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Objective: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). Method: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. Results: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. Conclusions: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals’ perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.

Objetivo: en su carácter de profesión de atención de la salud enfocadaen cuidar a las personas, la Enfermería requiere habilidades decomunicación sólidas. Sobre la base de un consenso internacional deexpertos, se presenta una propuesta sobre resultados de aprendizajeen la comunicación clínica para planes de estudio de las carreras degrado de Enfermería en países de habla hispana. Método: un comitéorientador, compuesto por 5 enfermeros y expertos en comunicación enciencias de atención de la salud, elaboró la primera lista de habilidadesde comunicación específicas para la carrera de Enfermería. Un comité de7 asesores científicos internacionales revisó y mejoró dicha propuesta.Se seleccionó a 70 expertos de 14 países a través del procedimiento demuestreo “bola de nieve”, y se los invitó a participar en un proceso deconsenso Delphi modificado a distancia en dos rondas de encuesta. Serealizó un análisis estadístico para establecer el nivel de consenso finalcorrespondiente a cada ítem. Resultados: se presentó un cuestionariocon 68 resultados de aprendizaje en comunicaciones clínicas para quelo evaluara el panel. En la primera ronda Delphi, el panel llegó a unconsenso estadístico en todos los ítems evaluados. No fue necesariauna segunda ronda para conciliar posiciones. Conclusión: se presentauna propuesta académica, aprobada con un elevado nivel de consensointernacional, a fin de orientar y unificar los resultados de aprendizajeen los planes de estudio sobre comunicación clínica para carreras degrado de Enfermería en países de habla hispana. Objective: as a health care profession focused on caring forpeople, Nursing requires sound communication skills. Based on aninternational expert consensus, a proposal on learning outcomes inclinical communication for undergraduate Nursing education curriculain Spanish speaking countries is presented. Method: a steeringcommittee, consisting of 5 nurses and experts in communication inhealth care sciences, drew up the first list of communication skillsspecific to the Nursing degree. Their proposal was reviewed andimproved by a committee of 7 international scientific advisers. 70experts from 14 countries were selected using a snowball samplingprocedure and invited to participate in a distance modified Delphiconsensus process in two survey rounds. Statistical analysis wascarried out to establish the final consensus level for each item.Results: a questionnaire with 68 learning outcomes in clinicalcommunications was submitted for panel assessment. In the firstDelphi round, the panel reached a statistical consensus on all theitems assessed. There was no need for a second round to reconcilepositions. Conclusion: an academic proposal, approved by a highlevel of international consensus, is presented to guide and unifythe learning outcomes on the clinical communication curriculum forundergraduate Nursing studies in Spanish speaking countries. Objetivo: como profissão orientada à atenção da saúde, focada nocuidado às pessoas, a Enfermagem precisa desenvolver habilidadesde comunicação sólidas. Com base em um consenso internacionalde especialistas, apresenta-se uma proposta sobre os resultados deaprendizagem na comunicação clínica para planos de estudos emcursos de Enfermagem em países hispanofalantes. Método: umcomitê orientador, composto por 5 enfermeiros e especialistas emcomunicação em ciências de atenção à saúde, elaborou a primeiralista de habilidades comunicacionais específicas para o curso deEnfermagem. Outro comitê de 7 assessores científicos internacionaisrevisou e melhorou a referida proposta. Foram selecionados 70especialistas de 14 países pelo procedimento de amostragem “bola deneve”, sendo convidados para participar em um processo de consensoDelphi modificado a distância em duas rodadas de pesquisa. Foirealizada a análise estatística para estabelecer o nível de consensofinal correspondente a cada item. Resultados: foi apresentado umquestionário com 68 resultados de aprendizagem em comunicaçõesclínicas para serem avaliados pelo painel. Na primeira rodada Delphi, opainel chegou a um consenso estatístico em todos os itens avaliados.Não foi necessária uma segunda rodada para conciliar posições.Conclusão: apresenta-se uma proposta acadêmica aprovada com umelevado nível de consenso internacional a fim de orientar e unificar osresultados de aprendizagem nos planos de estudo sobre comunicaçãoclínica para cursos de Enfermagem em países hispanofalantes.

