Informing patients of relevant health information and innovations: patient recall or annual physical

Recently the NEJM published an interesting debate on the value of the annual physical (also known as "periodic health examination") (Goroll 2015). "Today, because of the rapid growth of medical knowledge and the widening application of technology to medicine, there is a particular need for a continuing authoritative review of, standards for both preventive and therapeutic strategies. Some of these strategies are subsumed under the general category of the periodic health examination." (Canadian Task Force on the Periodic Health Examination 1979). Although the current debate of the annual physical has narrowly focused on preventive strategies in healthy individuals and building patient-physicians relationship, recent breakthrough clinical innovation in many fields, especially in genomic medicine, widens the need of review to new effective therapy and diagnostics. This is the case because genomic medicine indicates new therapeutic treatments and targets, and the costs of sequencing have been decreasing over timeFil: Holzer, Felicitas Sofia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales; ArgentinaFil: Mastroleo, Ignacio Damian. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mertelsmann, Roland. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Warum klassische Evaluation oftmals nicht ausreicht – eine Studie zur Ermittlung der Bedeutsamkeit Mentaler Modelle als Evaluationsmethode

Hohe Benutzertauglichkeit und Akzeptanz eines Webseitenservices sind nur dann gewährleistet, wenn diese auf die funktionalen Bedürfnisse, aber auch auf die strukturellen Vorstellungen ihrer Benutzer zugeschnitten sind. Im Kontext einer Webseite zur „Suche nach E-Learning-Produkten im Internet“ wurde untersucht, inwieweit die Kenntnis der Mentalen Modelle potenzieller Nutzer den Softwareentwicklungsprozess positiv beeinflussen kann. Dabei erlaubte die Erhebung Mentaler Modelle mit Hilfe der Struktur-Lege-Technik (SLT) als Evaluationsmethode einen Vergleich mit der tatsächlich entwickelten Webseite. Die Studie zeigte, dass trotz zuvor bereits durchgeführter, klassischer Evaluationen (Usability Tests, Anwendung von Heuristiken und Cognitive Walkthroughs) 40 Funktionsbereiche genannt wurden, die auf der tatsächlichen Webseite nicht vorgesehen oder umgesetzt sind. Daraus folgt, dass die Erhebung von Mentalen Modellen ebenfalls bereits vor dem Software-Entwicklungsprozess durchgeführt werden soll. (DIPF/Orig.

Adaptive Wissensvermittlung am Beispiel der eLearning-Umgebung "Psychopathology Taught Online" (PTO)

Der vorliegende Beitrag stellt das Projekt der eLearning-Umgebung „Psychopathology Taught Online“ (PTO) vor. PTO soll als ein zum bestehenden universitären Lehrangebot im Bereich Psychopathologie ergänzendes digitales Curriculum eingesetzt werden. Der inhaltliche Schwerpunkt liegt auf der Phänomenologie psychischer Störungen. Besonders hervorzuheben ist die zur Gewährleistung von inhaltlicher Adaptivität des Lernprogramms verwendete Methodik. Mittels robuster Nonmetrischer Multidimensionaler Skalierung (NMDS) können Wissenskarten des Lerners erstellt werden, welche speziell auf relationale Zusammenhänge der deklarativen Wissensinhalte sensitiv sind und diese in einem Raummodell darstellen. Auf der Basis des Vergleichs einer Lernerkarte mit einem Normmodell (durch Prokrustes-Transformation) können spezifische Wissensmängel detektiert werden. Dies erlaubt das Geben von automatisierten, individuell angepassten Lernempfehlungen. (DIPF/Orig.

