A demonstration of using formal consensus methods within guideline development; a case study.

BACKGROUND: Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these. METHODS: We conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations. RESULTS: The approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance. CONCLUSION: Formal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.

Strength of German accent under altered auditory feedback.

Borden's (1979, 1980) hypothesis that speakers with vulnerable speech systems rely more heavily on feedback monitoring than do speakers with less vulnerable systems was investigated. The second language (L2) of a speaker is vulnerable, in comparison with the native language, so alteration to feedback should have a detrimental effect on it, according to this hypothesis. Here, we specifically examined whether altered auditory feedback has an effect on accent strength when speakers speak L2. There were three stages in the experiment. First, 6 German speakers who were fluent in English (their L2) were recorded under six conditions--normal listening, amplified voice level, voice shifted in frequency, delayed auditory feedback, and slowed and accelerated speech rate conditions. Second, judges were trained to rate accent strength. Training was assessed by whether it was successful in separating German speakers speaking English from native English speakers, also speaking English. In the final stage, the judges ranked recordings of each speaker from the first stage as to increasing strength of German accent. The results show that accents were more pronounced under frequency-shifted and delayed auditory feedback conditions than under normal or amplified feedback conditions. Control tests were done to ensure that listeners were judging accent, rather than fluency changes caused by altered auditory feedback. The findings are discussed in terms of Borden's hypothesis and other accounts about why altered auditory feedback disrupts speech control.