Background Medical applications of ionising radiation and associated radiation protection research often encounter long delays and inconsistent implementation when translated into clinical practice. A coordinated effort is needed to analyse the research needs for innovation transfer in radiation-based high-quality healthcare across Europe which can inform the development of an innovation transfer framework tailored for equitable implementation of radiation research at scale. Methods Between March and September 2021 a Delphi methodology was employed to gain consensus on key translational challenges from a range of professional stakeholders. A total of three Delphi rounds were conducted using a series of electronic surveys comprised of open-ended and closed-type questions. The surveys were disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field. Approximately 350 professionals were invited to participate. Participants’ level of agreement with each generated statement was captured using a 6-point Likert scale. Consensus was defined as median ≥ 4 with ≥ 60% of responses in the upper tertile of the scale. Additionally, the stability of responses across rounds was assessed. Results In the first Delphi round a multidisciplinary panel of 20 generated 127 unique statements. The second and third Delphi rounds recruited a broader sample of 130 individuals to rate the extent to which they agreed with each statement as a key translational challenge. A total of 60 consensus statements resulted from the iterative Delphi process of which 55 demonstrated good stability. Ten statements were identified as high priority challenges with ≥ 80% of statement ratings either ‘Agree’ or ‘Strongly Agree’. Conclusion A lack of interoperability between systems, insufficient resources, unsatisfactory education and training, and the need for greater public awareness surrounding the benefits, risks, and applications of ionising radiation were identified as principal translational challenges. These findings will help to inform a tailored innovation transfer framework for medical radiation research.

RESUMEN Introducción: El método Delphi es una técnica que permite llegar al consenso en un grupo de expertos que opinan sobre un asunto específico. Se ha usado ampliamente en diferentes áreas del conocimiento, entre ellas las ciencias de la salud. La reumatología es una de las especialidades médicas que más ha empleado esta técnica de consenso. Objetivos: Realizar una revisión del proceso ideal que debe cumplir la aplicación del método Delphi. Describir el impacto actual del método Delphi en la investigación en salud y hacer una mirada crítica a su aplicación en la investigación en reumatología. Materiales y métodos: Se evaluó la frecuencia del uso del método Delphi en las publicaciones indexadas en MEDLINE como una aproximación a la medición de su empleo en ciencias de la salud. Se realizó una búsqueda de los artículos que reportan el uso del método Delphi como método de investigación en el área de reumatología. Resultados: Al realizar una búsqueda en Medline usando el término MeSH Delphi Technique se encontraron 4.574 artículos. Se incluyeron 148 artículos que aplicaron el método Delphi en investigación de reumatología. Se encontró que la aplicación del método no ha seguido los lineamientos definidos originalmente, ya sea tanto por no cumplir sus características definitorias u omitir alguna de sus fases, como por la falta de rigurosidad en el desarrollo de las mismas, hasta tal punto que solo una quinta parte de los artículos analizados cumplía las características definitorias del método, lo que puede poner en riesgo la validez de los resultados reportados por estas investigaciones. Conclusiones: El uso del método Delphi en investigación en salud es cada vez mayor, y la reumatología no es la excepción. La no estandarización y el apego a la metodología Delphi puede poner en riesgo la validez de los resultados que se obtienen de su uso en investigación. Los investigadores deben tener en cuenta los aspectos metodológicos básicos que definen el método Delphi para incluirlos en sus trabajos. ABSTRACT Introduction: The Delphi method is a technique that allows consensus to be reached by a group of experts who have opinions on a specific issue. It has been widely used in different areas of knowledge, including health sciences. Rheumatology is one of the medical specialties that has used this consensus technique the most. Objectives: To conduct a review of the ideal process for application of the Delphi method. To describe the current impact of the Delphi method on health research, and take a critical look at its application in rheumatology research. Materials and methods: The frequency of use of the Delphi method in publications indexed in MEDLINE was evaluated, as an approximation to the measurement of its use in health sciences. A search was made of the articles that mentioned the use of the Delphi method as a research tool in rheumatology. Results: A total of 4,574 articles were found when searching Medline using the MeSH term "Delphi Technique". The analysis included 148 articles that applied the Delphi method in rheumatology research. It was found that the application of the method did not follow the guidelines originally defined. This was due to not meeting its defining characteristics, or omitting some of its phases. There was also lack of rigour in developing it, to the point that only a fifth of the articles analysed fulfilled the defining characteristics of the method. All these can put the validity of the results reported by these investigations at risk. Conclusions: Use of the Delphi method in health research is growing, and rheumatology is no exception. The lack of standardisation and adherence to the Delphi methodology may jeopardise the validity of the results obtained from its use in research. Researchers must take into account the basic methodological aspects that define the Delphi method, in order to include them in their work.

