Fully Completed Spherical Fuzzy Approach-Based Z Numbers(PHIModel)for Enhanced Group Expert Consensus

This study aims to establish an expert consensus and enhance the efficacy of decision-making processes by integrating Spherical Fuzzy Sets(SFSs)and Z-Numbers(SFZs).A novel group expert consensus technique,the PHImodel,is developed to address the inherent limitations of both SFSs and the traditional Delphi technique,particularly in uncertain,complex scenarios.In such contexts,the accuracy of expert knowledge and the confidence in their judgments are pivotal considerations.This study provides the fundamental operational principles and aggregation operators associated with SFSs and Z-numbers,encompassing weighted geometric and arithmetic operators alongside fully developed operators tailored for SFZs numbers.Subsequently,a case study and comparative analysis are conducted to illustrate the practicality and effectiveness of the proposed operators and methodologies.Integrating the PHI model with SFZs numbers represents a significant advancement in decision-making frameworks reliant on expert input.Further,this combination serves as a comprehensive tool for decision-makers,enabling them to achieve heightened levels of consensus while concurrently assessing the reliability of expert contributions.The case study results demonstrate the PHI model’s utility in resolving complex decision-making scenarios,showcasing its ability to improve consensus-building processes and enhance decision outcomes.Additionally,the comparative analysis highlights the superiority of the integrated approach over traditional methodologies,underscoring its potential to revolutionize decision-making practices in uncertain environments.

Validation of adherence prediction system for lifestyle interventions in nonalcoholic fatty liver disease

This editorial delves into the research article by Zeng et al published in the latest issue of World Journal of Gastroenterology.The manuscript contributes significantly to addressing the global health issue of nonalcoholic fatty liver disease(NAFLD)by introducing and validating the Exercise and Diet Adherence Scale(EDAS).The article effectively conveys the importance of the study,highlighting the prevalence of NAFLD,the lack of approved drugs for its treatment,and the crucial role of lifestyle correction.The use of the Delphi method for scale development and the subsequent evaluation of its reliability add scientific rigor to the methodology.The results demonstrate that the scale is correlated with key lifestyle indicators,which makes it a promising tool for assessing patient adherence to interventions.The identification of specific score thresholds for predicting adherence to daily calorie intake and exercise adds practical value to the scale.The differentiation among scores indicative of good,average,and poor adherence enhances its clinical applicability.In conclusion,the manuscript introduces EDAS,a valuable instrument that can contribute substantially to the field of NAFLD research and clinical practice.

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.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Identifying nursing research priorities in Vietnam: a modified Delphi study

Objective: There is no single study that has examined nursing research priorities in Vietnam. This study aimed to gain consensus from experts on the nursing research priorities in Vietnam.Methods: A three-round modified Delphi study was used in this study. A focus group discussion among experts was conducted in round I to identify the nursing research priorities(n=23). Data in round I were analyzed using content analysis. In round Ⅱ, participants were invited to rate the importance of each nursing priority topic in a 5-point Likert scale questionnaire, which had a 74%(n=17) response rate. In round Ⅲ, the questionnaire was returned to the experts(n=17) until consensus was reached. Data from round Ⅱ and round Ⅲ were analyzed to produce mean score and final rank.Results: The top 12 research priority lists were identified, which included subthemes and areas of possible investigations. All priorities were classified into three groups in the rank order, namely:(i) nursing management and leadership, which included(1) nursing care quality,(2) management and leadership of nurse managers,(3) nursing image,(4) professional nurse competency, and(5) human resource management;(ii) nursing education, which included(1) knowledge-specific domain,(2) the linkage between education and practice, and(3) nurse teacher workforce;and(iii) nursing service, which included(1) adult nursing concern,(2) patient safety,(3) public health nursing concern, and(4) quality of life of patients and nurses.Conclusions: Consensus among experts was achiever, and the findings are considered as the basis of resources to the most essential research needs in Vietnam.

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.

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.

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.

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.

