Barriers to antigen detection and avoidance in chronic hypersensitivity pneumonitis in the United States

Abstract Background Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen. Antigen avoidance is associated with improved outcomes. We are unable to identify the antigen source in approximately half of patients. When an antigen is successfully identified, patients have difficulty with avoidance. Methods We conducted three structured group discussions with US based ILD specialists utilizing the nominal group technique (NGT). Participants listed barriers to antigen detection and avoidance in CHP. Each participant ranked what they perceived to be the top three barriers in the list in terms of importance. The master list of barriers was consolidated across the three groups into themes that were prioritized based on receiving the highest rankings by participants. Results Twenty-five physicians participated; 56% had experience caring for CHP patients for ≥ 16 years. Sixty barriers to antigen detection were categorized into seven themes of which the top three were: 1. unclear significance of identified exposures; 2. gaps in clinical knowledge and testing capabilities; 3. there are many unknown and undiscovered antigens. Twenty-eight barriers to antigen avoidance were categorized into five themes of which the top three were: 1. patient limitations, financial barriers and lack of resources; 2. individual patient beliefs, emotions and attachments to the antigen source; and 3. gaps in clinical knowledge and testing capabilities. Conclusions This study uncovered challenges at the individual patient, organizational, and societal levels and ranked them in terms of level of importance. These findings provide information to guide development and validation of multidisciplinary support and interventions geared towards antigen identification and avoidance in CHP.

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Psykologisk kontrakt med studenter i høyere utdanning

Praksisnær undervisning – i praksis og teori ◽

10.23865/noasp.94.ch3 ◽

2020 ◽

pp. 53-66

Author(s):

Gisle Heimly ◽

Egil Eide ◽

Njål Vidar Traavik

Keyword(s):

Psychological Contract ◽

Nominal Group Technique ◽

Nominal Group ◽

Vocational Teachers ◽

Whole Class ◽

The Individual ◽

High Degree ◽

Group Technique

In this article, we present how a shared psychological contract was negotiated with students at the Practical Pedagogical Education for Vocational Teachers (PPU-Y) at the beginning of the program, autumn 2016. A modified version of the nominal group technique (NGT) was used in groups and in whole class negotiations. General themes representing the individual students as well as common expectations of the role of the teacher and their own role as students were identified. The findings show that the students have a high degree of relational expectations to the teacher, expect structure and predictability in the study, and expect relevance between education and objectives of education and that individual expectations to the teacher and the negotiated psychological contract in class are relatively similar.

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Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

Journal of Athletic Training ◽

10.4085/1062-6050-0434.19 ◽

2020 ◽

Vol 55 (6) ◽

pp. 563-572

Author(s):

Brianna M. Mills ◽

Kelsey M. Conrick ◽

Scott Anderson ◽

Julian Bailes ◽

Barry P. Boden ◽

...

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Prehospital Care ◽

Athletic Trainers ◽

Nominal Group Technique ◽

The United States ◽

Nominal Group ◽

Spine Injury ◽

Group Technique

Introduction Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. Methods A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. Results The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. Conclusions These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

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Priorities of Unmet Needs for Those Affected by Colorectal Cancer: Considerations From a Series of Nominal Group Technique Sessions

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7655 ◽

2021 ◽

Vol 19 (6) ◽

pp. 693-699

Author(s):

Sharyn F. Worrall ◽

Andrea J. Dwyer ◽

Reese M. Garcia ◽

Keavy E. McAbee ◽

Anjelica Q. Davis

Keyword(s):

