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The purpose of this Delphi study was to explore and identify a panel of experts' opinions of essential elements for successful multi-family group therapy (MFGT) and to propose the identified elements as guidelines for future MFGT theoretical and program development. Multi-family group therapy continues to be implemented while there is little empirical research to support how it is effective and with what populations and presenting problems it is best employed. A panel of MFGT experts identified 35 essential elements for successful MFGT. Many of the identified elements coincided with elements identified in the relevant literature. However, elements specific to MFGT were distinguished. The essential elements are presented as guidelines for MFGT theoretical and program development. The implications of this study for theory, research, and practice are discussed. / Ph. D.

The purpose of this study was to identify and gain consensus on triadic listings of teacher competencies for evaluating industrial arts student teachers--based on the converged opinions of three groups of industrial arts educators. Starting with an initial set of teacher competencies three modified Delphi exercises were conducted simultaneously with each of three groups of industrial arts educators: (1) industrial arts classroom teachers, (2) industrial arts teacher educators, and (3) industrial arts supervisors. To encourage convergence of opinions, modified Delphi exercises allowed each group to rate competencies during three rounds of iteration. Twenty-seven classroom teachers, twenty-seven teacher educators, and twenty-four supervisors rated 72 competencies during each round of the study. The total group of educators was representative of the seven geographic regions of the American Industrial Arts Association (AIAA). The results of the study indicated that convergence of opinions occurred for each group of educators during the second and third rounds of the study. Based on the converged opinions of each group, triadic listings of teacher competencies were developed. The three listings of teacher competencies were rank ordered according to mean value of importance. The results also indicated a high rate of agreement between each group on the ranking of teacher competencies and that the rankings were reliable. Major conclusions of the study were as follows: 1. There was a significant amount of disagreement within the groups and between the groups on the importance of the following teacher competencies: (a) use club related activities to promote learning, (b) check attendance for each class daily, (c) write course objectives in behavioral terms, (d) demonstrate correct usage of the lecture technique, (e) participate in extracurricular activities of the school, (f) prepare bulletin boards and/or displays, and (g) record student achievement by use of progress charts. 2. Each group of educators rated more than 90 percent of the teacher competencies as being, “of extremely high importance," "of high importance," and "of medium importance" in evaluating industrial arts student teachers. 3. Each group of educators placed the highest emphasis on teacher competencies listed under the categories of Personal qualities, and teaching methods and techniques. The next highest emphasis was placed on competencies listed under the categories of Laboratory/classroom management and technical knowledge and Manipulative skill. Less emphasis was placed on competencies under the categories of Student evaluation and Organization of instructional materials. Major recommendations were: 1. Industrial arts educators should consider the teacher competencies identified in this study when designing evaluation instruments for industrial arts student teachers. Evaluation instruments designed around these competencies should place more emphasis on competencies related to personal qualities, teaching methods and techniques, laboratory/classroom management, and technical knowledge and manipulative skill. 2. Since the competencies identified in this study were stated as general objectives, it is recommended that the competencies be operationalized and stated in behavioral terms before being used as evaluative criteria. 3. Since increasing emphasis is being placed on competency-based teacher education, serious consideration should be given to developing such programs in industrial arts education. The competencies identified in this study can provide a basis for such development in industrial arts education. 4. The teacher competencies identified in this study should assist in the evaluation process. Therefore, teacher educators should not base student teacher evaluation on the development of competency alone. Evaluation should also be based upon the student teacher's potential and his/her own self assessment of success or failure in guiding learning experiences. / Ph. D.

