基于Delphi+BSC导向的基层医疗机构医疗质量控制指标体系构建研究

目的:构建一套与基层医疗机构发展导向相适应、科学合理且能有效应用的医疗质量控制指标体系。方法:通过文献研究及政策文件分析筛选初始指标,借鉴平衡计分卡理论并运用德尔菲法构建质控指标体系及指标权重。结果:通过两轮专家咨询构建了基层医疗机构质量控制指标体系并得出了指标权重,包括4个一级指标、39个二级指标,专家积极系数、权威程度和意见协调程度均较好。结论:该指标体系对基层医疗机构医疗质量控制管理具有较高的科学性和可行性。如果辅以智慧医疗信息化平台的支撑,将能开展常态化推广运用,形成同质化质控管理模式。

Outpatient Experience of Human Caring Scale （OEHC-Scale）： Improvement by Delphi Method

Based on the outpatient interview and literature review, the initial framework of the outpatient experience of human caring scale was formed with 9 dimensions of outpatient process. The research aim was to improve the scale by Delphi method. Sixteen experts in medical management, human caring or medical education were invited to evaluate the importance of the dimensions and items of the scale and provided some expertise via filling out the DeLphi consultation questionnaires twice in the consulting round. In the first round, the recovery rate showing the experts＇ positivity was 80%; the coefficient of reliability （Cr） ascertaining the authority of the evaluation was 0.92; the mean and full mark ratios responding the concentration of the evaluation were 2.88-4.94 and 6.25%-93.75% respectively; the coefficients of variation （CV） and the Kendall＇s W determining the concordance of the evaluation were 5.06%-52.15% and 0.21-0.24 respectively. In the second round, the recovery rate was 93.75%; the Cr was 0.93; the mean was 3.93-4.93; the full mark ratios were 26.67%-93.33%; the Kendall＇s W was 0.14- 0.31, the CV was 5.25%-23.61%. Via the two-round Delphi study, the scale that included 10 dimensions and 61 items has been improved. Ten dimensions are pre-hospital medical service, guidance, registration, waiting, diagnosis ＆ treatment, paying, inspection ＆ assay, medicine receiving, therapy/injection/transfusion and global evaluation. It was concluded that Chinese scholars have paid high attention to human caring and outpatient experience. The experts have given high agreements about the dimensions which were established with Chinese outpatient process. The dimensions are different from the similar researches about outpatient experience study. In the future, it is necessary to survey the outpatients to test the construct validity, internal consistency reliability and others of the scale to improve the scale.

Construction of the First Certification Evaluation Index System for Diabetes Specialist Nurses by Delphi Method

Objective: To establish an evaluation index system for the first-time certification of diabetes specialist nurses in line with the clinical nursing practice in China, and to provide a reference basis for government administrations and hospitals to formulate unified standards. Methods: After the research team has determined the theme, it will consult the development of A) specialist nursing through the library, Internet and electronic literature database;B) the history of the development of specialist nurses in diabetes and other fields;C) the selection criteria of specialist nurses;D) the training of specialist nurses system, assessment method;E) Specialist nurse certification body, evaluation standards and certification standards and other related documents, literature, books and report materials. The author established the preliminary index system through literature review, specialist interview and group discussion and used Delphi method to organize three rounds of 30 experts’ consultations. Results: A first certification evaluation index system including 8 fundamental indicators, 5 first-level indicators, 19 second-level indicators and 99 third-level indicators was constructed for diabetes nurses. Conclusion: The results of three rounds of expert consultation and demonstration are reliable, and the constructed index system is suitable for comprehensive evaluation of diabetes specialist nurses, which provides a basis for the effective management of nursing resources.

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.

Euler’s First-Order Explicit Method–Peridynamic Differential Operator for Solving Population Balance Equations of the Crystallization Process

Using Euler’s first-order explicit(EE)method and the peridynamic differential operator(PDDO)to discretize the time and internal crystal-size derivatives,respectively,the Euler’s first-order explicit method–peridynamic differential operator(EE–PDDO)was obtained for solving the one-dimensional population balance equation in crystallization.Four different conditions during crystallization were studied:size-independent growth,sizedependent growth in a batch process,nucleation and size-independent growth,and nucleation and size-dependent growth in a continuous process.The high accuracy of the EE–PDDO method was confirmed by comparing it with the numerical results obtained using the second-order upwind and HR-van methods.The method is characterized by non-oscillation and high accuracy,especially in the discontinuous and sharp crystal size distribution.The stability of the EE–PDDO method,choice of weight function in the PDDO method,and optimal time step are also discussed.