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.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

手术科室高质量发展评价指标体系构建及应用

目的构建一套科学适宜可靠的手术科室高质量发展评价指标体系,应用该体系评价分析手术科室高质量发展的成效与不足。方法运用文献研究和专家讨论明确手术科室高质量发展评价指标库。运用德尔菲法和层次分析法确定指标权重,形成指标体系。结果构建了一套手术科室高质量发展评价指标体系,其中一级指标3个、二级指标19个。运用该评价指标体系,以某医院某科室2019—2021年运营数据为例,进行应用研究,该科室2021年高质量发展得分最高(92.999分),提质维度的满分比最高(2021年为95.52%)。结论探索实践应用,构建科学指标体系,精准评价手术科室高质量发展;保持提质领先态势,改善降本增效薄弱环节,提升医疗服务效能;推进智慧管理,搭建高质量发展数据平台,形成监测评价反馈闭环。

应用德尔菲法探索消毒人员队伍建设和培养思路

目的探索构建符合上海市传染病防控需要的消毒人员队伍建设和培养的思路。方法通过德尔菲法结合需求调研、专家咨询,对职业化消毒人员队伍建设和培养思路进行调研。结果疾病预防控制机构、卫生监督、专业学会协会等20名专家参加了咨询,问卷回收率达100.00%。消毒人员重要性评分依次为事中职责、保障措施、事前准入和事后考核。三类消毒人员需求各不相同,消毒核心人员消毒知识技能以及承担工作的能力要求最高,分别为(4.73±0.46)分和(4.73±0.47)分。消毒服务人员任职资格最重要,为(4.90±0.45)分。消毒从业人员承担工作的能力要求最高,为(4.83±0.39)分。培训和知识技能在3类人员中都有着重要地位,且最重要的技能均为个人防护,其次为实际操作能力。结论本次调查专家积极程度和协调程度高,发现目前消毒人员专业队伍建设面临较大挑战。建议加强消毒员的职业认定和保障,同时针对性地分类培养,满足各类消毒人员的职业需求。

面向在线医疗平台的医生能力综合评价体系构建

目的基于服务质量模型、知识贡献理论、结构-过程-结果三维质量评价模型构建面向在线医疗平台的医生能力综合评价指标体系,以期助力平台打造具有公信力的医生榜单,促进患者精准评估医生能力和服务水平。方法采用文献分析法建立初始评价指标体系框架,邀请专家对指标进行筛选和评估,最后通过层次分析法对各级评价指标的权重赋值。结果建立的医生能力综合评价体系包含3个一级指标、7个二级指标、29个三级指标,其中一级指标(及其权重)分别为医生基础条件(0.420)、医生知识贡献(0.219)、医生服务表现(0.361)。结论研究构建了一套科学、可靠的面向在线医疗平台的医生能力综合评价体系,可为平台建立系统化的医生评价标准提供信息基础和参考依据。

基于德尔菲法的新发重大传染病预警指标筛选

目的筛选科学、完整、可操作性强的新发重大传染病预警指标。方法运用文献阅读法初步构建预警指标基本框架,采用德尔菲法进行两轮专家咨询对指标进行筛选,结合层次分析法和专家咨询权数法确定指标评价维度权重及指标权重系数。结果两轮专家咨询的积极系数分别为91.67%和100.00%,权威系数均数分别为(0.82±0.18)和(0.88±0.03),协调系数分别为0.379和0.412(均P<0.001)。最终筛选出包括3个一级指标、10个二级指标、45个三级指标的新发重大传染病预警指标,其中“医疗机构发现不明原因疾病的聚集性病例数(0.0244)”“参照以往的监测系统以及历年的传染病流行曲线预警等资料的预警指标(0.0241)”“诊断或疑似的各类传染病病例报告数和死亡数(0.0239)”“罕见传染病病例报告(0.0239)”“不明原因的严重症候群报告(0.0238)”的权重系数较高。结论应用德尔菲法和层次分析法筛选出的新发重大传染病预警指标具有一定的科学性和合理性,符合实际情况,可为发展和完善新发重大传染病预警监测系统提供思路和参考。

Construction of clinical research nurse training program based on position competence

