BACKGROUND: There are many infectious factors causing the outbreak of hemodialysis infection, which may easily lead to the delay of investigation and treatment. This study aimed to develop an investigation form for hemodialysis infection outbreak (HIO), and to identify sources of outbreak in early stage.
METHODS: After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 18 specialists.
RESULTS: A total of 87 studies of HIOs were eligible for inclusion. The mean authority coefficient (Cr) was 0.89. Kendall\'s W coefficient of the specialist consultation was 0.359 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 13 secondary items of the source of HIO, and tripartite distribution characteristics of infected patients, we constructed the investigation form.
CONCLUSIONS: The investigation form may be implemented during the initial phase of an outbreak investigation, it is a prerequisite for taking effective control measures, avoiding HIO occurrence. However, the efficacy of the investigation form needs to be further evaluated.

UNASSIGNED: Employee assistance programs require resources and manpower of various natures across different types of public sector organization.
UNASSIGNED: This study began by outlining elements for comparing employee assistance programs\' evaluation criteria in four types of public sector organization on the basis of 22 service measures for such programs implemented by the Ministry of Labor in relation to three major aspects: work, life, and health. Elements of the evaluation criteria for public sector employee assistance programs were determined by surveying a panel of experts using the modified Delphi method. Last, the weight associated with the elements of evaluation criteria were calculated using the fuzzy analytic hierarchy process, and the criteria of four types of public sector organization were explored.
UNASSIGNED: Data analysis indicated that the weight and priorities associated with elements of evaluation criteria for EAPs implemented by four types of public sector organization were not fully identical.
UNASSIGNED: The results of this study suggest that, in terms of EAPs, the Directorate-General of Personnel Administration of the Executive Yuan should be pursuant to appropriate employee assistance programs provided by various public sector organizations according to the needs of their employees as well as the diverse objective conditions in which these organizations operate.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is an innovative, minimally invasive bariatric procedure with an excellent safety and efficacy profile in adults with obesity. The purpose of the procedure is to shorten and tubularize the stomach along its greater curvature. Nevertheless, there are some heterogeneities in the approach to ESG, which will be important to address as the procedure sees increasingly widespread clinical adoption. Here, an expert consensus on standardized ESG techniques is presented.
METHODS: The modified Delphi method was used to establish the key procedural steps of an ESG. A panel of 8 experts was selected, of which 6 participated. The panel was selected based on their experience with performing the procedure and consisted of 1 bariatric surgeon and 5 interventional gastroenterologists. A neutral facilitator was designated and produced a skeletonized initial version of the key steps that was sent to each expert. Each survey began with the experts rating the given steps on a Likert scale of 1 to 5, with 1 being the most inaccurate and 5 being the most accurate. Furthermore, the final product was rated. The survey continued with open-ended questions designed to revise and polish the key steps. Areas of discrepancy were addressed using binary questions and a majority vote. The respondents were given 10 days to complete each survey. At the end of each round, the survey was redistributed with updated key steps and questions. This process was continued for a predesignated 3 rounds.
RESULTS: Of the 8 experts who were queried, 6/8, 5/8, and 5/8 replied to each round. The given ratings for the accuracy of the steps in each round were 4.2, 4.6, and 4.4. The final rating was 4.8. Although expert opinion varied around smaller portions of the procedure, such as the placement of an overtube and the shape of each suture line, there was consensus on the need for full-thickness bites and appropriate swirling of the tissue with the helix device. Whether or not to include the fundus in the gastroplasty was an additional area of discrepancy. Of note, 4 of 5 experts agreed that the fundus should remain intact. The final protocol consisted of 21 steps curated from the summarized responses of the experts.
CONCLUSIONS: Using the modified Delphi method, 21 key steps have been described for a safe and effective ESG. This rubric will be standardized across institutions and practitioners. Furthermore, these findings allow for the generation of educational assessment tools to facilitate training and increase the adoption of ESG by endoscopists.

BACKGROUND: China\'s population has begun to age rapidly in the past several years and this trend is predicted to continue. In the face of this growing older population, the existing number of aged care personnel, especially medical care professionals, can hardly meet the demand for aged care services.
OBJECTIVE: To develop geriatric nursing micro-credentials (MCs) for undergraduate nursing students based on standardized training objectives and to specify the learning goals and course modules that correspond to each specific MC.
METHODS: Modified Delphi study.
METHODS: An initial set of geriatric nursing MCs were developed based on the training objectives. Expert group discussion (n=13) reviewed the clarity and intelligibility of the statements\' wording and supplemented the framework. A three-round Delphi survey (n=15) was then employed to obtain a consensus on the learning goals and course modules via an online questionnaire. Descriptive statistics were used to analyze the data.
RESULTS: The final geriatric nursing MCs consisted of six courses, namely fundamentals of geriatric nursing (8 modules), geriatric sociology (6 modules), geriatric clinical nursing (3 modules), geriatric psychological nursing (8 modules), geriatric rehabilitation nursing (8 modules) and geriatric hospice care (10 modules).
CONCLUSIONS: Nursing faculty can use the geriatric nursing MCs developed in this study to train current undergraduate nursing students to become backups for current, fully credentialed geriatric caregivers.

