Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.

Weighing and Prioritizing Noise Control Methods Using the Delphi Technique and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) in an Iranian Tire Manufacturing Factory

Undoubtedly,noise has become a major hazardous issue in today’s industrial world,with a lot of people suffering from exposure to excessive noise in their work environments.This study was conducted to weigh and prioritize noise control methods in an Iranian tire manufacturing complex in Iran.The Delphi method and the Technique for Order Preference by Similarity and an Ideal Solution(TOPSIS)were utilized for this purpose.This cross-sectional,descriptive study was conducted in the baking hall of an Iranian tire manufacturing factory in 2016.To weigh and prioritize noise control methods,Analytic Hierarchy Process(AHP)and TOPSIS were applied.In total,4 criteria and 8 alternatives were examined.An AHP and TOPSIS questionnaire was then designed to prioritize noise control methods in the light of the objectives,criteria,and alternatives.Then,the collected data were fed into Expert Choise.V.11 and Excel and data analysis was carried out using TOPSIS.The results of data analysis indicated that the inconsistency rate in all the cases was smaller than 10%,hence the consistency of the responses was verified.According to the TOPSIS results and experts’opinions about the criteria,implementation and maintenance cost(with a weight of 0.481)and method effectiveness and efficiency(with a weight of 0.046)had the highest and lowest priority respectively.Based on the weights TOPSIS,the appropriate methods for controlling noise in tire manufacturing are designing and manufacturing silencer,requiring people in charge to quickly fix the leaks and change baking press washers on time.

Modeling Highway Traffic Safety for Developing Countries Using Delphi Technique and Bayesian Network： Case Study for Nigeria

Highway traffic safety is an issue confronting developing countries and those of industrialized nations. Nigeria, as a developing country, has been experiencing unusually high traffic related injury and fatality rates. In order to commence combating highway safety problems in Nigeria, the first task is to identify the major contributing factors; however, Nigeria has no reliable and comprehensive database of traffic accidents and casualties. Consequently, the Delphi technique was utilized in generating the required data such as number of registered automobiles, number of licensed drivers, and annual fatality count for modeling and forecasting accident rates in Nigeria. A Bayesian network model was developed and used, with the data obtained from Delphi process, to demonstrate possible traffic safety responses to different scenarios of changes in the Nigerian socio-political culture. Although the Delphi technique and the Bayesian network model only estimate the accident and safety data, those methods can be a realistic option when those data are not available, especially for the developing countries. As a result, the major accident contributors have been identified and the top three contributors-road condition, DUI （driving under the influence） and reckless driving-are policy related. The Nigerian traffic safety outlook would improve significantly if the existing laws and policies can be enforced, even at a very moderate level.

Using the Delphi Technique to Achieve Consensus on Prevention and Treatment of Preterm Single Birth in China

Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines,we generated the Delphi survey statements with five evaluation dimensions,including the definition of preterm birth,exclusion of risk factors for preterm birth,prevention,and prediction of preterm birth,treatment of preterm birth,and evaluation of intervention outcomes of preterm birth.Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey.All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel.Mean scores,rank sum,full score ratio,and the lowest score ratio were calculated to reflect the concentration of expert opinions.The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.Results::The expert response rate for both rounds of surveys was 100%(41/41).Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round.A total of 49 statements(mean scores≥3,full score ratio≥20%,coefficient of variation≤0.3)were explicitly included in this guideline to form recommendations,while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality.The Kendall W coefficient in the two rounds of the Delphi survey were 0.20(P<0.001)and 0.29(P<0.001).Conclusion::The five dimensions and 49 statements,agreed upon through a two-round Delphi study,determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China.The defined lower limit is set at≥28 gestational weeks;however,an update has been made to the definition of premature birth,specifying that"with the consent of the mother and her family,treatment is not abandoned for viable infants≥26 gestational weeks."

