Ratings of performance in multisource feedback: Comparing performance theories of residents and nurses

Background: Multisource feedback (MSF) is increasingly being used to assess trainee performance, with different assessor groups fulfilling a crucial role in utility of assessment data. However, in health professions education, research on assessor behaviors in MSF is limited. When assessing trainee performance in work settings, assessors use multidimensional conceptualizations of what constitutes effective performance, also called personal performance theories, to distinguish between various behaviors and sub competencies., This may not only explain assessor variability in Multi Source Feedback, but also result in differing acceptance (and use) of assessment data for developmental purposes. The purpose of this study was to explore performance theories of various assessor groups (residents and nurses) when assessing performance of residents.Methods: A constructivist, inductive qualitative research approach and semi-structured interviews following MSF were used to explore performance theories of 14 nurses and 15 residents in the department of internal medicine at Aga Khan University (AKU). Inductive thematic content analysis of interview transcripts was used to identify and compare key dimensions in residents\u27 and nurses\u27 performance theories used in evaluation of resident performance.Results: Seven major themes, reflecting key dimensions of assessors\u27 performance theories, emerged from the qualitative data, namely; communication skills, patient care, accessibility, teamwork skills, responsibility, medical knowledge and professional attitude. There were considerable overlaps, but also meaningful differences in the performance theories of residents and the nurses, especially with respect to accessibility, teamwork and medical knowledge.Conclusion: Residents\u27 and nurses\u27 performance theories for assessing resident performance overlap to some extent, yet also show meaningful differences with respect to the performance dimensions they pay attention to or consider most important. In MSF, different assessor groups may therefore hold different performance theories, depending on their role. Our results further our understanding of assessor source effects in MSF. Implications of our findings are related to implementation of MSF, design of rating scales as well as interpretation and use of MSF data for selection and performance improvement

Spectrum of Fugitive Diagnosis of Neurological Disorders in Elderly

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age \u3e60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or without associated co morbidities e.g., DM, HTN, IHD. Exclusion criteria: age \u3c60, all acquired other neurological disorder RESULTS Total number of patients (n=2570) visited to Neuro-clinic with various neurological disorders.950 patients had neurodegenerative diseases. A total of 241 patients(n=241) with neurodegenerative diseases like Parkinson’s disease, Alzheimer’s disease, Lewy body disease vascular dementia and fronto-temporal dementia having fugitive diagnosis during their course of treatment were included in the study. Study sample consisted of 134 males and 107 female patients. The patients included in study were aged equal to or more than 60 years. True diagnosis was as follows; refusal to take oral medications or keeping food in mouth 73/241, (30.29%), misdiagnosed as advanced dementia or early Alzheimer’s disease, Serotonin Syndrome 23/241, (09.54%), Subacute Encephalopathy 67/241, (27.80%) caused by infections e.g. urinary tract infection or pneumonia, hyponatremia, were taken as advanced widespread disease or deepening encephalopathy due to metabolic cause, Depression in 47/241, (19.50%), was taken as worsening of symptoms or polypharmacy. Impulse control disorders 31/241, (12.86%) were misdiagnosed as extremes of behavior with efforts leading to hospitalization in psychiatric institution. CONCLUSION Fugitive diagnosis in patients with neurologic symptoms and signs, especially in neurodegenerative disorders results in worsening of patient condition with no chance of benefit. The patient is subjected to inappropriate, ineffective and potentially harmful treatment. Fugitive diagnosis fails to address symptoms, delays appropriate therapy, and may lead to worst prognosis. Finally, it may lead to unnecessary higher cost of treatment for patient in particular and health care system in general. So clinical guidelines should be made to overcome these situations

Impact of Performance Appraisal on Employee Performance

This manuscript is an attempt of the researchers to highlight the significance of performance appraisal in the organizations and business world. Appraisal is one of the most significant and effective tool that can lead an organization to vanquish their ultimate goals by improving the efficiency and effectiveness of the employees. Performance appraisal helps managers to identify the gap between desired and actual performance and in case of deficiency, it can be removed by imparting required training. Fair performance evaluation and proper training motivates employees that results in improved performance and achieve organizational competitiveness. Keywords: Performance Appraisal, Employee Performanc

Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.Aim: To determine the barriers and perceptions in discussion of code status by physicians.Design: Questionnaire-based cross-sectional study.Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included.Results: A total of 77 (57.4%) physicians responded. Family-related barriers were found to be the most common barriers. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Regarding personal barriers, lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians.Conclusion: Family-related barriers are the most frequent roadblocks in the end-of-life care discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve end-of-life care. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries

Towards Arabic multi-modal sentiment analysis

In everyday life, people use internet to express and share opinions, facts, and sentiments about products and services. In addition, social media applications such as Facebook, Twitter, WhatsApp, Snapchat etc., have become important information sharing platforms. Apart from these, a collection of product reviews, facts, poll information, etc., is a need for every company or organization ranging from start-ups to big firms and governments. Clearly, it is very challenging to analyse such big data to improve products, services, and satisfy customer requirements. Therefore, it is necessary to automate the evaluation process using advanced sentiment analysis techniques. Most of previous works focused on uni-modal sentiment analysis mainly textual model. In this paper, a novel Arabic multimodal dataset is presented and validated using state-of-the-art support vector machine (SVM) based classification method