Energy Stable Nodal DG Methods for Maxwell’s Equations of Mixed-Order Form in Nonlinear Optical Media

In this work,we develop energy stable numerical methods to simulate electromagnetic waves propagating in optical media where the media responses include the linear Lorentz dispersion,the instantaneous nonlinear cubic Kerr response,and the nonlinear delayed Raman molecular vibrational response.Unlike the first-order PDE-ODE governing equations considered previously in Bokil et al.(J Comput Phys 350:420–452,2017)and Lyu et al.(J Sci Comput 89:1–42,2021),a model of mixed-order form is adopted here that consists of the first-order PDE part for Maxwell’s equations coupled with the second-order ODE part(i.e.,the auxiliary differential equations)modeling the linear and nonlinear dispersion in the material.The main contribution is a new numerical strategy to treat the Kerr and Raman nonlinearities to achieve provable energy stability property within a second-order temporal discretization.A nodal discontinuous Galerkin(DG)method is further applied in space for efficiently handling nonlinear terms at the algebraic level,while preserving the energy stability and achieving high-order accuracy.Indeed with d_(E)as the number of the components of the electric field,only a d_(E)×d_(E)nonlinear algebraic system needs to be solved at each interpolation node,and more importantly,all these small nonlinear systems are completely decoupled over one time step,rendering very high parallel efficiency.We evaluate the proposed schemes by comparing them with the methods in Bokil et al.(2017)and Lyu et al.(2021)(implemented in nodal form)regarding the accuracy,computational efficiency,and energy stability,by a parallel scalability study,and also through the simulations of the soliton-like wave propagation in one dimension,as well as the spatial-soliton propagation and two-beam interactions modeled by the two-dimensional transverse electric(TE)mode of the equations.

The forecasting efficiency under different selected regions by Pattern Informatics Method and seismic potential estimation in the North-South Seismic Zone

In 2022,four earthquakes with M_(S)≥6.0 including the Menyuan M_(S)6.9 and Luding M_(S)6.8 earthquakes occurred in the North-South Seismic Zone(NSSZ),which demonstrated high and strong seismicity.Pattern Informatics(PI)method,as an effective long and medium term earthquake forecasting method,has been applied to the strong earthquake forecasting in Chinese mainland and results have shown the positive performance.The earthquake catalog with magnitude above M_(S)3.0 since 1970 provided by China Earthquake Networks Center was employed in this study and the Receiver Operating Characteristic(ROC)method was applied to test the forecasting efficiency of the PI method in each selected region related to the North-South Seismic Zone systematically.Based on this,we selected the area with the best ROC testing result and analyzed the evolution process of the PI hotspot map reflecting the small seismic activity pattern prior to the Menyuan M_(S)6.9 and Luding M_(S)6.8 earthquakes.A“forward”forecast for the area was carried out to assess seismic risk.The study shows the following.1)PI forecasting has higher forecasting efficiency in the selected study region where the difference of seismicity in any place of the region is smaller.2)In areas with smaller differences of seismicity,the activity pattern of small earthquakes prior to the Menyuan M_(S)6.9 and Luding M_(S)6.8 earthquakes can be obtained by analyzing the spatio-temporal evolution process of the PI hotspot map.3)The hotspot evolution in and around the southern Tazang fault in the study area is similar to that prior to the strong earthquakes,which suggests the possible seismic hazard in the future.This study could provide some ideas to the seismic hazard assessment in other regions with high seismicity,such as Japan,Californi,Turkey,and Indonesia.

Re-discussing the content of the prescription rights of midwives under certain circumstances using the Delphi method

Objective： This study sought to investigate the content of the prescription rights and the prescription types of midwives under certain circumstances in China. Methods： The Delphi method was used to consult 18 nursing experts and 14 medical experts, A total of 30 experts finished the consulting. The reliability of the expert opinions was analyzed to determine the specific situations in which midwives may write prescriptions, the content of the prescription rights and the prescription types. Results： In six specific circumstances （uterine contraction fatigue, uterine contractions that are too strong, postpartum hemorrhage, premature rupture of the membranes, normal delivery and neonatal asphyxia）, midwives have the right to prescribe and administer medication, including 20 drugs and 13 auxiliary examinations. Of these drugs and examinations, 51.5% of the drugs and adjuvant examination prescriptions tend to be independent prescriptions, 30.3% tend to be protocol prescriptions, and 18.2% are similar to both types. Conclusions： The midwives should be granted some prescription rights to enhance their autonomy and the professionalism of midwifery.

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.