Background Since in children and adolescence prevalence is assessed mainly on self‐reported or proxy‐reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations. Objective To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents. Method A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro‐facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five‐item Likert scale ranging from ‘Strongly disagree’ to ‘Strongly agree’. Consensus level was set at 80% agreement for the first round, and at 70% for the next. Results After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed. Conclusion Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents., The Delphi process included three round and was used to was used to seek international consensus for Axis I assessment among 23 TMD experts. Thanks to this Delphi study, experts developed new instruments that aim to assess physical diagnoses (Axis I) of TMDs in children and in adolescents, by modifying the DC/TMD for adults.

Introdução: O aleitamento materno tem benefícios únicos, sendo recomendado em exclusividade até ao sexto mês de idade e mantido durante a diversificação alimentar. Como alternativa, podem ser usadas fórmulas infantis, as quais procuram mimetizar o leite humano, promovendo um perfil metabólico e de crescimento semelhantes. Este estudo pretendeu avaliar a opinião de pediatras portugueses relativamente à composição, alegados benefícios e indicações das fórmulas infantis comercializadas em Portugal. Material e Métodos: Estudo baseado no método de Delphi, com a aplicação de um questionário desenvolvido por uma comissão científica a um painel de pediatras peritos em nutrição pediátrica. O questionário foi aplicado em duas voltas, tendo a versão inicial 65 itens abrangendo 11 temas. Resultados: Participaram 21 peritos, tendo sido atingida, após as duas voltas, 87,5% de respostas. Este painel foi consensual em 68,3% dos itens, nomeadamente na indicação das fórmulas infantis apenas nos que não podem beneficiar de aleitamento materno. O painel teve opiniões heterogéneas numa série de questões, destacando-se as relacionadas com vantagens e indicações das fórmulas ‘especiais’ ou modificadas (hidrólise parcial da proteína, anticólica, antirregurgitação e antiobstipação) e das fórmulas ‘de crescimento’ durante o segundo ano de vida. Discussão: Houve um consenso alargado dos peritos quanto à qualidade nutricional, segurança alimentar e indicações atribuídas às fórmulas infantis comercializadas, nomeadamente as fórmulas para lactente e de transição. Conclusão: O painel foi consensual relativamente à maioria dos tópicos inquiridos. A ausência de consenso verificou-se, de forma geral, em questões que na literatura permanecem em debate e carecem de evidência científica robusta., Introduction: Breastfeeding has unique health benefits. Exclusive breastfeeding is recommended during the first six months of life and should be maintained during complementary feeding. Alternatively, infant formulas, which are designed to mimic human breastmilk to promote similar metabolic and growth profiles, can be used. This study aimed to assess the opinion of Portuguese paediatricians with expertise in nutrition on the composition, benefits and indications of commercialised infant formulas. Material and Methods: A survey based on the Delphi method with application of a questionnaire developed by a scientific committee was issued to a panel of paediatricians with expertise in nutrition. An initial questionnaire that included 65 items covering 11 areas was administered in two rounds. Results: Twenty-one experts participated, and the final response rate was 87.5%. The panel was in agreement in 68.3% of the enquired items, namely that infant formulas should be used only when breastfeeding is not possible. Notwithstanding, the opinion of the panel was heterogeneous on a number of issues, particularly those related to the advantages and indications of ‘special’ or modified infant formulas (partially hydrolysed formulas and anti-colic, anti-constipation and anti-regurgitation formulas) and of young child formulas (‘growing-up formulas’). Discussion: A wide consensus was recorded on the nutritional quality, food safety and indications attributed to commercialized infant formulas. Conclusion: The opinion of Portuguese experts was consensual in most of the enquired topics. The absence of consensus was mostly related to issues that remain under debate in the literature and lack robust scientific evidence.

