The eligibility criteria, training content, and scope of practice for prescriptive authority for midwives: a modified Delphi study†

Abstract Objective To investigate the necessary eligibility criteria for prescriptive authority for midwives, gather suggestions from experts on training content for prescriptive authority for midwives, and explore the scope of practice of their prescriptive authority in certain circumstances. The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives. Methods Based on a literature search and semistructured interviews, a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives. This stage included nursing experts (20) and medical experts (16) engaged in midwifery in many tertiary Grade A hospitals in China. Subsequently, consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts (18) and medical experts (14) engaged in midwifery in many tertiary Grade A hospitals in China. The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority, training content, circumstances, scope of practice for prescriptive authority, and the prescription forms. Results Among the consulted experts, 70.59% (the highest acceptance rate) considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority, 85.29% (the highest acceptance rate) considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority, and 50% (the highest acceptance rate) considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority. The applicants should at least be practicing at Grade C hospitals, which was the consensus among 91.18% of the consulted experts. Among the consulted experts, 100%, 100%, 97.06%, 94.12%, and 94.12% agreed that the applicants should have knowledge in pharmacology, laws and ethics, nursing, diagnostics, and midwifery, respectively. The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority, including uterine atony, excessive uterine contraction, postpartum hemorrhage, premature rupture of fetal membranes, normal labor, and neonatal asphyxia. Under these 6 circumstances, the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives. Of these prescriptions, 51.5% were independent prescriptions, 30.3% were protocol prescriptions, and the remaining 18.2% were both independent and protocol prescriptions. Conclusions Midwives who have an undergraduate degree, supervisor nurse position, and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority. Partial prescriptive authority could be granted after regulated training in fundamental theories and practices, which could improve the independence and professionalism of midwifery.

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Clinical indicators to identify neuropathic pain in low back related leg pain: a modified Delphi study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03600-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jai Mistry ◽

Deborah Falla ◽

Tim Noblet ◽

Nicola R. Heneghan ◽

Alison Rushton

Keyword(s):

Neuropathic Pain ◽

Delphi Study ◽

Leg Pain ◽

Complete Agreement ◽

Low Back ◽

Eligibility Criteria ◽

Clinical Indicators ◽

Modified Delphi ◽

Coefficient Of Concordance ◽

Kendall’S W

Abstract Background Neuropathic pain (NP) is common in patients presenting with low back related leg pain. Accurate diagnosis of NP is fundamental to ensure appropriate intervention. In the absence of a clear gold standard, expert opinion provides a useful methodology to progress research and clinical practice. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain. Methods A modified Delphi method consisting of three rounds was designed in accordance with the Conducting and Reporting Delphi Studies recommendations. Recruitment involved contacting experts directly and through expressions of interest on social media. Experts were identified using pre-defined eligibility criteria. Priori consensus criteria were defined for each round through descriptive statistics. Following completion of round 3 a list of clinical indicators that achieved consensus were generated. Results Thirty-eight participants were recruited across 11 countries. Thirty-five participants completed round 1 (92.1%), 32 (84.2%) round 2 and 30 (78.9%) round 3. Round 1 identified consensus (Kendall’s W coefficient of concordance 0.456; p < 0.001) for 10 clinical indicators out of the original 14, and 9 additional indicators were added to round 2 following content analysis of qualitative data. Round 2 identified consensus (Kendall’s W coefficient of concordance 0.749; p < 0.001) for 10 clinical indicators out of 19, and 1 additional indicator was added to round 3. Round 3 identified consensus for 8 indicators (Kendall’s W coefficient of concordance 0.648; p < 0.001). Following completion of the third round, an expert derived consensus list of 8 items was generated. Two indicators; pain variously described a burning, electric shock like and/or shooting into leg and pain in association with other neurological symptoms (e.g. pins and needles, numbness, weakness), were found to have complete agreement amongst expert participants. Conclusions Good agreement was found for the consensus derived list of 8 clinical indicators to identify NP in low back related leg pain. This list of indicators provide some indication of the criteria upon which clinicians can identify a NP component to low back related leg pain; further research is needed for stronger recommendations to be made.