Delphi methodology in healthcare research:How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited,ethically/logistically difficult or evidence is conflicting.However,the attempts to assess the quality standard of Delphi studies have reported significant variance,and details of the process followed are usually unclear.We recommend systematic quality tools for evaluation of Delphi methodology;identification of problem area of research,selection of panel,anonymity of panelists,controlled feedback,iterative Delphi rounds,consensus criteria,analysis of consensus,closing criteria,and stability of the results.Based on these nine qualitative evaluation points,we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019.There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members,defining consensus,closing criteria for rounds,and presenting the results.We propose our evaluation points for researchers,medical journal editorial boards,and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China:a modified Delphi study

Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0-5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as： the rating mean was 〉 3 and the coefficient of variation （CV） was 〈 0.5. Consensus for each item in the second round was defined as CV 〈 0.3. Consensus among experts was defined as： P value of Kendall＇s coefficient of concordance （W） 〈 0.05. After three rounds of consultation, a two-part tool was developed： the Immune Status Scale （ISS） and the Checklist of Risk Factors of Infection （CRFI）. There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool＇s efficacy.

Study of an evaluation index system of nursing undergraduate employability developed using the Delphi method

Purpose:To establish an evaluation index system of nursing undergraduate employability.Methods:Two-round expert consultation using the Delphi method and involving 26 nursing experts nationwide.Results:The usable response rates of the 2-round consultation were 89.7%and 100%in the first and second round,respectively.The specialist authority coefficient was 0.869 and the coordination coefficients were 0.205 and 0.212 for the first and second round,respectively,both were statistically different.The evaluation index system comprised four first-level indexes,13 second-level indexes,and 82 third-level items.Conclusion:High positivity representative of the consulted experts enabled the construction of a reliable index system that can be used as a reference for cultivating nursing undergraduate employability.

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

A Delphi Approach to the Selection of Good Agricultural Practices （GAPs） for Resilience Enhancement for Dry Land Farmers in North-Western Nigeria

An earlier baseline study （Jellason et al. in preparation） has identified some of the key challenges faced by farmers and from that, appropriate Good Agricultural Practices （GAPs） have been selected for the environment the farmers find themselves in and based on a review of available literature. Farmer action plans for enhancing smallholder resilience, GHGs emission mitigation and food security for these dry lands were developed. Expert opinions on the applicability of the selected GAPs to inform farmer co-learning and to validate the suitability of these practices in a dry land context were sought through the Delphi study. Experts were also invited to offer suggestions for improvement of the training action plan. Two rounds of a modified Delphi survey were carried out with experts from diverse backgrounds and locations across the globe to solicit their opinion. Results show that experts＇ agreement was reached on most of the action plan items. The results and opinions obtained from the survey were reviewed and adapted into the action plan leading to the development of GAPs for the co-learning exercise.

Construction and Application of Oral English Evaluation Index System Based on AHP

The paper confirms evaluation indexes of oral English with the application of Delphi technique and expert consultation, and then establishes hierarchical structure model of oral English evaluation index system. The weight of each evaluation index is determined with the methods of Delphi and expert consultation again. A group of students＇ oral English is subsequently evaluated by using AHP （Analytic Hierarchy Process） based on oral English evaluation index system and the weights we set up in this thesis.

Delphi study for developing a checklist of adverse events associated with acupotomy

Background Acupotomy,a more invasive procedure than acupuncture,involves the use of a thicker needle with an integrated knife at the tip,necessitating safety research.We aimed to define relevant adverse events(AEs)and create a standardized form of the ACUPOtomy-related AEs CHECKlist(ACUPOCHECK).Methods Before conducting the Delphi process,a systematic review and pilot prospective study were conducted to gather information on previously reported AEs.Using these data,pilot versions of the ACUPOCHECK and Delphi questionnaires were developed.The Delphi questionnaire involved selecting types of AE for inclusion,establishing separate criteria for acupotomy-related AEs,and achieving a consensus on AE assessment.Thirteen Korean doctors with experience in acupotomy or AE research were recruited to participate in each Delphi round.Consensus was considered to have been reached if the critical value for the content validity ratio met or exceeded 0.538.Results The final ACUPOCHECK was developed using four rounds of the Delphi method and one face-to-face consensus meeting.It included 12 local AEs(pain,hemorrhage,bruise,hematoma,edema,pruritus,rash,infection,nerve damage,dysesthesia,movement impairment,and pneumothorax)and 14 systemic AEs(disease aggravation,needle fatigue,sleepiness,procedural nausea,procedural vomiting,procedural headache,procedural dizziness,sweating,procedural shock,syncope,dyspnea,procedural pain,sleep disorder,and postprocedural infection).Separate criteria were established for pain,hemorrhage and bruising:pain was defined as pain that occurrs during daily activities and persists for longer than 72 h,hemorrhage as bleeding that continues for≥3 min despite pressure application,and bruising as having a bruise with a diameter of≥3 cm.Open-ended descriptions were allowed for AEs not covered by the checklist,and severity and causality were assessed using the Common Terminology Criteria for Adverse Events and modified World Health Organization-Uppsala Monitoring Center criteria.Conclusion ACUPOCHECK provides a standardization framework that can help research on traditional practices as well as new tools and techniques that are more invasive and may cause more severe AEs.Subsequent studies will use ACUPOCHECK to develop rational safety guidelines for acupotomy techniques.