Yes / To develop guidance for clinicians about essential elements that can support clinical decision-making in the diagnostic workup of young onset dementia. Methods/design: Three iterations of a modified e-Delphi consensus survey comprising 23 international expert clinicians specialising in diagnosis of young onset dementia. Outcome measures: A priori consensus was pre-defined as 80% of experts ranking statements in the upper threshold on a seven-point Likert scale that ranged from “not important at all” to “absolutely essential” to diagnosis. Results: 80% consensus was reached on 48 statements that were rated as “absolutely essential” or “very important” to a comprehensive assessment of dementia in a younger adult. In order to inform a subsequent audit of clinical records in which compliance with these statements was assessed, the statements were divided into a Minimum Standard, (consisting of the 15 statements voted by all experts as being “absolutely essential” or “very important”) and a Gold Standard where 48 statements were voted by 80% of the experts as being “absolutely essential” or “very important”. The experts’ response rate across the three rounds was 91.3%. Conclusion: A Minimum Standard and Gold Standard have been created for the diagnostic workup of young onset dementia. The standards provide a clinically useful tool for decision-making, particularly for generalists and those with less experience in the field. The standards will be used to inform a UK case note audit of recently diagnosed patients with young onset dementia. / This work was supported by the Alzheimer's Society grant number 278 AS-PG-15b-034.

Nearly 70% of process improvement projects are failing to provide the expected benefits (Grant 2002). The cost of process improvement projects can be quite substantial and the number of these projects occurring within organisations continues to increase. John Thorp (1998) describes an environment in which managers are struggling to demonstrate the connection between costs and expected business benefits. This eighteen month master's research project has identified a gap in both the academic literature and the business practices of most organisations. This thesis aims to make explicit the selection of processes to improve and to provide the link between process objectives and organisational goals (Davenport 1993; Hammer and Champy 1993). Published literature, coupled with the experience of the research team, has resulted in the development of a targeting methodology for defining and ranking critical processes, and then selecting which of those critical processes to improve first. Although the research team believes that the methodology is applicable to many industries, the research was undertaken in the application hosting centre (AHC) and application service provision (ASP) industry. A focus group and follow on Delphi study was used to ensure that the processes and functional area focused upon was of importance to the participants of the research. This research project was funded by the Australian Research Council's Linkage projects and undertaken with support by REALTECH. The participants included the top three information systems outsourcing companies in Australia and another in the top ten of this industry. The study commenced with identifying critical processes in the ASP environment. This involved both a focus group session and a Delphi study. The Delphi study was followed by four action learning cycles using case studies (action, observe, reflect and revise). These action learning cycles using case studies have revealed that the methodology (which includes the steps to implement the methodology) meets the needs of organisations to identify and select 'critical' processes for improvement. It provides business and researchers with a logical and explicit method to reduce the 'squeaky wheel' and 'latest fad' approaches to process improvement projects. These prior approaches improve processes not necessarily critical for achieving organisational goals consuming limited resources for little gain. The targeting method makes the alignment of process objectives with goals by explicitly linking processes to organisational goals possible. The limitations of this research project are that it does not intend to verify the achievement of business benefit, document the change to an organisation due to its use of the targeting methodology or determine the long term benefits to an organisation using the targeting methodology. These questions might be answered in a longer and larger study as this project is limited to an eighteen month time frame. As for generalisability, the study has focused on the AHC and ASP industries, and the participants, while operating within this industry, are quite different. For the different phases of this project the participants come from in-house providers, multinational outsourcing providers, commercialised government providers, specialist niche product providers, and enterprise system suppliers.

The purpose of the study was to explore and examine the roles and responsibilities of state councils related to planning, influencing, monitoring, and evaluating activities. These activities had been mandated by Congress for the improvement of services for the target population of the Developmentally Disabled Assistance and Bill of Rights Act of 1975, Public Law 94-103. Forecast responses were sought to twelve questions that addressed issues relating to roles and responsibilities identified for the councils (a) in the law, (b) the regulations issued pursuant to enactment of the law, and (c) the program guidelines that covered operation of the program. Based upon the findings from the analysis of data in the study and feedback from the panel, implications and conclusions were drawn and recommendations were made. Five of the most important conclusions made were 1. A continuing trend in accountability is demonstrated by the increased emphasis on performance of councils, progress of clients, and effectiveness of service programs; 2. Evaluation activities are being seen from a broad scope and comprehensive viewpoint rather than on a narrow, localized scale; 3. Influencing activities for state councils may be approached from a practical as well as political viewpoint; 4. The voice of the consumer will be stronger in council affairs and service activities; 5. The role of the councils as a planning and coordinating body is finding acceptance.