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Recommendations to improve the harmonisation of colorectal cancer cell percentage estimation in molecular oncology: a modified Delphi study

10.26226/morressier.5b4709886f4cb3001095199e ◽

2018 ◽

Author(s):

Kelly Dufraing ◽

Anca Oniscu ◽

Caterina Marchiò

Keyword(s):

Colorectal Cancer ◽

Cancer Cell ◽

Delphi Study ◽

Colorectal Cancer Cell ◽

Modified Delphi ◽

Molecular Oncology ◽

Cell Percentage

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European List of Essential Medicines for Medical Education: a protocol for a modified Delphi study

BMJ Open ◽

10.1136/bmjopen-2020-045635 ◽

2021 ◽

Vol 11 (5) ◽

pp. e045635

Author(s):

Erik Donker ◽

David Brinkman ◽

Milan Richir ◽

Paraskevi Papaioannidou ◽

Robert Likic ◽

...

Keyword(s):

Medical Education ◽

Delphi Study ◽

Medical Training ◽

Medical Center ◽

European Countries ◽

Essential Medicines ◽

Ethical Review ◽

Junior Doctors ◽

Direct Supervision ◽

Modified Delphi

IntroductionJunior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education.Methods and analysisThis modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in ≥80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision.Ethics and disseminationThe study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO‐ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.

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Barriers and facilitators to the implementation of interventions for medically unexplained symptoms in primary care: A modified Delphi study

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110386 ◽

2021 ◽

Vol 143 ◽

pp. 110386

Author(s):

Denise J.C. Hanssen ◽

Anika Ras ◽

Judith G.M. Rosmalen

Keyword(s):

Primary Care ◽

Delphi Study ◽

Medically Unexplained Symptoms ◽

Barriers And Facilitators ◽

Modified Delphi ◽

Medically Unexplained ◽

Unexplained Symptoms

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Expert Consensus on Clinical Application of Lateral Lumbar Interbody Fusion: Results From a Modified Delphi Study

Global Spine Journal ◽

10.1177/21925682211012688 ◽

2021 ◽

pp. 219256822110126

Author(s):

Yong Hai ◽

Jingwei Liu ◽

Yuzeng Liu ◽

Tie Liu ◽

Xinuo Zhang ◽

...

Keyword(s):

Lumbar Spine ◽

Delphi Method ◽

Delphi Study ◽

Interbody Fusion ◽

Expert Consensus ◽

Lumbar Spine Surgery ◽

Study Group ◽

Lumbar Interbody Fusion ◽

Modified Delphi ◽

Chinese Study

Study Design: Modified Delphi study. Objective: The objective of this study was to establish expert consensus on the application of lateral lumbar interbody fusion (LLIF) by using the modified Delphi study. Methods: From June 2019 to March 2020, Members of the Chinese Study Group for Lateral Lumbar Spine Surgery were selected to collect expert feedback using the modified Delphi method where 65 spine surgeons from all over China agreed to participate. Four rounds were performed: 1 face-to-face meeting and 3 subsequent survey rounds. The consensus was achieved with ≥a 70.0% agreement for each question. The recommendation of grade A was defined as ≥90.0% of the agreement for each question. The recommendation of grade B was defined as 80.0-89.9% of the agreement for each question. The recommendation of grade C was defined as 70.0-79.9% of the agreement for each question. Results: A total of 65 experts formed a panelist group, and the number of questionnaires collected was 63, 59, and 62 in the 3 rounds. In total, 5 sections, 71 questions, and 382 items achieved consensus after the Delphi rounds including summary; preoperative evaluation; application at the lumbar spinal stenosis, lumbar disc herniation, lumbar spondylolisthesis, adult degenerative scoliosis, postoperative adjacent segmental degeneration, and revision surgery; complications; and postoperative follow-up evaluation of LLIF. Conclusion: The modified Delphi method was utilized to ascertain an expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery to inform clinical decision-making in the application of LLIF. The salient grade A recommendations of the survey are enumerated.

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