Expert judgement in resource forecasting – the use of the Delphi method to achieve group consensus

Expert judgement is used in a novel resource forecasting method to build models that forecast resource requirements. In this study, a collaborative decision-making process is deployed to ensure user acceptance in an empirical setting with limited legacy data for model validation. The Delphi method allowed facilitating this process and to achieve group consensus during estimate collection. With action research, Delphi parameters are adjusted in three concurrent case studies involving different expert groups. This study shows that Delphi is a useful and valid approach to provide acceptable degree validation for quantitative empirical expert models if only limited legacy data is available for model validation

An Educational Knowledge-based System For Civil Engineering Students in Cement Concrete Construction Problems

AbstractCivil engineering students study only few courses in highway engineering that involves only little information about pavement construction. After their graduation, they face many problems in construction site that they cannot control as they do not have sufficient information. Therefore, developing of an educational system in this domain that contains a knowledge base including descriptions, causes and solutions to these problems is an effective way to help civil engineering students learn about the problems that they may encounter. This paper describes the development and evaluation stages of unprecedented system including knowledge acquisition, knowledge representation, system building, and system testing

Analysis of Delphi technique for decision making in critical ill patients: a systematic review

Introduction: The Delphi technique is a method used to reach consensus among experts on a given subject. Objectives: To develop a systematic review about the contribution and use of the Delphi method exclusively by physicians, for decision-making in critically ill patients. Methods: The study was conducted in the databases: PubMed, SciElo, Biblioteca Virtual em Saúde, Scopus, CAPES Periodicals and ClinicalTrials.gov, using the terms: “Delphi technique”, “Decision making”, “Critical care” and “Physicians”. Clinical trials or observational studies were selected to answer the guiding question: “What is the contribution of the Delphi technique to decision-making by physicians in critically ill patients?” To evaluate the level of evidence and degree of recommendation for the included studies, the scale from the Center for Evidence-Based Medicine in Oxford was used. Results: Eighteen articles were included to compose this study. The contributions of the Delphi method were considered important for the decision-making in fifteen of the studies analyzed, to: define management strategies, treatment and recommendations; manage and diagnose patients; set consensus for examinations; and identify controversial ideas and their underlying motives. From the limitations of the method, most frequent was the selection of specialists from different levels of knowledge. Conclusion: This study shows the applicability of the Delphi technique for critical patient management, drug treatment, recommendations for specific symptoms, guidelines for managing and diagnosing patients, consensus for tests and exams, and identification of topics of controversial ideas and their underlying motives in situations where there is no consensus in the medical literature.Introdução: A técnica Delphi é um método utilizado para alcançar consenso entre especialistas sobre determinado assunto. Objetivos: realizar revisão sistemática sobre a contribuição e utilização do método Delphi exclusivamente por médicos, para tomada de decisões em pacientes críticos. Métodos: A pesquisa foi realizada nas bases de dados: PubMed, SciElo, Biblioteca Virtual em Saúde, Scopus, Periódicos CAPES e ClinicalTrials.gov, utilizando os descritores: “Delphi technique”, “Decision making”, “Critical care” e “Physicians”. Selecionou-se ensaios clínicos ou estudos observacionais para responder à pergunta norteadora: “Qual a contribuição da técnica Delphi na tomada de decisão pelos médicos em pacientes críticos?” Para avaliação do nível de evidência e grau de recomendação dos estudos incluídos, foi utilizado a escala do Centro de Medicina Baseada em Evidências de Oxford. Resultados: Foram incluídos dezoito referências para compor este estudo. As contribuições do método Delphi foram consideradas importantes para a tomada de decisões em quinze estudos analisados, para: definir estratégias de manejo, tratamento e recomendações; gerenciar e diagnosticar pacientes; definir consenso para exames; identificar ideias controversas e seus motivos subjacentes. Das limitações do método, a mais recorrente foi a seleção de especialistas de diferentes níveis de conhecimento. Conclusão: Este estudo mostra a aplicabilidade da técnica Delphi para manejo de pacientes críticos, tratamento medicamentoso, recomendações para sintomas específicos, diretrizes para gerenciar e diagnosticar pacientes, consenso para testes e exames e identificação de tópicos de ideias controversas e seus motivos subjacentes em situações onde não há consenso na literatura médica

A diagnostic expert system to overcome construction problems in rigid highway pavement

