A systematic review of interactive multimedia interventions to promote children's communication with health professionals: implications for communicating with overweight children

Background: Interactive multimedia is an emerging technology that is being used to facilitate interactions between patients and health professionals. The purpose of this review was to identify and evaluate the impact of multimedia interventions (MIs), delivered in the context of paediatric healthcare, in order to inform the development of a MI to promote the communication of dietetic messages with overweight preadolescent children. Of particular interest were the effects of these MIs on child engagement and participation in treatment, and the subsequent effect on health-related treatment outcomes. Methods: An extensive search of 12 bibliographic databases was conducted in April 2012. Studies were included if: one or more child-participant was 7 to 11 years-of-age; a MI was used to improve health-related behaviour; child-participants were diagnosed with a health condition and were receiving treatment for that condition at the time of the study. Data describing study characteristics and intervention effects on communication, satisfaction, knowledge acquisition, changes in self-efficacy, healthcare utilisation, and health outcomes were extracted and summarised using qualitative and quantitative methods. Results: A total of 14 controlled trials, published between 1997 and 2006 met the selection criteria. Several MIs had the capacity to facilitate engagement between the child and a clinician, but only one sought to utilise the MI to improve communication between the child and health professional. In spite of concerns over the quality of some studies and small study populations, MIs were found useful in educating children about their health, and they demonstrated potential to improve children’s health- related self-efficacy, which could make them more able partners in face-to-face communications with health professionals. Conclusions: The findings of this review suggest that MIs have the capacity to support preadolescent child-clinician communication, but further research in this field is needed. Particular attention should be given to designing appropriate MIs that are clinically relevant

Tremor in microsurgery : The influence of microsurgical experience and microsurgical training on tremor.

Background: Tremor plays an important role in microsurgery, especially in stapes surgery because of the minute size and vulnerability of the middle ear structures. The apparent learning curve in stapes surgery suggests better outcomes after more practise. Earlier studies in the otolaryngology field about the effect of microsurgical experience on tremor suggest a trend towards better results in expert groups but the difference did not reach significance level. However, group sizes were small. Because of the declining number of stapes surgery cases and the complexity of stapes surgery, a wide variety of models have been developed to practise the stapes operation. Earlier studies suggest the benefits of these models and also a possible learning curve in stapes models. This study aims to validate whether microsurgical experience and microsurgical practise have beneficial effects on tremor. Methods: 86 subjects were divided in 3 levels of microsurgical experience and their tremor was measured on a tremor model. Differences of tremor outcomes between the 3 levels were analysed. 37 subjects with no microsurgical experienced trained on a stapes model for three times. Tremor measurements before and after training were compared. Results: No differences in tremor outcomes were found between the 3 levels of experience. Microsurgeons with stapes surgery experience did have lower tremor values. Training on a stapes model lowered tremor values down to the same level as experienced stapes surgeons. Conclusions: Microsurgical experience does not seem to be of influence on tremor outcomes. However, experience with stapes surgery does seem to decrease tremor values. Because only 6 surgeons with stapedotomy experience were included it is suggested to measure the tremor of more microsurgeons with stapedotomy experience. Practising on the used stapes model decreases tremor values significantly down to the same level as stapes surgeons. This suggests that the stapes model used is a good tool for practising stapes surgery on.

Assessing the applicability of the structured expert evaluation method (SEEM) for a wider age group

This paper describes a study which examines whether a predictive evaluation method (SEEM) is suitable to assess products for an older age group than for which the evaluation method was originally developed. SEEM stands for Structured Expert Evaluation Method and is an analytical evaluation method especially developed for assessing the fun and usability of young children’s educational computer games (children from 5 to 7 years old). In the present study SEEM was applied to assess educational computer games for children between 9 and 11 years old. Outcomes on scores for thoroughness (whether SEEM finds all problems), validity (whether SEEM makes predictions that are likely to be true) and appropriateness (whether SEEM is applied correctly) were compared. The results show that the trends for the thoroughness and the validity are the same for the two different age groups; however SEEM scores a bit better for the oldest age group. The appropriateness scores are about the same for the two age groups. The results indicate that SEEM can also be applied for assessing educational computer games for children between 9 and 11 years old