Adequately assessing dehydration: A holy grail of paediatric emergency medicine

We read the work by Pringle at al. [1] with interest. One of the holy grails of Paediatric Emergency Medicine has been the rapid and reliable identification of the child with serious dehydration, and the converse, the ability to know when to safely discharge a child with a history of gastroenteritis. Recently there has been an external validation of a previously derived clinical dehydration scale by Bailey et al. [2]. It is encouraging to see this type of study as too often scoring systems are created without further testing. However we wondered about the generalisability of this result to routine Pediatric Emergency Care. Specifically we noted that in that study participating nurses undertook an additional training programme prior to study commencement. Is the score still valid if used by Pediatric Emergency Care staff who have not had this additional training? Our previous work has shown that experience and training in assessment may be vital in correctly assigning dehydration categories in children [3]. We found significant variability between junior doctors' assessments of dehydration compared to their seniors. We concluded previous studies on dehydration scoring systems may have benefited from well-trained staff and the introduction of these systems to naive health care professionals may not replicate initial results. The Pringle et al. study, while containing only a small number of subjects, challenges this conclusion again as it appears the care setting may influence the utility of the tool. The holy grail has yet to be found

Refining and testing the diagnostic accuracy of an assessment tool (PAT-POPS) to predict admission and discharge of children and young people who attend an emergency department : protocol for an observational study

Background: Increasing attendances by children (aged 0–16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose. This study aims to revise and improve the existing tool and determine its utility in determining safe admission and discharge decision making. Methods/design: An observational study to improve diagnostic accuracy using data from children and young people attending the ED and Urgent Care Centre (UCC) at three hospitals over a 12 month period. The data being collected is part of routine practice; therefore opt-out methods of consent will be used. The reference standard is admission or discharge. A revised PAT-POPs scoring tool will be developed using clinically guided logistic regression models to explore which components best predict hospital admission and safe discharge. Suitable cut-points for safe admission and discharge will be established using sensitivity and specificity as judged by an expert consensus meeting. The diagnostic accuracy of the revised tool will be assessed, and it will be compared to the former version of PAT-POPS using ROC analysis. Discussion: This new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities. Trial registration: NIHR RfPB Grant: PB-PG-0815-20034. ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018. Keywords: Paediatric, Emergency department, Diagnostic accuracy, Early identification systems, screening tool, Observational, Early warning score, Early warning system, hospital admission

Are you a SCEPTIC? SoCial mEdia Precision and uTility in Conferences

We analysed Twitter feeds at an emergency medicine scientific conference to determine the (1) accuracy of disseminated educational messages and the (2) use in providing rapid feedback to speakers. Most speakers were happy for key messages to be tweeted, and the majority of tweets (34/37) represented these accurately. It is important that speakers and conference organisers consider Twitter use and its potential benefits and disadvantages

What does the ‘chat’ tell us about participation and engagement in online video conferencing?

Although much is known about the experiential nature of online conferencing, we know less about actual participation and engagement. This paper investigates delegate interactions in the “parallel chat” function of a video platform during an online medical education conference. We collected 813 unique messages, posted while speakers presented on a digital stage. We used descriptive statistics to summarize message/chat content in terms of participant categories and topic. 23% of delegates posted in the chat. However, to go beyond these dimensions, we used conversation analytic methods to identify the actions accomplished in messages and their interconnectedness. We developed a coding scheme to report this analysis across the complete dataset. We found that messages mostly comprised positive assessments (“Wonderful talk!”) and appreciations (“Thank you!”). ‘Second’ messages were more common than initiations or ‘first’ messages, indicating extensive engagement between participants. Few messages received no response. Delegates also formulated what speakers said to develop ‘learning moments’ in the chat. Overall, we argue that a richer and more precise understanding of participation and engagement in video conferencing can be achieved by analysing actual participation and its content, rather than relying only on post-hoc reports and surveys. Data are in British English

A systematic review of the organizational, environmental, professional and child and family factors influencing the timing of admission to hospital for children with serious infectious illness

Abstract Background Infection, particularly in the first 5 years of life, is a major cause of childhood deaths globally, many deaths from infections such as pneumonia and meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional. Objective Examine what organizational and environmental factors and individual child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness. Design Systematic review. Data sources Key search terms were identified and used to search CINAHL Plus, Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute Database of Systematic Review. Study appraisal methods Primary research (e.g. quantitative, qualitative and mixed methods studies) and literature reviews (e.g., systematic, scoping and narrative) were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies. Main findings Thirty-six papers were selected for full text review; 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children’s illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians non-recognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of ‘gut feeling’ by clinicians, and sub-optimal management within primary, secondary and tertiary services. Conclusions The pathways taken by children with a serious infectious illness to hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to ‘gut feeling’. Implications Relatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness