scholarly journals The factors influencing the effective early career and rapid transition to a nursing specialty in differing contexts of practice: a modified Delphi consensus study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028541 ◽  
Author(s):  
Diane Chamberlain ◽  
Desley Hegney ◽  
Clare Harvey ◽  
Bruce Knight ◽  
Anne Garrahy ◽  
...  
Keyword(s):  
Delphi Study ◽  
Early Career ◽  
Nominal Group ◽  
Structured Interviews ◽  
Delphi Consensus ◽  
Final Model ◽  
Transition Processes ◽  
Modified Delphi ◽  
Rapid Transition ◽  
Time Continuum

ObjectivesThis study aimed to test and further develop the ‘Early Career and Rapid Transition to a Nursing Specialty’ (TRANSPEC) model to a nursing specialty developed from a systematic review. Semi-structured interviews of specialist clinically based nurses and a consensus Delphi study with an expert panel were used to expand and achieve consensus, agreement, reliability and stability of the model.DesignA modified Delphi, two rounds (64 and 52 Likert items) of reiterative online questionnaires and one round as a nominal group technique, was informed by qualitative thematic analysis of semi-structured interviews.Setting and participantsInterviews with 14 specialists clinical practicing registered nurses and a panel of 25 national experts participated in the Delphi study.ResultsThe interview participants experienced 14 rapid transitions and three were early career transition. The overarching themes from the preliminary model were confirmed and further expanded. These were the self (personal and professional); the transition processes (final and informal); a sense of belonging; and the overarching context of practice over a time continuum. In the Delphi, the highest rating item was ‘Specialty work colleagues respect, include, support, and accept specialist nurse on completion of transition processes’. Pre-entry was highlighted as an important time point prior to transition. All items reaching consensus were included in the final model. Cronbach α increased from 0.725 to 0.875 for the final model.ConclusionsThe TRANSPEC model is a valid and reliable evidence-based tool for use in the career pathway and development of nursing specialists. Using the Benner model ‘Novice to Expert’ after the novice incomer phase is achieved, further lifelong learning development will transform the novice specialist over time continuum.

scholarly journals Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

2020 ◽  
Vol 29 (155) ◽  
pp. 190147 ◽  
Author(s):  
Franck F. Rahaghi ◽  
Nadera J. Sweiss ◽  
Lesley Ann Saketkoo ◽  
Mary Beth Scholand ◽  
Joseph B. Barney ◽  
...  
Keyword(s):  
Adverse Events ◽  
Delphi Study ◽  
Severe Disease ◽  
Pulmonary Sarcoidosis ◽  
Event Management ◽  
Delphi Consensus ◽  
Consensus Recommendations ◽  
Modified Delphi ◽  
Immunosuppressive Medications ◽  
Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

scholarly journals Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach

Rheumatology ◽  
2020 ◽  
Author(s):  
Seza Özen ◽  
Erdal Sag ◽  
Eldad Ben-Chetrit ◽  
Marco Gattorno ◽  
Ahmet Gül ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
Nominal Group ◽  
Evidence Based ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Health Authorities ◽  
Colchicine Resistance ◽  
Mediterranean Fever ◽  
Definition Of ◽  
The Impact

Abstract Objectives Colchicine is the main treatment for familial Mediterranean fever (FMF). Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. Methods A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and pediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. Results Consensus among the panel was achieved on 8 core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period), or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. Conclusion Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.

scholarly journals A balanced approach to identifying, prioritising and evaluating all potential consequences of quality improvement: modified Delphi study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023890 ◽  
Author(s):  
Madalina Toma ◽  
Tobias Dreischulte ◽  
Nicola M Gray ◽  
Bruce Guthrie
Keyword(s):  
Quality Improvement ◽  
Delphi Study ◽  
Qualitative Evaluation ◽  
Unintended Consequences ◽  
Consensus Methods ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Balanced Approach ◽  
Trade Offs ◽  
Qualitative Work

