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Nominal Group Technique (nominal + group_technique)
Selected AbstractsUsing explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort studyJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2010V. Maio PharmD MS MSPH Summary Background and objective:, Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. Methods:, A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals ,65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. Results and discussion:, A total of 23 662 elderly in the cohort (25·8%) had at least one PIP. Of these, 14·1% received prescriptions for two medications of concern, and 2·0% for three or more. Using the expert panel's categories, 59·2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33·9% for rarely appropriate drugs, and 19·1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35·7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17·6%), doxazosin (15·5%), and amiodarone (13·6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. Conclusion:, Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy. [source] Identifying service needs of children with disruptive behavior problems using a Nominal Group TechniqueNURSING & HEALTH SCIENCES, Issue 4 2000Diana R. Keatinge RN, M ADMIN Abstract A recent study used both qualitative and quantitative methods to examine families' perceptions of service needs for children with disruptive behavior problems. Focusing on the qualitative component of the study, the present paper discusses the modified Nominal Group Technique used in focus groups attended by carers living in rural, regional or metropolitan contexts. Three questions posed to each focus group sought to identify families' concerns about health facilities and/or related support services currently available to them, the benefits they perceived in these services and the changes needed to make these services more appropriate or accessible to them. Major themes in the responses relating to each of these questions included concerns about a lack of, or perceived need for, access to help/support, benefits in schools that accommodated the needs of the children, and support from the community. Families' recommendations for change included increased access to health care advice, information and/or support systems. [source] Content validity of the expanded and revised Gross Motor Function Classification SystemDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2008Robert J Palisano PT ScD The aim of this study was to validate the expanded and revised Gross Motor Function Classification System (GMFCS-E&R) for children and youth with cerebral palsy using group consensus methods. Eighteen physical therapists participated in a nominal group technique to evaluate the draft version of a 12- to 18-year age band. Subsequently, 30 health professionals from seven countries participated in a Delphi survey to evaluate the revised 12- to 18-year and 6- to 12-year age bands. Consensus was defined as agreement with a question by at least 80% of participants. After round 3 of the Delphi survey, consensus was achieved for the clarity and accuracy of the descriptions for each level and the distinctions between levels for both the 12- to 18-year and 6- to 12-year age bands. Participants also agreed that the distinction between capability and performance and the concept that environmental and personal factors influence methods of mobility were useful for classification of gross motor function. The results provide evidence of content validity of the GMFCS-E&R. The GMFCS-E&R has utility for communication, clinical decision making, databases, registries, and clinical research. [source] Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group techniqueHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2009Gill Sarre LCST Abstract Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7,9 defined strong support, 4,6 indicated moderate support and 1,3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice. [source] Cost,benefit analysis of team supervision: the development of an innovative model and its application as a case study in one Finnish university hospitalJOURNAL OF NURSING MANAGEMENT, Issue 5 2001Kristiina Hyrkäs Lic. Aim To develop a model of costs and benefits of team supervision and a formula, which are examined more closely by means of an example. Background The popularity of clinical supervision (CS) as one of the methods of supporting health care practitioners' professional development (formative function), coping (restorative function) and quality improvement (normative function) has increased in the 1990s. CS may take the form of one-to-one or group supervision. Team supervision is a special form of group supervision. It means a group that has an interrelated work life outside the group. A host of literature and articles is available on CS. However, the costs and benefits of CS are less examined even though these have given rise to discussion particularly among decision-makers, because the monetary benefit of CS remains unsolved. Method A nominal group technique was used to develop a model of costs and benefits of team supervision and a formula was derived on the basis of the model. The existing statistical data, for example a hospital ward's annual reports, data on sick days and reports on indemnities were utilized in the application of the formula. Findings and conclusion Team supervision was efficient in economic terms on the example ward. The model and the formula constitute a first attempt to ascertain the net present benefit of team supervision. Both the model and the formula need to be further tested, specified and refined. [source] A New Diagnosis Grouping System for Child Emergency Department VisitsACADEMIC EMERGENCY MEDICINE, Issue 2 2010Evaline A. Alessandrini MD Abstract Objectives:, A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type. Methods:, A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP). Results:, A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity. Conclusions:, The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning. ACADEMIC EMERGENCY MEDICINE 2010; 17:204,213 © 2010 by the Society for Academic Emergency Medicine [source] Research Priorities for Human Immunodeficiency Virus and Sexually Transmitted Infections Surveillance, Screening, and Intervention in Emergency Departments: Consensus-based RecommendationsACADEMIC EMERGENCY MEDICINE, Issue 11 2009Jason S. Haukoos MD Abstract This article describes the results of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI) prevention in the emergency department (ED) component of the 2009 Academic Emergency Medicine Consensus Conference entitled "Public Health in the ED: Surveillance, Screening, and Intervention." The objectives were to use experts to define knowledge gaps and priority research questions related to the performance of HIV and STI surveillance, screening, and intervention in the ED. A four-step nominal group technique was applied using national and international experts in HIV and STI prevention. Using electronic mail, an in-person meeting, and a Web-based survey, specific knowledge gaps and research questions were identified and prioritized. Through two rounds of nomination and refinement, followed by two rounds of election, consensus was achieved for 11 knowledge gaps and 14 research questions related to HIV and STI prevention in EDs. The overarching themes of the research priority questions were related to effectiveness, sustainability, and integration. While the knowledge gaps appear disparate from one another, they are related to the research priority questions identified. Using a consensus approach, we developed a set of priorities for future research related to HIV and STI prevention in the ED. These priorities have the potential to improve future clinical and health services research and extramural funding in this important public health sector. [source] Collaborative curriculum development: Clinicians' views on the neurology content of a new occupational therapy courseAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2000Annie McCluskey Academics are often accused of being out of touch with clinical practice. This can result in graduates who are poorly prepared to work in local health-care systems. To avoid this scenario, occupational therapy clinicians in New South Wales were invited by mail to list 10 topics related to neurology, which they felt should be included in a new undergraduate curriculum. Fifty-two clinicians responded. A modified nominal group technique was then used with 10 expert clinicians, to further explore the written responses. Content analysis revealed four areas which clinicians felt needed attention in the new curriculum. These areas or themes have been named: (i) Integrated Foundation Studies; (ii) The Art of a Thorough Assessment; (iii) Treatment Approaches in Neurology; and (iv) Building Confidence. Clinicians felt that neuroscience material needed to be better integrated with professional subjects; that observational skills and activity analysis should receive more class time, and that three different approaches to motor training should be taught. More practical student experience was also recommended, on and off campus, to help increase confidence when conducting initial assessments and upper limb retraining. Information from this study will be of interest to clinicians in neurology and to occupational therapy educators across Australia. [source] | ||||||||||