Introdução: O aleitamento materno tem benefícios únicos, sendo recomendado em exclusividade até ao sexto mês de idade e mantido durante a diversificação alimentar. Como alternativa, podem ser usadas fórmulas infantis, as quais procuram mimetizar o leite humano, promovendo um perfil metabólico e de crescimento semelhantes. Este estudo pretendeu avaliar a opinião de pediatras portugueses relativamente à composição, alegados benefícios e indicações das fórmulas infantis comercializadas em Portugal. Material e Métodos: Estudo baseado no método de Delphi, com a aplicação de um questionário desenvolvido por uma comissão científica a um painel de pediatras peritos em nutrição pediátrica. O questionário foi aplicado em duas voltas, tendo a versão inicial 65 itens abrangendo 11 temas. Resultados: Participaram 21 peritos, tendo sido atingida, após as duas voltas, 87,5% de respostas. Este painel foi consensual em 68,3% dos itens, nomeadamente na indicação das fórmulas infantis apenas nos que não podem beneficiar de aleitamento materno. O painel teve opiniões heterogéneas numa série de questões, destacando-se as relacionadas com vantagens e indicações das fórmulas ‘especiais’ ou modificadas (hidrólise parcial da proteína, anticólica, antirregurgitação e antiobstipação) e das fórmulas ‘de crescimento’ durante o segundo ano de vida. Discussão: Houve um consenso alargado dos peritos quanto à qualidade nutricional, segurança alimentar e indicações atribuídas às fórmulas infantis comercializadas, nomeadamente as fórmulas para lactente e de transição. Conclusão: O painel foi consensual relativamente à maioria dos tópicos inquiridos. A ausência de consenso verificou-se, de forma geral, em questões que na literatura permanecem em debate e carecem de evidência científica robusta., Introduction: Breastfeeding has unique health benefits. Exclusive breastfeeding is recommended during the first six months of life and should be maintained during complementary feeding. Alternatively, infant formulas, which are designed to mimic human breastmilk to promote similar metabolic and growth profiles, can be used. This study aimed to assess the opinion of Portuguese paediatricians with expertise in nutrition on the composition, benefits and indications of commercialised infant formulas.Material and Methods: A survey based on the Delphi method with application of a questionnaire developed by a scientific committee was issued to a panel of paediatricians with expertise in nutrition. An initial questionnaire that included 65 items covering 11 areas was administered in two rounds.Results: Twenty-one experts participated, and the final response rate was 87.5%. The panel was in agreement in 68.3% of the enquired items, namely that infant formulas should be used only when breastfeeding is not possible. Notwithstanding, the opinion of the panel was heterogeneous on a number of issues, particularly those related to the advantages and indications of ‘special’ or modified infant formulas (partially hydrolysed formulas and anti-colic, anti-constipation and anti-regurgitation formulas) and of young child formulas (‘growing-up formulas’). Discussion: A wide consensus was recorded on the nutritional quality, food safety and indications attributed to commercialized infant formulas.Conclusion: The opinion of Portuguese experts was consensual in most of the enquired topics. The absence of consensus was mostly related to issues that remain under debate in the literature and lack robust scientific evidence.