Consensus on diagnostic criteria for Yin deficiency syndrome in hypertension:a modified Delphi study

OBJECTIVE:To reach consensus on the diagnostic criteria for Yin deficiency syndrome in hypertension(YDSH)patients by a modified Delphi method.METHODS:Our study was consistent with T/CACM 1032-2017.The methodology of RAND/UCLA appropriateness was used to develop consensus guidance statements.A nationwide panel of experienced clinical experts from 19 provinces was constructed.These experts were all prominent in Traditional Chinese Medicine(TCM)of cardiovascular diseases.This consensus process consisted of two rounds of questionnaires and a final round of consultation to analyze the weight score of each item.Moreover,the data extraction process is carried out independently by third-party researchers(LIANG Junya,SUN Yang,and DU Xiaona).When there is disagreement in all three rounds,the expert panel group(odd number)are invited to vote,and the one with more votes wins.In the questionnaires,participants were asked to rate the appropriateness of each syndrome item using a nine-point Likert scale.The consensus was defined as a panel median rating 1-3 or 7-9 without disagreement.And then the diagnostic criteria of YDSH were formed according to the weight score in the final round.RESULTS:Twenty-eight experts(84.8%)participated in the first round,and thirty-one(93.9%)finished the second round.After two rounds,the consensus of YDSH was reached on 11 items(25.6%),including symptoms,signs,and pulse condition.Twenty-one experts(63.6%)completed the final round in which they used a grading system for each item.Red tongue with scanty fur had the highest weighting(22.8%),followed by heat in the palms and soles(20.1%).CONCLUSIONS:The consensus-based diagnostic criteria for YDSH,formed by a modified Delphi method,can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our YDSH criteria.

Development of international guidelines by Tuina practitioners for specific acupoints of paediatrics Tuina(2022 version)

OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus involved three distinct stages.Initially,a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review,which was subsequently supplemented through expert interviews.In the second stage,the Delphi method was employed to assess the significance of acupoint locations,manipulations,functions,and indications.In situations where the questionnaire survey failed to yield agreement or when the experts held reservations,the nominal group approach was utilized during the expert consensus meeting.The final version of the technical standardized material was ultimately determined during an expert consensus conference.After undergoing external peer review and evaluation,the completed draft was prepared for public dissemination RESULTS:The comprehensive list identified a total of 66 specific acupoints.The location and manipulation questionnaire consisted of 156 items based on the literature database,while the function and indication questionnaire contained 116 items.Two rounds of Delphi surveys were conducted for the location and manipulation category,and another two rounds of Delphi surveys were conducted for the function and indication category.During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions,resulting in the formulation of technical guidelines for the locations,manipulations,functions,and indications of 64 paediatric Tuina acupoints.Subsequently,the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina,which was finalized after external review and feedback.CONCLUSION:This study successfully established the recognized technical standards for practitioners of paediatric Tuina,thereby standardizing clinical practices and providing a foundation setting the framework for future research.The guidelines offer theoretical insights and recommendations for conducting clinical studies comparing different acupoint sites,as well as modifying or enhancing treatment regimens.

Identification of a detailed function list for public health emergency management using three qualitative methods

Background At present, many administrators lack a theoretica health emergencies. This study developed a detailed function building the management systems scientifically. guide to build management systems to cope with public list for public health emergency management to help Methods The five steps in this study including literature review, semistructured interviews with experts, focus group, Delphi study and focus group were conducted to develop the detailed list of functions. Results An initial list of 25 functions with 188 items was formed through literature review. The list was reduced to 10 functions with 57 items by semistructured interviews with experts and focus group. Next, all these 57 items reached the consensus through one-round Delphi study. Some revisions of the consensus were done by the same focus group. Conclusion The final 10 functions with 57 items could be used as a guide for most countries during their building of a public health emergency management system.