ObjectivesHealthcare is a complex system, so quality improvement will commonly lead to unintended consequences which are rarely evaluated. In previous qualitative work, we proposed a framework for considering the range of these potential consequences, in terms of their desirability and the extent to which they were predictable or expected during planning. This paper elaborates on the previous findings, using consensus methods to examine what consequences should be identified, why and how to prioritise, evaluate and interpret all identified consequences, and what stakeholders should be involved throughout this process.DesignTwo-round modified Delphi consensus study.Setting and participantsBoth rounds were completed by 60 panellists from an academic, clinical or management background and experience in designing, implementing or evaluating quality improvement programmes.ResultsPanellists agreed that trade-offs (expected undesirable consequences) and unpleasant surprises (unexpected undesirable consequences) should be actively considered. Measurement of harmful consequences for patients, and those with high workload or financial impact was prioritised, and their evaluation could also involve the use of qualitative methods. Clinical teams were agreed as important to involve at all stages, from identifying potential consequences, prioritising which of those to systematically evaluate, undertaking appropriate evaluation and interpreting the findings. Patients were necessary in identifying consequences, managers in identifying and prioritising, and improvement advisors in interpreting the data.ConclusionThere was consensus that a balanced approach to considering all the consequences of improvement can be achieved by carefully considering predictable trade-offs from the outset and deliberately pausing after implementation to identify any unexpected surprises and make an informed decision as to whether quantitative or qualitative evaluation is needed and feasible. Stakeholders’ roles in in the process of identifying, prioritising, evaluating and interpreting potential consequences should be explicitly addressed within planning and revisited during and after implementation.

scholarly journals 41 A Modified Delphi Consensus Approach to Clinical Guidelines for Tardive Dyskinesia

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 197-198
Author(s):  
Stanley N. Caroff ◽  
Leslie Citrome ◽  
Jonathan Meyer ◽  
Kimberly Riggs ◽  
Martha Sajatovic ◽  
...  
Keyword(s):  
Tardive Dyskinesia ◽  
Clinical Guidelines ◽  
Involuntary Movement ◽  
Steering Committee ◽  
Delphi Process ◽  
Diagnosis And Treatment ◽  
Nominal Group ◽  
Cumulative Exposure ◽  
Delphi Consensus ◽  
Modified Delphi

AbstractObjectiveVesicular monoamine transporter 2 (VMAT2) inhibitors are the first class of drugs approved to treat tardive dyskinesia (TD). With the recent approval of these medications, a modified Delphi process was implemented to address the need for updated clinical guidelines for TD screening, diagnosis, and treatment.MethodsA Steering Committee of 11 TD experts met in a Nominal Group meeting format to discuss/prioritize questions to be addressed about TD and identify individuals to be invited to serve as Delphi survey panelists. Two survey rounds were conducted anonymously; responses were collected, collated, and analyzed. Respondent agreement was defined a priori by the Steering Committee as unanimous (100%), consensus (75–99%), or majority (50–74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥4 (“agree completely” or “agree”). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with <25% agreement (deemed unlikely to achieve consensus) and some questions that already achieved consensus (>75% agreement).ResultsOnline surveys were sent to 60 individuals; 29 agreed to participate as panelists (23 psychiatrists; 6 neurologists). Respondents unanimously agreed (100%) that all patients currently taking dopamine receptor blocking agents (DRBAs) should be screened for TD, and that the Abnormal Involuntary Movement Scale (AIMS) is the standard structured assessment for monitoring severity of TD. There was consensus (76%) that a semi-structured assessment could be used for more frequent routine TD screening. Respondents unanimously agreed that treatment with first generation antipsychotics, older age, and longer cumulative exposure to antipsychotics were risk factors for TD. For TD diagnosis, consensus (89%) was reached that a patient with an AIMS score >2 (mild) affecting 1 body area should be considered as having possible TD; consensus (93%) was also reached that TD was most often evident in orofacial musculature, although other body areas may be affected and should not be neglected. Consensus was not reached on minimum cumulative duration of DRBA exposure for TD diagnosis, but a majority (70%) agreed that minimum cumulative exposure of 1month may be sufficient. For TD treatment, unanimity or consensus was reached on 4 strategies to consider: discussion of treatment options with patients/caregivers (100%), modification of antipsychotic regimen (100%), treatment with VMAT2 inhibitor (100%), and modification of anticholinergic regimen (86%).ConclusionsUsing a Nominal Group and modified Delphi process, consensus was reached within 1−2 rounds on several key aspects of TD screening, diagnosis, and treatment. This process may offer an expedient method to identify gaps in agreement and facilitate updated management guidelines.Funding Acknowledgements: Sponsored by Neurocrine Biosciences,Inc.