Breastfeeding has unique health benefits. Exclusive breastfeeding is recommended during the first six months of life and should be maintained during complementary feeding. Alternatively, infant formulas, which are designed to mimic human breastmilk to promote similar metabolic and growth profiles, can be used. This study aimed to assess the opinion of Portuguese paediatricians with expertise in nutrition on the composition, benefits and indications of commercialised infant formulas.A survey based on the Delphi method with application of a questionnaire developed by a scientific committee was issued to a panel of paediatricians with expertise in nutrition. An initial questionnaire that included 65 items covering 11 areas was administered in two rounds.Twenty-one experts participated, and the final response rate was 87.5%. The panel was in agreement in 68.3% of the enquired items, namely that infant formulas should be used only when breastfeeding is not possible. Notwithstanding, the opinion of the panel was heterogeneous on a number of issues, particularly those related to the advantages and indications of 'special' or modified infant formulas (partially hydrolysed formulas and anti-colic, anti-constipation and anti-regurgitation formulas) and of young child formulas ('growing-up formulas').A wide consensus was recorded on the nutritional quality, food safety and indications attributed to commercialized infant formulas.The opinion of Portuguese experts was consensual in most of the enquired topics. The absence of consensus was mostly related to issues that remain under debate in the literature and lack robust scientific evidence.Introdução: O aleitamento materno tem benefícios únicos, sendo recomendado em exclusividade até ao sexto mês de idade e mantido durante a diversificação alimentar. Como alternativa, podem ser usadas fórmulas infantis, as quais procuram mimetizar o leite humano, promovendo um perfil metabólico e de crescimento semelhantes. Este estudo pretendeu avaliar a opinião de pediatras portugueses relativamente à composição, alegados benefícios e indicações das fórmulas infantis comercializadas em Portugal. Material e Métodos: Estudo baseado no método de Delphi, com a aplicação de um questionário desenvolvido por uma comissão científica a um painel de pediatras peritos em nutrição pediátrica. O questionário foi aplicado em duas voltas, tendo a versão inicial 65 itens abrangendo 11 temas. Resultados: Participaram 21 peritos, tendo sido atingida, após as duas voltas, 87,5% de respostas. Este painel foi consensual em 68,3% dos itens, nomeadamente na indicação das fórmulas infantis apenas nos que não podem beneficiar de aleitamento materno. O painel teve opiniões heterogéneas numa série de questões, destacando-se as relacionadas com vantagens e indicações das fórmulas ‘especiais’ ou modificadas (hidrólise parcial da proteína, anticólica, antirregurgitação e antiobstipação) e das fórmulas ‘de crescimento’ durante o segundo ano de vida. Discussão: Houve um consenso alargado dos peritos quanto à qualidade nutricional, segurança alimentar e indicações atribuídas às fórmulas infantis comercializadas, nomeadamente as fórmulas para lactente e de transição. Conclusão: O painel foi consensual relativamente à maioria dos tópicos inquiridos. A ausência de consenso verificou-se, de forma geral, em questões que na literatura permanecem em debate e carecem de evidência científica robusta.

Introduction: Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines. Material and methods: An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results. Results: Eleven paediatric pulmonologists and allergists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they had required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impaired their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids. Conclusions: This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma. Resumen: Introducción: La identificación adecuada del paciente pediátrico con asma grave es esencial para su correcto manejo. Sin embargo, los criterios para definir el asma grave y las recomendaciones para su control varían mucho entre las distintas guías. Material y métodos: Se elaboró una encuesta telemática para analizar las opiniones relativas a la definición y control del asma grave pediátrica. Para lograr un consenso se siguió una metodología Delphi modificada. Con los resultados se elaboraron recomendaciones prácticas. Resultados: El cuestionario fue respondido por 11 neumólogos y alergólogos pediátricos expertos en asma grave. Hubo consenso en 50 de los 65 ítems planteados (76,92%). Se consideró que un paciente tiene asma grave si en el último año ha requerido 2 o más ciclos de corticoides orales, si requiere tratamiento diario con corticoides inhalados a dosis medias (con otra medicación controladora) o dosis altas (con o sin otra medicación controladora), si no responde a un tratamiento convencional optimizado, o si la enfermedad pone en riesgo su vida o deteriora gravemente su calidad de vida. La definición de asma grave también podría incluir a los pacientes que consumen recursos sanitarios de manera regular y justificada, o tienen factores psicosociales o ambientales que impiden su control. Para la monitorización, se recomienda usar cuestionarios específicos de población pediátrica (CAN o ACT). Respecto al tratamiento, se debería considerar el uso de omalizumab en un escalón anterior al de los corticoides orales. Conclusiones: El presente trabajo ofrece recomendaciones consensuadas que pueden ser de utilidad en el manejo del asma grave pediátrica.