International expert consensus on laparoscopic pancreaticoduodenectomy

Importance:While laparoscopic pancreaticoduodenectomy(LPD)is being adopted with increasing enthusiasm worldwide,it is still challenging for both technical and anatomical reasons.Currently,there is no consensus on the technical standards for LPD.Objective:The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review:An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy.Statements were produced upon reviewing the literature and assessed by the members of the expert panel.The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019.The Web of Science,Medline,and Cochrane Library and Clinical Trials databases were searched,The search strategy included,but was not limited to,the terms'laparoscopic','pancreaticoduodenectomy,'pancreatoduodenectomy','Whipple's operation',and'minimally invasive surgery'.Reference lists from the included articles were manually checked for any additional studies,which were included when appropriate.Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements.The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan,China.Findings:Twenty-eight international experts from 8 countries constructed the expert panel.Sixteen statements were produced by the members of the expert panel.At least 80%of responders agreed with the majority(80%)of statements.Other than three randomized controlled trials published to date,most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument.Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD.LPD is currently in its development and exploration stages,as defined by the international IDEAL framework for surgical innovation.More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

A Summary of Chinese Expert Consensus on Fetal Growth Restriction (An Update on the 2019 Version)

Fetal growth restriction(FGR)is a common complication of pregnancy associated with higher rates of perinatal mortality and morbidity,as well as a variety of long-term adverse outcomes.To standardize the clinical practice for the management of FGR in China,Fetal Medicine Subgroup,Chinese Society of Perinatal Medicine,Chinese Medical Association and Maternal-Fetal Medicine Committee,Chinese Society of Obstetrics and Gynecology,Chinese Medical Association organized an expert committee to provide official consensus-based recommendations on FGR.We evaluated the evidence provided by relevant high-quality literature,performed a three-round Delphi study and organized face-to-face meetings with experts from multidisciplinary backgrounds.The consensus includes the definition,prenatal screening,prevention,diagnosis,monitoring and management of FGR.

The Importance of Evidence for the Integration of Traditional and Complementary Medicine into Western Healthcare?

Policy makers should consider improving access to treatments normally considered outside of healthcare in the west, particularly given the recent WHO strategy. However, research on integrating traditional and complementary medicines(T&CM) into conventional health care is lacking. T& CM approaches, may provide a cost effective option given the increase in chronic diseases with evidence of effectiveness of T& CM being key if such approaches are to be offered as part of integrative patient care, in most countries, an integrated healthcare approach is unavailable to patients. Evidence based clinical guidelines on T& CM should influence care provision. However evidence that is available may not even be cited. Poor use of evidence may possibly be a reflection of lack of knowledge and/or biases of guideline developers but additionally stakeholders vary in their perceived need for evidence to implement health policy change. Journal editors should focus on publishing high quality manuscripts, with clear rationales, design and reporting frameworks. Researchers should consider carrying out careful feasibility studies prior to conducting trials taking into account the UK Medical Research Council's framework on complex interventions. Examples of feasibility studies highlighting their importance for trial design are given in this paper. If preparation for more definitive studies is conducted this will in turn improve the quality of research being designed, executed and published and subsequently encourage the inclusion of evidence by guideline developers. Robust evidence is necessary in order to inform governments' health policies providing appropriate T&CM interventions which can ultimately help to provide best patient care.

Sustainability criteria of apicultural industry:evidence from Iran

This study aimed to determine the sustainability criteria of the beekeeping industry in Iran,which was performed using three-stage classical Delphi technique.The participants were 32 experts in beekeeping industry who were purposefully selected using the snowball sampling method.The criteria identified,after three Delphi stages,consisted of 70 items,which were categorized into 13 general criteria and into four economic,environmental,social,and institutional dimensions.The general criteria were presented in the form of a conceptual model,including:farmers’environmental behavior quality,beekeepers'environmental behavior quality,the quality of marketing and sales of beekeeping productions,productivity and performance improvement,amount of monetization from pollinations'right,the amount of monetization of byproducts and value added,employment rate and job stability,the level of social development of stakeholders,the quality of the role-playing of non-governmental stakeholders,the quality of extension and education new sciences and technologies to stakeholders,comprehensiveness of laws and programs,quality of role-playing of stakeholder non-governmental organizations,and the quality of the roleplaying of governmental institutions stakeholder.Using them,a comprehensive perception of the necessary criteria for the sustainability of Iran's beekeeping industry can be obtained and a comprehensive program can be designed for its implementation.