scholarly journals Expert opinion on the UK standard of care for haemophilia patients with inhibitors: a modified Delphi consensus study

2021 ◽  
Vol 12 ◽  
pp. 204062072110070
Author(s):  
Kate Khair ◽  
Elizabeth Chalmers ◽  
Thuvia Flannery ◽  
Annabel Griffiths ◽  
Felicity Rowley ◽  
...  
Keyword(s):  
Delphi Study ◽  
Online Survey ◽  
Treatment Options ◽  
Tolerance Induction ◽  
Standard Of Care ◽  
Steering Committee ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Bypassing Agents ◽  
The Uk

Background and Aims: Despite advances in haemophilia care, inhibitor development remains a significant complication. Although viable treatment options exist, there is some divergence of opinion in the appropriate standard approach to care and goals of treatment. The aim of this study was to assess consensus on United Kingdom (UK) standard of care for child and adult haemophilia patients with inhibitors. Methods: A modified Delphi study was conducted using a two-round online survey. A haemophilia expert steering committee and published literature informed the Round 1 questionnaire. Invited participants included haematologists, haemophilia nurses and physiotherapists who had treated at least one haemophilia patient with inhibitors in the past 5 years. Consensus for 6-point Likert scale questions was pre-defined as ⩾70% participants selecting 1–2 (disagreement) or 5–6 (agreement). Results: In all, 46.7% and 35.9% questions achieved consensus in Rounds 1 ( n = 41) and 2 ( n = 34), respectively. Consensus was reached on the importance of improving quality of life (QoL) and reaching clinical goals such as bleed prevention, eradication of inhibitors and pain management. There was agreement on criteria constituting adequate/inadequate responses to immune tolerance induction (ITI) and the appropriate factor VIII dose to address suboptimal ITI response. Opinions varied on treatment aims for adults and children/adolescents, when to offer prophylaxis with bypassing agents and expectations of prophylaxis. Consensus was also lacking on appropriate treatment for mild/moderate patients with inhibitors. Conclusion: UK healthcare professionals appear to be aligned on the clinical goals and role of ITI when managing haemophilia patients with inhibitors, although novel treatment developments may require reassessment of these goals. Lack of consensus on prophylaxis with bypassing agents and management of mild/moderate cases identifies a need for further research to establish more comprehensive, evidence-based treatment guidance, particularly for those patients who are unable/prefer not to receive non-factor therapies.

scholarly journals A Methodological Checklist for fMRI Drug Cue Reactivity Studies: Development and Expert Consensus

2020 ◽  
Author(s):  
Hamed Ekhtiari ◽  
Mehran Zare-Bidoky ◽  
Arshiya Sangchooli ◽  
Amy C. Janes ◽  
Marc J. Kaufman ◽  
...  
Keyword(s):  
Delphi Study ◽  
Cue Reactivity ◽  
Consensus Method ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Meta Analyses ◽  
Methodological Aspects ◽  
Drug Cue

AbstractBackgroundCue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been many promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, heterogeneities in participant characteristics, task design, craving assessment, scanning preparation and analysis decisions limit rigor and reproducibility in the field of fMRI of drug cue reactivity (FDCR), hampering clinical translation and synthesis by systematic reviews and meta-analyses. The aim of this consensus paper and Delphi study is to outline the important methodological aspects of FDCR studies and present a list of items and recommendations that should be taken into account when designing FDCR studies and reporting their results.MethodsFifty-five FDCR scientists from around the world participated. First, an initial checklist of items deemed important in FDCR studies was developed by a group of members from the ENIGMA Addiction Consortium based on a systematic review. Then, using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist. Subsequently, experts were asked to rate the importance of the items.ResultsThirty-seven items were proposed in the first round. After the commenting phase, seven new items suggested by experts were added and six were removed. The final 38 items that reached a defined consensus threshold in the rating phase were classified under seven categories and are considered important for conducting and reporting in any FDCR study.ConclusionThis paper proposes a list of items and additional recommendations that researchers in the field of FDCR are encouraged to note and report when designing an FDCR study and reporting its results. Along with the presentation of a quality control checklist with Yes/No ratable items, various challenges in moving towards greater homogeneity in FDCR research and widespread use of FDCR to investigate SUDs and develop clinically relevant biomarkers are discussed.