Research on the Application of Montessori Education Method in Cognitive Training of Patients with Alzheimer’s Disease

Objective:To study the application of the Montessori education method in cognitive training in patients with Alzheimer’s disease(AD).Methods:40 cases of senile dementia patients who were admitted to our hospital from January 2022 to January 2023 were selected and randomly divided into an intervention group and a control group according to the single and double number table method,with 20 cases in each group.The intervention group used the Montessori education method,the principle of which was to implement individualized health interventions based on the individual conditions of the patients,for a period of 6 months;the control group was given conventional treatment and nursing of the disease.The Mini-Mental State Examination(MMSE)was used to compare the effects of the two groups of patients before and after health intervention and conduct statistical analysis.Results:The score of the intervention group was higher than that of the control group,and there was a statistical difference between the two(P<0.05).Conclusion:Implementing the Montessori education method for diagnosed Alzheimer’s patients can effectively improve their cognitive function and delay the progress of further dementia.

Study on traditional Chinese medicine syndrome of esophageal cancer based on Delphi method

Esophageal cancer is one of the common malignant tumors in humans.Traditional Chinese medicine(TCM)has unique advantages in the treatment of esophageal cancer.However,the TCM syndrome classification of esophageal cancer is not standardized.This Delphi survey aimed to explore the TCM syndrome classification and symptom characteristics of esophageal cancer.Methods:Based on literature research,an expert consultation questionnaire was developed for the study of the TCM syndrome rules of esophageal cancer.Two rounds of questionnaire surveys were conducted among 62 experts across the country.Statistical description and statistical analysis of the mean,coefficient of variation,grade sum,and unimportant percentage of the retrieved data.TCM syndrome rules and diagnostic indicators for esophageal cancer after screening and sorting out the questionnaire items,convening experts to demonstrate.Results:62 valid questionnaires were collected,and the expert positive coefficient was 100%.The Kendall's coefficient of concordance W of the first and second rounds are 0.232 and 0.2334 respectively.In addition,the Kendall's coefficient of concordance W of the second round has been improved compared with the first round,suggesting that experts have a better degree of coordination on the importance of indicators.The common TCM syndromes of esophageal cancer are obtained:"liver-stomach disharmony,phlegm and qi obstruction syndrome","liver and spleen disorders,phlegm accumulating with stagnation syndrome","deficiency of liver and kidney yin,stubborn blood syndrome","deficiency of spleen and kidney yang,stubborn blood syndrome".Conclusion:The TCM syndrome indicators of esophageal cancer has been established.It provides a basis for the standardized research of TCM syndrome diagnosis of esophageal cancer,which is of positive significance for improving the level of clinical diagnosis and treatment.

Content Validity of a Self-Management Behavior Assessment Tool for Adult Post-Renal Transplant Recipients Using a Modified Delphi Method

Background: Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transplant kidney function, etc. However, because recipients may be unable to adequately self-manage, healthcare providers need to provide self-management support for recipients to improve their skills and confidence in managing their disease. However, it is difficult to comprehensively assess the self-management behaviors in a busy outpatient support setting. Furthermore, since there are no uniform standards for assessment, it is based on the experience and abilities of medical personnel. Therefore, self-management behavior of post-renal transplant recipients is not sufficiently evaluated. Objective: This study aimed to evaluate content validity of a tool that can assess self-management behaviors of adult post-renal transplant recipients, consisting of consensus components from experts familiar with the follow-up of adult post-renal transplant recipients. Methods: A three-round modified Delphi method was used to assess the self-management behaviors of adult post-renal transplant recipients by a panel of experts consisting of certified transplant recipient coordinators, physicians, outpatient nurses, and researchers familiar with the follow-up of post-renal transplant recipients. Regarding management behaviors of adult post-renal transplant recipients, the experts rated the appropriateness and validity of each item using a Likert scale. Consensus ratings from the experts were made by calculating the median, interquartile range, and interquartile range percentage. In the third round, an item-level content validity index was calculated to assess content validity. Conclusions: The 41-item self-management behavior scale for kidney transplant recipients assessed self-management behaviors in five domains: medication, exercise, fluids and diet, disease and symptom prevention and management, and psychosocial adjustment. The content validity of this tool was confirmed, and it can be used to more easily assess the recipients’ self-management behaviors in the post-renal transplant follow-up. This tool can potentially contribute to the maintenance of transplant kidney function and high QOL in recipients.

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.