Introduction: Education of physiotherapists still fails to meet the health and social needs of society. One instrument to steer change in health sciences education is a re-designed curriculum. The overall intent of this study was to develop standards of competencies, teaching and learning strategies, and assessment, for an undergraduate community physiotherapy curriculum in South Africa. The grounding for this research was pragmatism. The Six-step model for curriculum development and the Clinical Prevention and Population Health Curriculum framework guided the research process and main analysis. Methods : A sequential mixed method design was used. First, a two-phase parallel situation analysis was conducted which included a qualitative document analysis of community physiotherapy curricula of the eight physiotherapy university departments in South Africa and a review of health policy documents. The experience of 12 purposively selected physiotherapists who had completed a compulsory community service year was qualitatively explored through interviews within an appreciative inquiry stance. In phase 2, input was gained from physiotherapists, from all ecological levels, on the community physiotherapy curriculum through a Delphi study. Three rounds were used. Round 1 explored the roles of physiotherapy in community health, round 2 quantified consensus in overarching competency domains, and round 3 gathered learning and teaching, and assessment, strategies to gain these competencies. Results : All eight universities had gaps in their community physiotherapy curriculum and were variedly aligned with South African health policies and health profile. Graduates need to be able to provide physiotherapy over the lifespan, to conditions mirroring the quadruple burden of disease, in settings varying from hospitals to homes of clients, with emphasis on health education and promotion within an interprofessional team. They must be prepared for suboptimal practice environments and to utilise the compulsory community service year as a gateway in professional development. Graduates need resilience to cope during the year and awareness about the importance of identifying a mentor in the frequent absence of a profession-specific supervisor. Community physiotherapy needs three core knowledge and skill sets; i.e. clinical physiotherapy, population health and community development. Consensus of 70%+ was gained on competency criteria in the domains of the following professional roles: clinician, professional, communicator and collaborator, scholar, health promoter, public health practitioner, community developer (change agent), and manager/leader. Service-learning was identified as a strategy to develop these roles supported by learning and assessment portfolios. Reflection in different formats – essays, presentations, case analysis, projects such as community wellness programmes, diaries - is a core activity to facilitate learning. A range of complementary strategies were suggested that included direct observation, role-play, and journal clubs. Core to assessment for professional competencies is for the students to be able to give evidence of their own learning (e.g. in a portfolio or oral examination) and to get frequent formative feedback. Conclusion : The physiotherapy profession is important for improving the health status of the South African population. Physiotherapy students should be educated to take on relevant professional roles through the application of appropriate educational standards. The study recommends that the curriculum standards be implemented and evaluated and that the application of complex theory in the further development and implementation of the curriculum be investigated. Lastly, future research in the generic professional domains, such as public health and community development, should be interprofessional in nature. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiology / Unrestricted

BACKGROUND: There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE: To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS: A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS: Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION: In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.

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Cataract surgery is the most commonly performed surgery within the UK with 400,000 surgeries performed each year. Currently no guidelines exist for clinicians regarding target refraction discussions, spectacle provision post-operatively and driving advice following surgery. The PhD aimed to start the process of developing pre- and post-operative management guidelines for patients developed by both optometrists and ophthalmologists which could then be disseminated to both professions in the hope of improving the overall outcome of surgery. The current literature highlighted target refraction discussions were lacking or non-existent which left some myopes dissatisfied after surgery due to an emmetropic target refraction leaving them unable to read without glasses as they did prior to surgery. Target refraction discussions were found to be linked with years of experience and this needs further exposure in continuing professional development. Post-operative driving advice was found to be inconsistent and vary between practitioners and between optometry and ophthalmology. Advice was found to vary from driving “immediately” following surgery up to 6 weeks post-operatively. Re-analysis of (de Juan et al. 2013) data during our systematic review and meta-analysis found refraction to be stable 1-2 weeks following surgery for 93% of patients. It was found a large change between pre- and post-surgery cylindrical power/axis may be an indicator that refractive stability has not occurred. Although this study had limitations it confirmed refraction is stable sooner than the current guidelines of 4-6 weeks. Finally, we used a Delphi process to develop refractive management guidelines with a total of fifteen recommendations finalised.