RESUMEN
OBJECTIVE: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT). DESIGN: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale. SETTING: Eight UK paediatric units. PARTICIPANTS: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos. MAIN OUTCOME MEASURES: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors. RESULTS: 188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r > 0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors - "clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationship building skills (2-tailed significance < 0.001). Conclusions The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.
RESUMEN
OBJECTIVE: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT). DESIGN: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale. SETTING: Eight UK paediatric units. PARTICIPANTS: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos. MAIN OUTCOME MEASURES: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors. RESULTS: 188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r>0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors--"clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationship-building skills (2-tailed significance <0.001). CONCLUSIONS: The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.
Asunto(s)
Competencia Clínica/normas , Pediatría/normas , Relaciones Médico-Paciente , Adolescente , Niño , Preescolar , Métodos Epidemiológicos , Humanos , Lactante , Revisión por Pares , Relaciones Profesional-Familia , Psicometría , Grabación en VideoRESUMEN
Effective consultations with patients and their families are important for patient satisfaction, adherence to treatment, and recovery from illness. Communication problems among health professionals are common. Fortunately, the skills of effective communication can be taught and learned. This paper highlights evidence based approaches to teaching these skills with minimal resources.
Asunto(s)
Comunicación , Educación Médica Continua/métodos , Pediatría/educación , Relaciones Médico-Paciente , Enseñanza/métodos , Niño , Humanos , Relaciones Profesional-Familia , Materiales de EnseñanzaAsunto(s)
Insuficiencia Suprarrenal/inducido químicamente , Androstadienos/efectos adversos , Antiinflamatorios/efectos adversos , Asma/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Enfermedad Aguda , Administración por Inhalación , Administración Tópica , Niño , Preescolar , Esquema de Medicación , Fluticasona , Glucocorticoides , HumanosRESUMEN
Irrigating solutions are commonly used in the preparation of bony surfaces before total joint replacement components are cemented. Using an experimental cemented arthroplasty model, metal pseudo-prostheses were cemented to a cadaveric bone surface prepared with a specific irrigating solution. A tension load was then applied to the prosthesis until failure occurred at the cement-bone interface. A quantitative analysis of the effect of three commonly used irrigating solutions on the strength of the cement-bone interface is presented. Sixty trials were performed with normal saline, povidone iodine and hydrogen peroxide. Irrigation with hydrogen peroxide afforded statistically superior cement fixation in this arthroplasty model when compared with either normal saline or povidone iodine (P less than 0.01 Chi-squared test).