Antecedentes: La libre elección no es fácil cuando se carece de información adecuada. Para ello son necesarios métodos de evaluación de la calidad asistencial que ofrezcan al paciente una información integral y comprensible de los servicios hospitalarios. Objetivos: Definir una propuesta metodológica para evaluar la calidad asistencial de los servicios hospitalarios, cuyos resultados sirvan para ofrecer una información útil al ciudadano. La propuesta debe fundamentarse en el consenso y en la experiencia de los especialistas médicos y definir complementariamente vías de mejora. Métodos: Estudio Delphi sobre calidad asistencial en Nefrología, estructurado en tres apartados: evaluación de resultados, medios necesarios para la calidad, e importancia del consejo médico y de la encuesta a especialistas. El cuestionario fue cumplimentado por un panel formado por 32 nefrólogos. Resultados: Los nefrólogos aceptaron 55/62 (89 %) de los criterios de resultados en calidad asistencial. También aceptaron 87/92 (95 %) de los medios propuestos para la calidad asistencial. El 81 % de los nefrólogos consideró de actualidad el consejo médico de un especialista a un paciente acerca del servicio donde podrían tratar mejor su enfermedad. Un 86 % creyó oportuno incluir encuestas sobre consejo médico como criterio adicional en la evaluación de la calidad asistencial. Conclusiones: Es posible obtener una propuesta metodológica consensuada para la evaluación y mejora de la calidad asistencial que incluya resultados de calidad asistencial, medios para la calidad asistencial y el consejo médico derivado de encuestas a especialistas para identificar los mejores servicios. Este método podría facilitar una orientación fiable y comprensible para el ciudadano. Background: Free choice is not easy when there is a lack of information. Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary. Objectives: To draft a methodological proposal for evaluating quality of care of hospital departments, the data of which can provide citizens with useful care quality information. The proposal should be based on consensus and on the experience of medical specialists, defining thus complementary paths to improvement. Methods: A Delphi study on the quality of care in Nephrology, comprising three phases: assessment results, necessary means for quality, and importance of medical advice and surveys among specialists. The questionnaire was administered to a panel of 32 nephrologists. Results: The nephrologists accepted the outcome criteria on quality of care 55/62 (89%), as well as the proposed means for quality of care 87/92 (95%). 81% of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases. 86% of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care. Conclusions: It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care, means for quality of care, and medical advice based on surveys carried out among specialists to identify the best Nephrology departments. This method could provide reliable and understandable guidance for citizens.

Introducción: Las guías de práctica clínica deben basarse en la mejor evidencia disponible para formular recomendaciones aplicables y específicas a la práctica clínica. Objetivos: Revisar la técnica Delfos para lograr consenso entre los expertos y presentar recomendaciones basadas en la evidencia a fin de mejorar el desarrollo de una guía clínica. Método: Este artículo revisa la estructuración necesaria que se debe considerar durante el consenso para formular recomendaciones en las guías de práctica clínica. Conclusión: La técnica Delfos ayuda a obtener opiniones de una pregunta de investigación particular. Está basado en la premisa de que la inteligencia colectiva, desde el juicio individual, captura la opinión colectiva de un grupo de expertos sin necesidad de estar físicamente conectados. Introduction: Clinical practice guidelines should be based on the best available evidence. Other considerations beyond the evidence are therefore needed in order to formulate specific and applicable recommendations for clinical practice. Objective: The aim of this paper was to review the Delphi technique for achieving consensus among experts in the development of evidence-based guidelines. Method: This paper reviews the structuring necessary for obtaining consensus in the process of formulating recommendations for clinical guidelines. Conclusion: The Delphi technique is a method for collecting opinions on a particular research question. It is based on the premise that pooled intelligence enhances individual judgment and captures the collective opinion of a group of experts without them being physically present.

La técnica Delphi se puede considerar como una importante técnica de investigación para utilizarse en el contexto de los Servicios de Salud. En las ciencias sociales se considera una forma efectiva y válida de reunir información sobre un tema donde hay escasas evidencias o acuerdos. El objetivo de este artículo es presentar una revisión bibliográfica y se examina críticamente esta técnica. Se analizan sus principales características, las diversas variantes en su aplicación y, finalmente, se discute su uso en los Servicios de Salud. The method Delphi can be considered as an important investigation methodology to be used in the context of health services. In the social sciences it is considered an effective and valid method of gathering information on a topic about which there is scarce evidence or agreement. The objective of this article is to present a biblio-graphical revisión and to examine this method critically. Its main characteristics will be analyzed, the diverse varíants in its application, and finally, its use is discussed, regarding the health services.