Determining Highly Desirable Traits of an Effective Emotional Freedom Techniques Practitioner: A Delphi Study

2017 ◽  
Vol 9 (2) ◽  
pp. 13-25
Author(s):  
Peta Stapleton ◽  
Hannah Chatwin
Keyword(s):  
Content Analysis ◽  
Delphi Study ◽  
Delphi Technique ◽  
Structured Interviews ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Core Elements ◽  
Modified Delphi Technique ◽  
Emotional Freedom Techniques ◽  
Many Core

Due to the distinct lack of definition surrounding the desirable attributes of an effective Emotional Freedom Techniques (EFT) practitioner, this study utilized a modified Delphi technique to explore this. This method is designed to achieve a consensus amongst skilled panelists when an accepted body of literature is lacking. A three-round modified Delphi approach was used and participants were skilled in delivering EFT as a practitioner (N = 22). The first round was an open-ended series of questions derived from the literature, and responses to these initial questions were analyzed using content analysis (nVivo), with common themes identified and grouped together. These themes were then utilized to develop more specific quantitative questions (Likert format) to be used in the subsequent rounds. Consensus was set at 75% agreement on an item and was reached for 11 out of the 15 traits of an effective EFT practitioner identified in round 1. Consensus was also reached for seven out of the eight traits of an ineffective EFT practitioner, but was not reached for many core elements in training. These included adequate training, knowledge of other energy techniques, and the use of structured interviews, among other issues. Consensus was also not reached for the use of screening processes prior to training. These results are discussed in terms of standardization in EFT

scholarly journals Early-Career Challenges of Youth Development Extension Educators and Effective Strategies

2021 ◽  
Vol 13 (16) ◽  
pp. 9017
Author(s):  
Koralalage S. U. Jayaratne ◽  
Daniel P. Collins ◽  
Shannon B. McCollum
Keyword(s):  
Youth Development ◽  
Delphi Method ◽  
Delphi Study ◽  
Research Study ◽  
Expert Panel ◽  
Early Career ◽  
Future Research ◽  
Extension Educators ◽  
Effective Strategies ◽  
Modified Delphi

The purpose of this research study was to determine the challenges faced by early-career youth development extension educators and strategies helpful in managing those challenges. This study used the modified Delphi method of three rounds with a specifically selected expert panel of 24 members to build consensus on the challenges that early-career youth development extension educators faced and managing strategies of those challenges. The expert panel of this Delphi study was selected from two south-eastern states in the U.S. based on their proven success and effectiveness in youth development extension programming in their respective counties. The three-round Delphi study led to building the consensus on 16 challenges faced by early-career youth development extension educators and 14 strategies helpful in managing those challenges. The findings of this study have implications for planning onboarding training programs for early-career youth development extension educators. Future research is needed to understand how identified strategies contribute to managing early-career challenges faced by youth development extension educators.

scholarly journals Developing a hospital accreditation model: a Delphi study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Mohammad Mosadeghrad ◽  
Fatemeh Ghazanfari
Keyword(s):  
Delphi Study ◽  
Process Management ◽  
Accreditation Body ◽  
Structured Interviews ◽  
Senior Managers ◽  
Hospital Accreditation ◽  
University Professors ◽  
Military Hospitals ◽  
Modified Delphi ◽  
Modified Delphi Technique

Abstract Background Hospital accreditation (HA) is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program. Methods This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country’s health system, university professors in the fields of health policy and management across the country. Results A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers (“Management and leadership”, “Planning”, “Education and Research”, “employee management”, “patient management”, “resource management”, and “process management”) and three are the results (“employee results”, “patient and society results” and “hospital results”). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model’s total scores respectively. Then, about 150 accreditation standards were written and verified. Conclusions A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

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