty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. ResultsFifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.

Core outcome research measures in anal cancer (CORMAC): protocol for systematic review, qualitative interviews and Delphi survey to develop a core outcome set in anal cancer

IntroductionThe incidence of anal squamous cell carcinoma (ASCC) has increased threefold in the last 30 years. Initial treatment is chemoradiotherapy, associated with short-term and long-term side effects. Future therapy innovations...

Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria

ObjectivesOlder adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and...

Developing Common Competencies for Southeast Asian General Dental Practitioners.

Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils have proposed the "Common Major Competencies for ASEAN General Dental Practitioners" to harmonize undergraduate dental education. This article discusses how the ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills, and attitudes across ASEAN. The competencies were developed through four processes: a questionnaire about current national oral health problems, a two-round Delphi process that sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Key themes of the ASEAN competencies were compared with the competencies from the U.S., Canada, Europe, Australia, and Japan. A total of 33 competency statements, consistent with other regions, were agreed upon and approved. Factors influencing the ASEAN competencies and their implementation include oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. The ASEAN competencies will serve as the foundation for further developments in ASEAN dental education including policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for successful harmonization of ASEAN dental education.

Consensus-building on developing dysphagia competence: a North West of England perspective.

Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England. A four-phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two-round Delphi process. Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus. There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings.

How do local communities adapt to climate changes along heavily damaged coasts? A Stakeholder Delphi study in Ky Anh (Central Vietnam)

The Central Vietnamese coast faces increasing impacts on the local livelihoods of coastal communities as a result of the increasing natural hazards which include tropical storms, heavy rains, and floods. A challenge for the local populations is improving their adaptation capacity to climate change hazards in a sustainable way. This study deals with the impacts of climate change-associated hazards and adaptation capacity in coastal communes of the Ky Anh district, Ha Tinh province along the coast in Central Vietnam. A combination of the Stakeholder Delphi technique and the DPSIR (drivers–pressures–states–impacts–responses) framework was used. Delphi questionnaires allowed assessing the consensus among the respondents of a stakeholder group. Twenty questions and 20 statements were listed reflecting the DPSIR components. Thirty-six panel members, which were randomly selected from four stakeholder groups which included local authorities, farmers, fishermen, and fish traders, were involved in a two-round Delphi process. The results show that, both agricultural and non-agricultural sectors are main drivers (D); migration, calamities, population growth, mineral mining, aquaculture processing, and agriculture are main pressures (P); changes in the frequency of extreme weather events, increasing intensity of storms, floods, and droughts indicate main states (S); changes in agricultural land use and productivity are main impacts (I); construction of and upgrading dykes and irrigation systems should be the principal responses (R) in the vision of the local stakeholders. The Kendall’s W value for the second round is 0.681, indicating a high degree of consensus among the panel members and confidence in the ranks. Overall, the study advocates developing sustainable ecosystems, an upgraded New Rural Planning, and renewable energy strategies as the main local adaptations to climate change hazards in this area.

After 10 Years: A Vision Forward for Progress in Community Health Partnerships.

In 2007 the journal Progress in Community Health Partnerships was launched to advance the field of community-engaged research and the journal's editors engaged in a Delphi process to identify priorities for the journal and field. Ten years later, the increased adoption of community-engaged research continues to improve public health. The purpose of this manuscrip t is to i dentify community-engaged research priorities for the next 10 years. The study engaged leaders in community-engaged research using a two-round Delphi process, whereby leaders in the field were asked to identify and then rank order topics in community-engaged research that needed to be prioritized for the next decade. In stage 1, 41 respondents generated 441 priorities across 8 categories (e.g., theory, epidemiology, intervention science) that were collapsed into 90 priority topics, ranging from 8 to 15 per category. In stage 2, 73 respondents ranked five prioritized items for each category. The prioritized items are provided, with the following themes present across all categories: 1) improvements to equity among partners, 2) partnership sustainability, and 3) increased efforts to translate community-engaged research into policy change. We compare the findings from this Delphi process with the priorities identified in 2007 to reflect on how the field has progressed. It is our hope that community and academic stakeholders will be able to use these priorities as a guide to their community-engaged research in the coming years.

Facilitating emergency hospital evacuation through uniform discharge criteria

BackgroundThough hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria. Basic proceduresStandards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013–2014, before and after formulation of discharge criteria. Main findingsConsensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p<0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST=8,452 versus MST=264,366, respectively; p<0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p=0.001). Principle conclusionsThe study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans.