Constructing highway pavements faces complex problems, which are affected by multiple factors, where solution is nearly impossible without expert assistance. Diagnosing such construction problems and suggesting most suitable cost efficient solutions requires significant engineering expertise, which might not be available in all construction sites due to inadequate resource and remote locations. Developing an expert system in this domain is a very effective way to help novice engineers to overcome these problems and to learn about them. Moreover, the system can be used as an archive to document engineering knowledge and to share expertise among the experts in this domain. This article describes the development and evaluation stages of such a system, including knowledge acquisition, knowledge representation, system building, and system verification and validation. The initial knowledge is acquired from literature reviews. More expert knowledge is elicited through interviews and questionnaires. This knowledge is documented, analyzed, represented, and converted to computer software using the Visual Basic programming language and the system is called ES-CCPRHP. The system has been verified and validated in three ways: by extensive testing, comparison between system performance and expert reasoning, and case study. It can therefore be employed with confidence by end users. First published online: 24 Oct 201

High Dependency Care provision in Obstetric Units remote from tertiary referral centres and factors influencing care escalation: A mixed methods study

The three video vignettes used during the focus group study, may be obtained by contacting Alison James ([email protected])Thesis embargo extended until 16.10.2018. SE DCBackground Due to technological and medical advances, increasing numbers of pregnant and post natal women require higher levels of care, including maternity high dependency care (MHDC). Up to 5% of women in the UK will receive MHDC, although there are varying opinions as to the defining features and definition of this care. Furthermore, limited evidence suggests that the size and type of obstetric unit (OU) influences the way MHDC is provided. There is robust evidence indicating that healthcare professionals must be able to recognise when higher levels of care are required and escalate care appropriately. However, there is limited evidence examining the factors that influence a midwife to decide whether MHDC is provided or a woman’s care is escalated away from the OU to a specialist unit. Research Aims 1. To obtain a professional consensus regarding the defining features of and definition for MHDC in OUs remote from tertiary referral units. 2. To examine the factors that influence a midwife to provide MHDC or request the escalation of care (EoC) away from the OU. Methods An exploratory sequential mixed methods design was used: Delphi survey: A three-round modified Delphi survey of 193 obstetricians, anaesthetists, and midwives across seven OUs (annual birth rates 1500-4500) remote from a tertiary referral centre in Southern England. Round 1 (qualitative) involved completion of a self-report questionnaire. Rounds 2/3 (quantitative); respondents rated their level of agreement or disagreement against five point Likert items for a series of statements. First round data were analysed using qualitative description. The level of consensus for the combined percentage of strongly agree / agree statements was set at 80% for the second and third rounds Focus Groups: Focus groups with midwives across three OUs in Southern England (annual birth rates 1700, 4000 and 5000). Three scenarios in the form of video vignettes were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission with chest pain receiving facial oxygen and continuous ECG monitoring. Two focus groups were conducted in each of the OUs with band 6 / 7 midwives. Data were analysed using a qualitative framework approach. Findings Delphi survey: Response rates for the first, second and third rounds were 44% (n=85), 87% (n=74/85) and 90.5% (n= 67/74) respectively. Four themes were identified (conditions, vigilance, interventions, and service delivery). The respondents achieved consensus regarding the defining features of MHDC with the exceptions of post-operative care and post natal epidural anaesthesia. A definition for MHDC was agreed, although it reflected local variations in service delivery. MHDC was equated with level 2 care (ICS, 2009) although respondents from the three smallest OUs agreed it also comprised level 1 care. The smaller OUs were less likely to provide MHDC and had a more liberal policy of transferring women to intensive care. Midwives in the smaller OUs were more likely to escalate care to ICU than doctors. Focus Groups: Factors influencing midwives’ EoC decisions included local service delivery, patient specific / professional factors, and guidelines to a lesser extent. ‘Fixed’ factors the midwives had limited or no opportunity to change included the proximity of the labour ward to the ICU and the availability of specialist equipment. Midwives in the smallest OU did not have access to the facilities / equipment for MHDC provision and could not provide it. Midwives in the larger OUs provided MHDC but identified varying levels of competence and used ‘workarounds’ to facilitate care. A woman’s clinical complexity and potential for physiological deterioration were influential as to whether MHDC was assessed as appropriate. Midwifery staffing levels, skill mix and workload (variable factors) could also be influential. Differences of opinion were noted between midwives working in the same OUs and varying reliance was placed on clinical guidelines. Conclusion Whilst a consensus on the defining features of, and definition for MHDC has been obtained, the research corroborates previous evidence that local variations exist in MHDC provision. Given midwives from the larger OUs had variable opinions as to whether MHDC could be provided, there may be inequitable MHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable MHDC care including MHDC education and training for midwives and precise EoC guidelines (so workarounds are minimised). The latter must take into consideration local service delivery and the ‘variable’ factors that influence midwives’ EoC decisions.Plymouth Universit