Colorectal Cancer ◽

Adverse Effects ◽

Unmet Needs ◽

Nominal Group Technique ◽

The United States ◽

Nominal Group ◽

Disease Stage ◽

Caregiver Support ◽

Race Ethnicity ◽

Group Technique

Background: Colorectal cancer (CRC) is the third most common cancer among men and women in the United States. Patients and survivors experience a range of challenges, including anxiety, financial issues, long-term adverse effects, and more. The intent of this project was to assess the needs of the CRC community directly from survivors and their caregivers and to lay a foundation for ongoing support. Methods: Twelve nominal group technique sessions were facilitated. Participants were randomized and presented with the following questions: “What information do you wish you had at the time of diagnosis?” and “What information do you need now as a survivor?” After the nominal group technique process, each statement’s score was divided by the number of people in the session, providing the average to identify the top-ranked statements. Themes and subthemes were applied to statements. Results were compared between coders. Results: There was a total of 79 participants, 49 of whom self-identified as a patient with or survivor of cancer. Patient/survivor demographics were as follows: stage IV disease (n=20), stage III disease (n=22), stage II disease (n=5), stage I disease (n=2), caregiver/family member (n=30), male (n=16), female (n=63), White (n=50), Native Hawaiian/Pacific Islander (n=1), Hispanic/Latino (n=13), Black/African American (n=11), Asian (n=1), and more than one race/ethnicity (n=3). The most frequent themes among responses to the first question were communication and coordination with care team and access to CRC resources. The most frequent themes among responses to the second question were psychosocial support and family/caregiver support. Frequent themes among responses across both questions were understanding treatment options and adverse effects. Conclusions: These findings highlight gaps in support for individuals affected by CRC, and lay a foundation for ongoing assistance. Future studies exploring differences based on disease stage, race/ethnicity, age, gender identity, geographic location, and tumor location are needed to further tailor support for those experiencing CRC. Themes identified in this project require a multidisciplinary approach to ensure that the unmet needs of survivors are addressed.

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Policy Deployment and Learning in Complex Business Domains: The Potentials of Role Playing

International Journal of Business and Management ◽

10.5539/ijbm.v11n12p15 ◽

2016 ◽

Vol 11 (12) ◽

pp. 15 ◽

Cited By ~ 6

Author(s):

Federico Barnabè

Keyword(s):

Conceptual Knowledge ◽

Management Education ◽

Nominal Group Technique ◽

Role Playing ◽

Nominal Group ◽

Role Playing Games ◽

Concrete Experience ◽

Relevant Role ◽

Role Playing Game ◽

The Individual

<p>This article focuses on the use of Role Playing games in management education, aiming at demonstrating that they have the potential to provide concrete experiences in which participants can acquire conceptual knowledge and operative skills, both at the individual and the collective level. More specifically,<strong> </strong>Role Playing games are powerful tools able to support participants’ learning at different degrees, since they provide a context and the conditions for concrete experience, reflective observation, abstract conceptualization, and active experimentation. To pursue this aim, a specific Role Playing game was used in an MBA setting focusing on the management of a typical supply chain. Additionally, a nominal group technique facilitated the emergence of group consensus, and the development of improvement policies. The research design and the results of several gaming sessions are discussed and analyzed according to the theoretical framework presented in the article. Overall, this study shows that Role Playing simulations can play a serious and relevant role in management education, providing free and safe environments in which participants can face decision-making issues, and problem-solving challenges.</p>

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Co-producing Progression Criteria for Feasibility Studies: A Partnership between Patient Contributors, Clinicians and Researchers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193756 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3756 ◽

Cited By ~ 2

Author(s):

Hannah Young ◽

Samantha Goodliffe ◽

Meeta Madhani ◽

Kay Phelps ◽

Emma Regen ◽

...