Development of a measure of therapy provision for spasticity management in the paretic lower limb – the Leg Therapy recording Schedule (LegTS)

Purpose: In rehabilitation studies, it is critical to understand the constituents of interventions. First, to enable replication of the work and second, to identify what treatments work best. The development of a tool to describe and quantify therapy interventions in the context of focal spasticity management is presented.Methods: Potential intervention categories were identified from: (a) retrospective analysis of prospectively collected data from a cohort of patients (n = 62) receiving physical interventions in the context of botulinum toxin (BoNT) injection for leg spasticity and (b) cognitive de-briefing with Patient and Carer Advisory Group (PCAG) of patient and carer dyads (n = 8). Item reduction was achieved through consultation with a purposively-selected group of physiotherapists and occupational therapists (n = 16) in a two-round Delphi process. This was followed by review of findings by PCAG members.Results: A list of 24 possible therapy categories were identified and then reduced, resulting in a tool with two domains: (1) postural management; four categories and (2) exercise and retraining; four categories. The Leg Therapy recording Schedule (LegTS) wording and presentation were refined for clinical and research use.Conclusions: The LegTS is designed to record therapy interventions for the paretic lower limb in the context of spasticity intervention. Content and face validity have initially been addressed within the development process.Implications for RehabilitationClinicians need to understand intervention effectiveness, and to do so, it is critical to capture all the components of a complex intervention.In clinical practice or research, patient experience measures are required to capture the complexity of intervention provided and monitor intervention effectiveness on a case by case basis.Clinicians involved in rehabilitation and management of focal spasticity in the leg can use the Leg Therapy recording Schedule (LegTS) to enable an understanding of the entirety of the intervention package provided.

Development and content validation of an assessment tool for medicine compounding on hospital wards.

Background Medicines should be compounded by using an aseptic technique to assure patient safety. The parenteral administration of microbiologically contaminated doses can result in bacteriaemia, other morbidity and even death. Objective The purpose was to develop and content validate an assessment tool for medicine compounding on hospital wards suitable for self-assessment and external audit to ensure the safety of medicine compounding on wards. Setting Finland as setting. Method The first draft of the tool was based on ISMP "Guidelines for safe preparation of sterile compounds" and a systematic literature search. The tool was validated by using a two-rounded Delphi-method with a panel of 19 experts. Suitability and feasibility of each item was evaluated. Main outcome measure An agreement of ≥70% on each item was required. Results The final tool comprises of 64 items under the following topics: (1) general principles of good compounding practices (23 items), (2) recording and confirming medicine orders on the wards (5 items), (3) storage of medicines on the wards (7), (4) aseptic compounding of intravenous medicines (25 items) and (5) quality assurance (4 items). Most items related to General principles of good compounding practices and Compounding of IV medicines (36 and 38% of the items, respectively). Conclusion It was possible to develop and content validate, by the Delphi method, an assessment tool for safe aseptic compounding on hospital wards. A two-round Delphi process yielded consensus on 64 items for this purpose.

PCV70 - The Direct Cost Components in Heart Failure with Preserved Ejection Fraction (HF-PEF) in Turkey: The Results of A Delphi Panel

The aim of the present study was to analyze the health-related direct cost components in HF-pEF in Turkey. A two-round Delphi process to get the opinions of local experts (eleven cardiologists who were experienced in HF), was performed. A questionnaire with items to collect the opinions of the panelists on all cost components, including medications, surgical treatment, hospitalization and out-patient follow-up procedures were developed under supervision of one of the experts (ZÖ). Then experts responded to this questionnaire independently via e-mail at first round. At the second round, they met around a table, discussed about all items in detail and revised their responses, when necessary. End-of-2015 local prices released by Ministry of Health and Social Security Institution in Turkey were used as references. End of 2015 Euro/TL currency rate (3.065 TL/Euro) was used. 20.1% of HF-pEF patients are hospitalized directly at internal medicine ward with a rate of 0.33 hospital stays per patient-year for an average length-of-stay of 2.31 days per year. Estimated total annual costs of HF-pEF is calculated as 245 Euro. Main cost driver is the cost of medications (110 Euro/year; 45% of the total). When cost items related with hospitalization were examined, the annual cost of hospital stay is calculated as 47 Euro. The cost of a single hospital stay is 29 Euro and the cost of a single day of hospital stay is 22 Euro. This total direct costs of HF-pEF is reasonable. The major reason of this finding is the low rate of hospitalization, short duration of stay and low daily cost of hospitalization. In order to maintain this budget-friendly position of HF-pEF, controlling the disease under appropriate medical treatment is suggested.

Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations.

Expert judgement has a role in model-based economic evaluations (EEs) of healthcare interventions. This study aimed to produce reporting criteria for two types of study design to use expert judgement in model-based EE: (i) an expert elicitation (quantitative) study; and (ii) a Delphi study to collate (qualitative) expert opinion. A two-round online Delphi process identified the degree of consensus for four core definitions (expert; expert parameter values; expert elicitation study; expert opinion) and two sets of reporting criteria in a purposive sample of experts. The initial set of reporting criteria comprised 17 statements for reporting a study to elicit parameter values and/or distributions and 11 statements for reporting a Delphi survey to obtain expert opinion. Fifty experts were invited to become members of the Delphi process panel by e-mail. Data analysis summarised the extent of agreement (using a pre-defined 75% 'consensus' threshold) on the definitions and suggested reporting criteria. Free-text comments were analysed using thematic analysis. The final panel comprised 12 experts. Consensus was achieved for the definitions of expert (88%); expert parameter values (83%); and expert elicitation study (83%). The panel recommended criteria to use when reporting an expert elicitation study (16 criteria) and a Delphi study to collate expert opinion (11 criteria). This study has produced guidelines for reporting two types of study design to use expert judgement in model-based EE: (i) an expert elicitation study requiring 16 reporting criteria; and (ii) a Delphi study to collate expert opinion requiring 11 reporting criteria.