Analysis and Modeling of Quality Improvement on Clinical Fitness Landscapes

Widespread unexplained variations in clinical practices and patient outcomes, together with rapidly growing availability of data, suggest major opportunities for improving the quality of medical care. One way that healthcare practitioners try to do that is by participating in organized healthcare quality improvement collaboratives (QICs). In QICs, teams of practitioners from different hospitals exchange information on clinical practices, with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts, due to non-linear interactions among various demographics, treatments, and practices. I.e., the clinical landscape is a complex socio-technical system that is difficult to search. In this dissertation we develop methods for analysis and modeling of complex systems, and apply them to the problem of healthcare improvement. Searching clinical landscapes is a multi-objective dynamic problem, as hospitals simultaneously optimize for multiple patient outcomes. We first discuss a general method we developed for finding which changes in features may be associated with various changes in outcomes at different points in time with different delays in affect. This method correctly inferred interactions on synthetic data, however the complexity and incompleteness of the real hospital dataset available to us limited the usefulness of this approach. We then discuss an agent-based model (ABM) of QICs to show that teams comprising individuals from similar institutions outperform those from more diverse institutions, under nearly all conditions, and that this advantage increases with the complexity of the landscape and the level of noise in assessing performance. We present data from a network of real hospitals that provides encouraging evidence of a high degree of similarity in clinical practices among hospitals working together in QIC teams. Based on model outcomes, we propose a secure virtual collaboration system that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs, without any institutions having to sacrifice the privacy of their own data. To model the search for quality improvement in clinical fitness landscapes, we need benchmark landscapes with tunable feature interactions. NK landscapes have been the classic benchmarks for modeling landscapes with epistatic interactions, but the ruggedness is only tunable in discrete jumps. Walsh polynomials are more finely tunable than NK landscapes, but are only defined on binary alphabets and, in general, have unknown global maximum and minimum. We define a different subset of interaction models that we dub as NM landscapes. NM landscapes are shown to have smoothly tunable ruggedness and difficulty and known location and value of global maxima. With additional constraints, we can also determine the location and value of the global minima. The proposed NM landscapes can be used with alphabets of any arity, from binary to real-valued, without changing the complexity of the landscape. NM landscapes are thus useful models for simulating clinical landscapes with binary or real decision variables and varying number of interactions. NM landscapes permit proper normalization of fitnesses so that search results can be fairly averaged over different random landscapes with the same parameters, and fairly compared between landscapes with different parameters. In future work we plan to use NM landscapes as benchmarks for testing various algorithms that can discover epistatic interactions in real world datasets

The exposure to verbal abuse of student nurses gaining placement experience

Clinical placement experience has a key role to play in the socialisation and preparation of future members of the nursing profession. Aggression experienced by healthcare workers is currently receiving considerable attention and student nurses have been identified as a group vulnerable to experiencing workplace abuse (Little 1999). The primary aim of the study is to gain a greater understanding of the nature, severity, frequency and sources of verbal abuse experienced by student nurses in health care settings in the south east of England, using as a definition, “the use of inappropriate words… causing distress” (Department of Health 2003). A convenience sample of 156 third year student nurses of all four branches of one preregistration nursing programme in the south east of England was studied with questionnaires distributed retrospectively; 11 4 student nurses returned the questionnaires equating to a response rate of 73%. Results 46% of respondents reported experiencing verbal abuse, 39% had witnessed other students experiencing verbal abuse and 61% reported that they were aware of other students experiencing verbal abuse. Students reported experiencing threats to kill, racial abuse, sexually orientated verbal abuse and bullying while gaining placement experience. Student nurses are a high risk group for experiencing verbal abuse whilst gaining placement experience.In the literature, mental health and learningdisability settings are viewed as high risk areasfor experiencing aggression (Beech and Leather 2003); this study suggests that student nurses experience verbal abuse in a variety of settings and verbal abuse may be more prevalent on general medical and surgical wards than previously expected

Knowledge elicitation for validation of a neonatal ventilation expert system utilising modified Delphi and focus group techniques

Objective, methods &amp; materials, results It is well known that ventilation strategies for newborn in may vary significantly between individual doctors The aim of this study was to elicit knowledge of ventilation management to provide a baseline for evaluating the performance of an expert system for neonatal ventilation (FLORENCE) The modified Delphi method and focus group techniques were used to arrive at consensus management strategies on 40 hypothetical ventilation scenarios The underlying cognitive processes of the experts were also explored further to assist in the development of the expert system The strategies armed at were used to provide a performance level which FLORENCE was tested against The solutions were Judged to be equivalent between FLORENCE and neonatologists in 29 of the 40 cases In the remaining 11 scenarios, FLORENCE also provided adequate solutions Conclusions The focus group technique was more effective than modified Delphi method in achieving consensus on ventilation management This consensus on ventilation was used as the baseline to evaluate the performance of an expert system. (C) 2009 Elsevier Ltd All rights reserved</p