Delphi Approach (delphi + approach)

Distribution by Scientific Domains

Selected Abstracts

Emergency Medicine Practitioner Knowledge and Use of Decision Rules for the Evaluation of Patients with Suspected Pulmonary Embolism: Variations by Practice Setting and Training Level

Michael S. Runyon MD
Abstract Background Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments. Objectives To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs for PE. Methods By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions. The questions were designed to determine the respondents' familiarity, frequency of use, and comprehension of the Canadian and Charlotte rules. The survey also queried the frequency of use of unstructured (gestalt) pretest probability assessment and reasons why physicians choose not to use decision rules. The surveys were sent to physicians, physician assistants, and medical students at 32 academic and community hospitals in the United States and the United Kingdom. Results Respondents included 555 clinicians; 443 (80%) work in academic practice, and 112 (20%) are community based. Significantly more academic practitioners (73%) than community practitioners (49%) indicated familiarity with at least one of the two decision rules. Among all respondents familiar with a rule, 50% reported using it in more than half of applicable cases. A significant number of these respondents could not correctly identify a key component of the rule (23% for the Charlotte rule and 43% for the Canadian rule). Fifty-seven percent of all respondents indicated use of gestalt rather than a decision rule in more than half of cases. Conclusions Academic clinicians were more likely to report familiarity with either of these two specific decision rules. Only one half of all clinicians reporting familiarity with the rules use them in more than 50% of applicable cases. Spontaneous recall of the specific elements of the rules was low to moderate. Future work should consider clinical gestalt in the evaluation of patients with possible PE. [source]

A Delphi survey of the views of adult male patients with personality disorders on psychoeducation and social problem-solving therapy

Mary McMurran
Background,Psychoeducation and social problem-solving therapy are treatment components that work well in tandem for offenders with personality disorders, hence it is worthwhile to maintain and improve their effectiveness. Aim,The aim was to seek patients' views of these therapies to contribute to their development. Method,A Delphi survey was conducted with all 12 male inpatients of a personality disorder hospital treatment unit. Results,Round 1 produced 30 statements for psychoeducation and 59 for social problem-solving therapy to be rated in Round 2. There was consensus at a level of 70% for all items. Both psychoeducation and social problem-solving therapies were viewed as useful by these patients. The men also suggested improvements in psychoeducation, including minimizing the delay between assessment and feedback, provision of reference material, preparation for the work and support afterwards. Areas identified for improvement in social problem-solving therapy included more frequent review of progress, greater consistency of delivery, eliciting problems more effectively, providing reference material, supporting patients in group work, and the development of an advanced therapy. Discussion,A Delphi approach to evaluation of therapies with the people receiving them is not only feasible but seems to offer a practical way of making useful clinical adjustments to the work. Further research with larger samples might usefully focus on whether such an approach enhances treatment compliance. Copyright 2007 John Wiley & Sons, Ltd. [source]

NANDA and NIC: Mediators to Describe Irish Intellectual Disability Nursing

Fintan Sheerin
PURPOSE To identify the foci of interest specific to nursing interventions within residential, intellectual disability nursing through the use of the terms and meanings presented in NANDA and NIC. METHODS Data were collected using a Delphi approach involving a purposive sample of 8 individuals with relevant expertise, followed up by the conduct of three focus groups held with a total sample of 17 intellectual disability nurses working in three Irish service settings: traditional residential, community residential, and nurse education. Data were examined for contextual meaning as well as consensus of perceptions. FINDINGS Many potential interventions and diagnoses were identified for the field of residential learning disability nursing. Interventions that elicited a >50% consensus among participants across groups were examined for contextual meaning, based on the taped and noted responses, and potentially related NIC interventional labels were then applied. These led, through a reverse NIC-NANDA linkage exercise, to the identification of 8 potentially related interventions. The contextual aspect directed the analysis process to identify the nursing diagnoses associated with the interventions to be used, and 21 resultant diagnoses were identified. DISCUSSION Further analysis and study are needed to verify the relevance of these diagnoses and interventions to residential learning disability. A quick comparison of the results with those of studies carried out in other countries demonstrates that certain diagnoses have been identified by one or more authors in their studies. CONCLUSIONS This study identified a number of foci that have achieved various levels of consensus among the study participants. The ongoing study plan will further examine nurses' and managers' perceptions while also looking at these within the context of current service philosophy. [source]

A study to identify the training needs of life insurance sales representatives in Taiwan using the Delphi approach

Chiang Ku Fan
This article reports a study conducted to identify the needs for continuing professional development for life insurance sales representatives and to examine the competencies needed by those sales representatives. A modified Delphi technique was used. Most life insurance companies in the USA implement an education and training plan advocated by the Life Office Management Association. Insurance companies in Taiwan implement similar education and training plans, but they do not seem to result in the successful performance of their sales representatives. Besides augmenting knowledge of various financial products and marketing approaches, this study also suggests that life insurance companies need to train their sales representatives to an adequate standard in competencies of problem solving, communication, information technology utilization, culture compatibility, emotional intelligence, collective competence and ethics. [source]

Developing multidisciplinary guidelines for the management of early rheumatoid arthritis

BA Hons, Sheena Hennell RGN
Abstract Objective:,To develop an evidence based guideline, for the multidisciplinary management of early rheumatoid arthritis (RA). Methods:,Recommendations were developed using both an evidence-based approach and expert opinion. The scientific committee, composed of key members of the rheumatology multidisciplinary team used a Delphi approach to evaluate topics and standard statements, which formed the basis for developing recommendations for management of RA in the first 2 years of disease. Evidence taken from literature was used to support these recommendations. Results:,24 evidence based recommendations for the management of early RA, with a grade of recommendation from A to C, were developed. In addition an algorithm of care was designed to promote a clear multidisciplinary management pathway. A mechanism for audit was also identified. Conclusion:,Involvement of the multidisciplinary rheumatology team has enabled a holistic guideline to be developed for the management of patients presenting with early RA. This guideline is based around best practice that is supported by published literature. Whilst most statements in the guideline are based on strong evidence, others have been formulated by expert consensus in the absence of data and should serve as an opportunity to improve current practice through future research and audit. The development and implementation of such a guideline should improve the care of patients with early RA. Copyright 2007 John Wiley & Sons, Ltd. [source]

The Delphi process , an expert-based approach to ecological modelling in data-poor environments

D. C. MacMillan
Abstract Resource managers are involved in difficult decisions that affect rare species and habitats but often lack relevant ecological knowledge and experience. Ecological models are increasingly being looked to as a means of assisting the decision-making process, but very often the data are missing or are unsuited to empirical modelling. This paper describes the development and application of the Delphi approach to develop a decision support tool for wildlife conservation and management. The Delphi process is an expert-based approach to decision support that can be used as a means for predicting outcomes in situations where ,absolute' or ,objective' models are unavailable or compromised by lack of appropriate data. The method aims to develop consensus between experts over several rounds of deliberation on the assumption that combining the expertise of several individuals will provide more reliable results than consulting one or two individuals. In this paper the approach is used to engineer soft knowledge on the conservation requirements of capercaillie Tetrao urogallus, an endangered woodland grouse, into a model that can be used by forests managers to improve the quality of forest habitat for capercaillie over extensive commercial forest areas. This paper concludes with a discussion of the potential advantages and disadvantages of Delphi and other soft knowledge approaches to ecological modelling and conservation management. [source]