Keyword(s):

Nominal Group Technique ◽

Feasibility Studies ◽

Discussion Groups ◽

Nominal Group ◽

Study Patient ◽

Loss To Follow Up ◽

Second Stage ◽

Modified Nominal Group Technique ◽

The Individual

There is a lack of guidance for developing progression criteria (PC) within feasibility studies. We describe a process for co-producing PC for an ongoing feasibility study. Patient contributors, clinicians and researchers participated in discussions facilitated using the modified Nominal Group Technique (NGT). Stage one involved individual discussion groups used to develop and rank PC for aspects of the trial key to feasibility. A second stage involving representatives from each of the individual groups then discussed and ranked these PC. The highest ranking PC became the criteria used. At each stage all members were provided with a brief education session to aid understanding and decision-making. Fifty members (15 (29%) patients, 13 (25%) researchers and 24 (46%) clinicians) were involved in eight initial groups, and eight (two (25%) patients, five (62%) clinicians, one (13%) researcher) in one final group. PC relating to eligibility, recruitment, intervention and outcome acceptability and loss to follow-up were co-produced. Groups highlighted numerous means of adapting intervention and trial procedures should ‘change’ criteria be met. Modified NGT enabled the equal inclusion of patients, clinician and researcher in the co-production of PC. The structure and processes provided a transparent mechanism for setting PC that could be replicated in other feasibility studies.

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The Right to Urban Streams: Quantitative Comparisons of Stakeholder Perceptions in Defining Adaptive Stream Restoration

Sustainability ◽

10.3390/su12229500 ◽

2020 ◽

Vol 12 (22) ◽

pp. 9500

Author(s):

Chang-Yu Hong ◽

Eun-Sung Chung ◽

Heejun Chang

Keyword(s):

South Korea ◽

Ecological Restoration ◽

Stream Restoration ◽

Nominal Group Technique ◽

Coastal Region ◽

Nominal Group ◽

Urban Stream ◽

Priority Score ◽

The Individual ◽

The Right

Assuring healthy streams in the urban environment is a major goal for restoration scientists, urban planners, and city practitioners around the globe. In South Korea, many urban stream restoration efforts are designed to provide safe water to society and enhance ecological functions. We examined the extent to which the individual interests and different values of multiple stakeholders were considered in previous decision-making in two urban stream restoration projects. The relevant data on stream restoration were collected through the nominal group technique (NGT) and the analytic hierarchy process (AHP) for the two stream cases of a populated inland area and a coastal region in South Korea. The AHP results provide information about the comparative weights of the values of ecological restoration (priority score: 0.487), social restoration (priority score: 0.231), and landscape revitalization (priority score: 0.279) of the Ahn-Yang stream and ecological restoration (priority score: 0.527), social restoration (priority score: 0.182), and landscape revitalization (priority score: 0.290) of the Sahn-Jee stream. The stakeholders of the populated metropolitan area had a relatively high awareness of their role in environmental restoration, thus it was natural for them to place a high value on social restoration.

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Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13101019 ◽

2020 ◽

Vol 15 (5) ◽

pp. 673-684 ◽

Cited By ~ 2

Author(s):

Simon A. Carter ◽

Talia Gutman ◽

Charlotte Logeman ◽

Dan Cattran ◽

Liz Lightstone ◽

...

Keyword(s):

Focus Groups ◽

Nominal Group Technique ◽

The United States ◽

Glomerular Disease ◽

Nominal Group ◽

Family Impact ◽

Importance Score ◽

Future Health ◽

The United Kingdom ◽

And Control

Background and objectivesShared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices.Design, setting, participants, & measurementsWe purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically.ResultsAcross 16 focus groups, 134 participants (range, 19–85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family.ConclusionsPatients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.

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Barriers to Adherence to a Weight Loss Diet Using the Nominal Group Technique

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_014 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1297-1297

Author(s):

Angela De Leon ◽

James Roemmich ◽

Shanon Casperson

Keyword(s):