Ship System Maintenance Strategy Selection Based on DELPHI-AHP-TOPSIS Methodology

Maintenance decision problems generally involve multiple criteria which apparently are best addressed using Multi-Criteria Decision Making (MCDM) tools. This paper describes the use of a hybrid MCDM technique in prioritizing maintenance strategy for ship systems. The Hybrid MCDM technique combines Delphi method, AHP and TOPSIS methods. While the Delphi method and AHP are applied in screening of decision criteria and decision criteria weights determination respectively, the TOPSIS method is used in the ranking of alternative maintenance strategies. Five alternative maintenance strategies which include corrected maintenance, scheduled overhaul, scheduled replacement, continuous on-condition task and scheduled on-condition task are considered and the optimum maintenance strategy is selected based on twelve critical maintenance decision criteria. To demonstrate the suitability of the approach a case study of sea water pump of the central cooling system of a marine diesel engine is used.

Establishing nursing adverse events’reporting content of hospital:using the Delphi method

Objective:To develop nursing adverse events’reporting content of hospital.Methods:The study included two phases.The first phase was to develop the category and definition of nursing adverse events that need to be reported through an expert meeting.The second phase was to develop every nursing adverse event’s reporting content by using the Delphi method.In total,8 experts attended the meeting and 15 experts conducted two rounds of consultation letter.Results:Nursing adverse events that need to be reported of hospital include pressure sore,fall/falling from bed,unplanned extubation,medication error,and accident.Reporting content of these events in detail had also been obtained,which was helpful for cause analysis systematically.Conclusions:The reporting content of the nursing adverse event of hospital is established,and it is a basis for further study of the development of nursing adverse event reporting and feedback system.

Construction of nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19 (mild and common) in Beijing based on Delphi method

Objective:The objective of this study is to establish a nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19(mild and common)in Beijing,to provide reference for clinical nursing of patients with COVID‑19(mild and common).Methods:Through online communication meeting with nurses who are in the frontline of anti‑epidemic,clinical investigation,literature research,and expert demonstration meeting are carried out to prepare the draft of the standard,and the Delphi method is applied to determine the standard of integrated traditional Chinese and Western medicine care for patients with COVID‑19(mild and common)in Beijing.Results:The nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19(mild and common)was established,which included 5 first‑level indicators,14 second-level indicators and 60 third‑level indicators.After two rounds of Delphi method,the positive coefficients of experts were 96%and 83%,the authoritative coefficients of experts were 0.89 and 0.91,and the Kendall’s coefficient of concordance(W)of experts were 0.12,0.09,0.10,0.13(P<0.05)and 0.44,0.43,0.37,0.39(P<0.05).Conclusion:The standard of integrated traditional Chinese and Western medicine nursing for patients with COVID‑19(mild and common)in Beijing constructed by the Delphi method is scientific and practical,which provides a reference for clinical application of integrated traditional Chinese and Western medicine nursing to fight against COVID‑19 infection.

高职教师绩效考核体系设计——基于AHP和Delphi Method的综合运用

高职教师绩效考核的核心是教师工作业绩细化指标的设计,它的设计与教学改革相关性最大,基于AHP和Delphi Method的综合运用,从一级指标的权重看,教师科研工作业绩明显大于教学工作业绩;从二级指标看,教学研究与改革的重要性正逐步被认识;教学工作虽是衡量工作业绩的第一要素,但其内容已经丰富化,不再局限于课堂教学;教学政策的评定也更加多样化。

基于Delphi的B/S结构数据库应用系统实现方法

介绍了 B/ S体系结构、Web服务器应用程序类型和 Delphi中 Web开发组件 ,并结合实例介绍了利用 Delphi开发 Web应用程序的方法。

Delphi环境中利用MSCOMM实现PLC与上位机的串口通信

本文在Delphi环境下利用MSCOMM控件,开发设计了上位机的串行通信程序;根据S7200系列PLC的自由通讯口方式,设计了PLC的串口通信程序,从而实现了上位机与S7200系列PLC的通信,对水厂自动供水系统进行实时设备监控与信息管理。经过试验测试和实际运行,通信模块能够准确、快速的完成通信任务。

基于Delphi-AHP和GIS的区域水产养殖发展规划研究

科学、合理、可操作性强的区域农业规划可为地方农业发展提供了科学理论依据和战略指导。将Delphi-AHP和GIS技术综合应用于水产养殖规划,不仅可有效结合定量分析和定性判断对非定量信息进行量化分析,而且可为规划信息的准确定位、快速处理、数据分析提供强有力支撑。以天津市武清区淡水养殖为例,在综合利用Delphi-AHP、ArcGIS软件和IDRISI软件的基础上,构建了武清区淡水养殖适宜度评价指标体系,获得了养殖乡镇的适宜度评价结果,将可养殖区域划分为"不适宜"、"一般适宜"、"适宜"和"非常适宜"4种类型,并据此提出了武清区淡水养殖发展的区域发展布局、优势与劣势,以及发展规划建议。