Measuring empathy in pediatrics: validation of the Visual CARE measure

Background: Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). Methods: The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. Results: Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93). Conclusions: The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics

MTPA Tracking Algorithms for IPMSMs and SynRMs: Accurate Evaluation and Adaptive Tuning of Real Signal Injection and Virtual Signal Injection

Two main classes for Maximum-Torque-Per-Amp\ue8re (MTPA) tracking in Interior Permanent Magnet (IPM) and Synchronous Reluctance (SynR) machines have been proposed in literature, namely Real Signal Injection (RSI) and Virtual Signal Injection (VSI). Unfortunately, a fair evaluation of the accuracy and performance of each class and a direct comparison between them is still missing, and is the first contribution of this paper. Validation and evaluation of the accuracy and performance is considered, by taking into account a non-linear model of a SynRM, based on an analytical representation of flux-linkage, in order to reduce the errors due to approximations, allowing therefore a quantitative comparison. A new technique is proposed, allowing both tuning and adaptation of the VSI tracking loop gains, therefore assuring both stability and the same dynamical performance in the whole machine torque/speed range. Finally, an original strategy to compensate for steady-state MTPA tracking errors due to non-linear flux maps is proposed, thus increasing the accuracy of VSI even in the case the machine flux maps are known with relatively low quantization. An IPM motor drive is considered to validate the proposed contributions

Evaluation of the Post-Operatory Period in Neurosurgical Pediatric Patients with Central Nervous Sistem Tumor: A Single General Center Experience

Background/Objectives: Morbidity following tumor surgery is greater than other types of neurosurgery. Accurate data col- lection allows comparison between institutions and quality improvement. The aim was to analyze the 30-day or inpatient outcome of pediatric patients with central nervous system (CNS) tumors in terms of significant adverse events (SAE) in our general institution in the post-operatory (PO) period. Design/Methods: AE of children 0-16 years operated at our institution (2009-2018) for CNS tumors were prospec- tively registered and retrospectively analyzed with consensus definitions. Results: Seventy-eight procedures were performed in 65 patients (54% male, mean age 9.1 years). Tumors were supratentorial in 59% children and Astrocytic tumor was the most frequent diagnosis (55%). Fifty-eight percent underwent gross total resection, 31% partial removal and 11% biopsy. Six percent developed Hydrocephalus in the PO period, 5% maior CSF-leakage and 8% pseudomeningocele. Nineteen percent developed new moderate-severe neurological deficits (73% infraterorial tumors), 5% seizures and 6.4% a CNS infection. We recorded 5 ischemic events (6.4%) but no hemorrhages. Mortality was 0% while 30.1% procedures were linked to at least one SAE; in these children the mean Hospital and ICU length of stay were significantly longer (p< 0.00001-p<0.005). Using a logistic regression model we found no association with sex (p=0.17), age at the onset (p=0.21) and histology (p=0.19) while we found that total resection had a 79% lower risk (OR=0.21; 95%CI=0.06- 0.68) of SAE in comparison with partial removal-biopsy (p=0.009) and that sovratentorial tumors had a 87% lower risk (OR=0.13; 95%CI=0.03-0.49) of SAE in comparison with infratentorial-spinal tumors (p=0.003). Conclusions: SAE rate in a general tertiary hospital is high but comparable to pubblished data of international pediatric institutions. Recognition of adverse events is fundamental for appropriate patient management and could affect long term outcome therefore continuous surveillance is needed. Infratentorial and not completely resectable tumors are inde- pendent risk factors for SAE