Objective: The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. Material and Methods: A consensus development study was conducted in the United States with participants, including 31 health care professionals, 12 public policy members or public health payers, and 18 public members, representing 24 states. A modified Delphi method and modified nominal group technique were utilized. Results: Twenty-one potential core outcomes were developed by combining the outcomes reported in three systematic reviews that evaluated the frequency of prenatal care visits or modality of prenatal visit type (e.g., in person, telemedicine, or hybrids of both). Eighteen consensus outcomes were identified from the Delphi process, following which 10 maternal and 4 neonatal outcomes were agreed at the consensus development meeting. Maternal core outcomes include maternal quality of life; maternal mental health outcomes; the experience of maternity care; lost time; attendance of recommended visits; unplanned care utilization; completion of the American College of Obstetricians and Gynecologists-recommended services; diagnosis of obstetric complications-proportion and timing; disparities in care outcomes; and severe maternal morbidity or mortality. Neonatal core outcomes include gestational age at birth, birth weight, stillbirth or perinatal death, and neonatal intensive care unit admissions. Conclusions: The core outcome set for the frequency and modality of prenatal visits should be utilized in forthcoming randomized controlled trials and systematic reviews. Such application will warrant that in future research, consistent reporting will enrich care and improve outcomes. Clinical Trial Registration number: 2021.

BACKGROUND: To develop an investigation form for postoperative infection outbreak (PIO), and to identify sources of the outbreak in the early stage.
METHODS: After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 20 specialists.
RESULTS: A total of 203 studies of PIO were eligible for inclusion. The mean authority coefficient (Cr) was 0.87. Kendall\'s W coefficient of the specialist consultation was 0.704 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 19 secondary items of the source of PIO, and tripartite distribution characteristics of infected patients, we constructed the PIO investigation form.
CONCLUSIONS: The PIO investigation form can be used in the investigation of the early-stage cluster of cases, it\'s a prerequisite for taking effective control measures, avoiding PIO occurrence. However, the effect of the investigation form needs to be further evaluated.

This study aims to establish precise quality indicators for evaluating and enhancing ultrasound performance, employing a methodology based on a comprehensive review of the literature, expert insights, and practical application experiences. We conducted a thorough review of both the domestic and international literature on ultrasound quality control to identify potential indicators. A dedicated team was formed to oversee the complete indicator development process. Utilizing a three-round modified Delphi method, we sought expert opinions through personalized email correspondence. Subsequently, data from diverse hospital indicators were collected to validate and assess feasibility. A novel set of seven indicators was compiled initially, followed by the convening of a 36-member nationally representative expert panel. After three rounds of meticulous revisions, consensus was reached on 13 indicators across three domains. These finalized indicators underwent application in various hospital settings, demonstrating their initial validity and feasibility. The development of thirteen ultrasound quality indicators represents a significant milestone in evaluating ultrasound performance. These indicators empower hospitals to monitor changes in quality effectively, fostering efficient quality management practices.

Taking the recommendations development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Clinical Practice Guideline for Female Urinary Incontinence as an example, this study analyzed the consensus expert composition, specific consensus process, and results in the development of the guideline\'s recommendations. It systematically examined the advantages of using the modified Delphi method in the formation of recommendations for acupuncture and moxibustion clinical practice guideline, with the aim of providing reference for the development of acupuncture and moxibustion guidelines in the same field.
以世界针灸学会联合会（WFAS）标准《女性尿失禁临床实践指南》的推荐意见形成为例，围绕该指南推荐意见研制的共识专家构成、具体共识过程及结果，系统分析改良德尔菲法在针灸临床实践指南推荐意见形成过程中的优势，以期为后续针灸指南的研制提供参考。.

UNASSIGNED: Understanding the occurrence and severity of child injuries is the cornerstone of preventing child injuries. Currently, there is no standardized child injury surveillance dataset in China.
UNASSIGNED: Multistage consultation by a panel of Chinese experts in child injury to determine items to include in the core dataset (CDS) was performed. The experts participated in two rounds of the modified Delphi method comprising a consultation questionnaire investigation (Round 1) and a face-to-face panel discussion (Round 2). Final consensus was established based on the opinions of the experts regarding the modified CDS information collection items. Enthusiasm and authority exhibited by the experts were evaluated by the response rate and using the expert authority coefficient, respectively.
UNASSIGNED: The expert panel included 16 experts in Round 1 and 15 experts in Round 2. The experts during both rounds had a high degree of authority, with an average authority coefficient of 0.86. The enthusiasm of the experts was 94.12%, and the proportion of suggestions reached 81.25% in Round 1 of the modified Delphi method. The draft CDS evaluated in Round 1 included 24 items, and expert panelists could submit recommendations to add items. Based on findings in Round 1, four additional items, including nationality, residence, type of family residence, and primary caregiver were added to the draft of the CDS for Round 2. After Round 2, consensus was reached on 32 items arranged into four domains-general demographic information, injury characteristics, clinical diagnosis and treatment, and injury outcome-to include in the final CDS.
UNASSIGNED: The development of a child injury surveillance CDS could contribute to standardized data collection, collation, and analysis. The CDS developed here could be used to identify actionable characteristics of child injury to assist health policymakers in designing evidence-based injury prevention interventions.

BACKGROUND: Integrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap.
OBJECTIVE: To establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools.
METHODS: We used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen\'s EPA Quality rubric. Data analysis was performed via modes and quartile deviations.
RESULTS: The following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen\'s EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool.
CONCLUSIONS: The development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.