Weight Loss ◽

Nominal Group Technique ◽

The United States ◽

Nominal Group ◽

Female Population ◽

Weight Loss Diet ◽

Weight Loss Interventions ◽

Environmental Level ◽

Group Technique

Abstract Objectives At any given time, a large percentage of the female population, especially those of childbearing age, is engaged in some form of weight loss behavior. Although numerous weight loss plans and diets have been shown to achieve weight loss in the short term, the long-term maintenance of weight loss is modest at best. The identification of factors associated with difficulty adhering to a weight loss diet and sustaining weight loss maintenance is paramount to improving the long-term success of weight loss interventions. Methods As part of a study investigating the effects of dietary protein distribution on weight loss in women (N = 33; age = 33 ± 8; BMI = 36 ± 4), we conducted a series of nominal group technique (NGT) sessions aimed at identifying perceived barriers to adherence to a weight-loss diet. NGT generates a large number of unique responses to a specific research question, in this case, factors that make it hard to stick to a weight-loss diet. Responses from all NGT sessions were then aggregated and grouped into major themes to create an overall thematic framework of highest ranking responses. Results The major themes to emerge were individual- and environmental-level barriers. Individual-level themes rated the most highly by the groups were knowledge, cravings, emotions, habits, impatience, and willpower—specifically, knowing when to stop eating, being able to control cravings and emotional eating, and sustaining dietary lifestyle changes. The highest ranking environmental-level themes included family/social, time constraints, eating out, food being present, and cost. Events that bring people together, especially those centered around food and drink, and busy schedules were particularly challenging for women's efforts to stay “on track” with their weight control goals. Conclusions Our findings provide a rich depiction of the barriers that women find most salient in adhering to a weight-loss diet. These results highlight the importance of understanding the intricate interplay between individual- and environmental-level factors that make achieving and maintaining a healthy body weight difficult. This information can be used to inform the planning and implementation of behavioral weight-loss interventions in women. Funding Sources The United States Department of Agriculture, Agricultural Research Service and the North Dakota Beef Commission.

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Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education

F1000Research ◽

10.12688/f1000research.74779.1 ◽

2022 ◽

Vol 11 ◽

pp. 37

Author(s):

Aisha Rafi ◽

Muhammad Idrees Anwar ◽

Ayesha Younas ◽

Shamaila Manzoor

Keyword(s):

Medical Education ◽

Blended Learning ◽

Paradigm Shift ◽

Personal Experience ◽

Nominal Group Technique ◽

Learning System ◽

Nominal Group ◽

Current Evidence ◽

Practical Guidelines ◽

The Individual

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world’s economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert’s own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

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The Use of Hierarchical Sampling in the Surveillance Program for Plum pox virus Incidence in the United States

Plant Disease ◽

10.1094/pdis.2002.86.3.259 ◽

2002 ◽

Vol 86 (3) ◽

pp. 259-263 ◽

Cited By ~ 25

Author(s):

G. Hughes ◽

T. R. Gottwald ◽

L. Levy

Keyword(s):

United States ◽

The United States ◽

Nominal Group ◽

Survey Method ◽

Enzyme Linked Immunosorbent Assay ◽

Surveillance Program ◽

Plum Pox Virus ◽

Individual Tree ◽

Hierarchical Sampling ◽

The Individual

Plum pox virus (PPV) was first reported in North America in late 1999. As part of the eradication effort mounted in response to this finding, a Plum Pox Virus National Surveillance Program has been implemented in the United States. The survey method adopted for this program is a form of “group testing” that utilizes relationships between disease incidence at two levels in a spatial hierarchy, known as hierarchical sampling. Leaf material is collected from groups of four trees and tested by enzyme-linked immunosorbent assay (ELISA) for PPV infection without distinguishing between the individual trees in a group. PPV incidence at the scale of the individual tree is then calculated by means of a formula. Incidence data were collected during an initial survey conducted by the Pennsylvania Department of Agriculture from nine PPV-infected orchards in the fall of 1999 and from an additional 11 PPV-infected orchards during the spring and summer of 2000. The pattern of PPV-infected trees at the within-group scale was weakly aggregated. As a result, an effective sample size of v = 3.2, rather than the nominal group size of four, should be used in the formula to calculate an estimate of incidence at the scale of the individual tree from observations of incidence collected at the group scale.

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