How communication affects prescription decisions in consultations for acute illness in children:a systematic review and meta-ethnography

BACKGROUND: Communication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach. RESULTS: Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation. CONCLUSIONS: Misunderstandings occurred due to parents and clinicians talking at cross purposes about the ‘seriousness’ of the illness and because parents’ expressions of concern or requests for additional information were sometimes perceived as a challenge to the clinicians’ diagnosis or treatment decision. This modifiable problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary care clinicians should be offered training to understand parent communication primarily as expressions of concern or attempts at understanding and always to check rather than infer parental expectations

Lecture archiving on a larger scale at the University of Michigan and CERN

The ATLAS Collaboratory Project at the University of Michigan has been a leader in the area of collaborative tools since 1999. Its activities include the development of standards, software and hardware tools for lecture archiving, and making recommendations for videoconferencing and remote teaching facilities. Starting in 2006 our group became involved in classroom recordings, and in early 2008 we spawned CARMA, a University-wide recording service. This service uses a new portable recording system that we developed. Capture, archiving and dissemination of rich multimedia content from lectures, tutorials and classes are increasingly widespread activities among universities and research institutes. A growing array of related commercial and open source technologies is becoming available, with several new products introduced in the last couple years. As the result of a new close partnership between U-M and CERN IT, a market survey of these products was conducted and a summary of the results are presented here. It is informing an ambitious effort in 2009 to equip many CERN rooms with automated lecture archiving systems, on a much larger scale than before. This new technology is being integrated with CERN's existing webcast, CDS, and Indico applications.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85420/1/jpconf10_219_082003.pd

P. robustu

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