BACKGROUND As one of the most important members in clinical trials,the number of clinical research nurses(CRN)can't keep up with the growth of experimental projects,so it is urgent to build clinical research training and strengthen the background knowledge of nurses.AIM To construct CRN training program based on position competence,accelerate the construction of CRN talent pool,and provide scientific guidance significance for CRN training.METHODS Based on the position competence model,combined with literature research and qualitative interview results,the first draft was prepared of the CRN training program.Two rounds of correspondence with 16 experts were conducted using the Delphi method to determine the training program.RESULTS The effective recovery rate of the expert correspondence questionnaire was 100%and the authority coefficients of the 2 rounds of experts were 0.826 and 0.895.Finally,4 first-level indicators and determine 15 s-level indicators of training objectives.The training program included 4 first-level indicators,training requirements,content,methods,assessment and evaluation,15 s-level indicators,and 74 third-level indicators.CONCLUSION The CRN training program based on position competence is scientific and extendable,providing a basis for participation in CRN training.

药品价格指数的构建与应用

目的基于药品零售价格大数据构建药品价格指数,描述其波动特征,发挥其药品价格宏观监管作用,促进药品价格保持合理水平。方法运用链式拉氏指数构建原理建立药品价格指数模型,运用时间序列模型描述指数波动特征,识别并分析药品价格波动异常状况。结果2015年1月—2020年12月,药品价格总指数小幅上涨,累计涨幅为14.43%,年均涨幅约2.40%,市场化改革成效较为显著。通过基于局部加权回归的季节趋势分解(seasonal-trend decomposition using loess,STL)方法对获得的药品价格总指数时间序列进行分析,指数呈长期平缓上升趋势,不规则波动值为-1.41~2.03,说明药品价格受外因影响较小,周期性特征仍有待进一步研究。2015年1月—2020年12月,根据药品价格指数共监测到价格异常风险32次。结论药品价格指数较全面地反映药品价格走势,对于药品价格异常波动具有一定的预警作用,能够为我国药品价格监管提供有效工具。

Early warning systems for enteral feeding intolerance in patients with stroke

Objective:The objective of this study was to construct an early warning system(EWS)to facilitate risk assessment,early identification,and appropriate treatment of enteral nutrition feeding intolerance(FI)in patients with stroke,so as to provide a reference for risk classification standards and interventions toward a complete EWSs for nursing care of stroke.Materials and Methods:Based on evidence and clinical nursing practice,a structured expert consultation method was adopted on nine experts over two rounds of consultation.Statistical analysis was used to determine the early warning index for FI in patients with stroke.Results:The expert authority coefficient was 0.89;the coefficients of variation for the two rounds of consultation were 0.088-0.312 and 0.096-0.214,respectively.There were significant differences in the Kendall’s concordance coefficient(P<0.05).Finally,22 items in five dimensions of patient age,disease,treatment,biochemical,and enteral nutrition-related factors were identified.Conclusion:The early warning index for FI in patients with a history of stroke is valid and practical.It provides a reference for the early clinical identification of FI risk.

Establishment of the benchmarking tool for evaluating the operation of biorepositories for pathogenic resource using a modified Delphi method

In recent years,as the infectious diseases caused by pathogens such as novel coronavirus and mpox(formerly called monkeypox)spread globally,the significance of identification,preservation,and sharing of pathogenic resources become prominent.Along with the rapid development of biorepositories,it is imperative to evaluate their operation in a scientific manner.By using the literature review and modified Delphi method,this study develops a benchmarking tool for the comprehensive evaluation of the operation of biorepositories for pathogenic resources.The effective response rates of both rounds of expert surveys were 100%.The authority coefficients(Cr)were 0.82 and 0.85,respectively,manifesting the reliability of consultation results.In the second‐round survey,the Kendall’s coefficient of concordance(Kendall’s W)of all indicators ranged from 0.09 to 0.31(P<0.001),the comprehensive score ranged from 4.02 to 4.94,the standard deviation ranged from 0.21 to 0.77,and the coefficient of variation(CV)ranged from 0.04 to 0.22,indicating that the expert opinions reached consensus.The final benchmarking tool was composed of 4 primary indicators,12 secondary indicators,and 65 tertiary indicators.The weights of the four primary indicators allocated through the rank‐sum ratio method,namely organizational structure,management requirements,biobanking capacity,and sharing capacity,were 30.50%,30.08%,25.45%,and 13.97%,respectively.The benchmarking tool established in this study provides references for the comprehensive evaluation of the operation and puts forward advice for the sustainable development of biorepositories for pathogenic resources.