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Case Scenarios (case + scenario)
Kinds of Case Scenarios Selected AbstractsConsidering effective divorce mediation: Three potential factorsCONFLICT RESOLUTION QUARTERLY, Issue 4 2002Jerry Gale The purpose of this exploratory, qualitative stgdy was to examine mediator efect by employing a repeated measures research design in which we videotaped mediators working with actors and a scripted divorce case scenario. What factors distinpish higher-rated mediators from lower-rated ones? Our discourse analysys of four divorce mediations suggested three signijcant factors of injuence that finction interactively and afect both mediation outcome and process. Ethical implications regarding how mediators achieve success in these three domains are discussed. This article presents implications for researchers, trainers, and practitioners; it suggests important directions for fiture research with nonsimulated mediation. [source] Worst case scenario: Carcinoma of unknown originDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2006Michael L. Cibull M.D. No abstract is available for this article. [source] Social risk assessment of large technical systemsHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 4 2003H.J. Pasman A probabilistic approach to engineering advances. Since risk adhering to a technical structure can be determined quantitatively easier and more accurately than before, criteria for decision making are becoming more important. If the structure is in the public domain, and benefits are not felt, the voluntariness of being subjected to the risk becomes low. Decisions become, in such a case, a political issue on the basis of considerations of ethics, law, and social justice. For a specific case, the comparison of the economic benefits with the total costs, including risk reduction in a worst case scenario, play a major role as we have seen over and over again in, for example, planning nuclear power generation. A criterion for individual risk of 10,5 per year for the purpose of "external safety" is generally accepted. For social risk assessment, however, a group risk criterion is essential and much more difficult to define. An analysis is made. Examples of inconsistency are given. Further dialogue is encouraged. © 2003 Wiley Periodicals, Inc. Hum Factors Man 13: 305,316, 2003. [source] Do medical courses adequately prepare interns for safe and effective prescribing in New South Wales public hospitals?INTERNAL MEDICINE JOURNAL, Issue 7 2009S. N. Hilmer Abstract Aims: To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. Methods: A cross-sectional study was performed on all interns (n= 191) who attended intern orientation programmes at four NSW hospitals in January 2008. A clinical case scenario that tested prescribing ability and a survey investigating impressions of clinical pharmacology training in medical school were administered to the interns in exam format. Outcome measures were: (i) ability to prescribe medications safely and appropriately for the clinical case scenario and (ii) interns' impressions of their training in clinical pharmacology at medical school. Results: No intern completed all prescribing tasks correctly. No intern charted the patient's usual medications on admission completely correctly, only six wrote an accurate discharge medication list, and none wrote both an accurate discharge medication list and a legal Schedule 8 discharge script. None of the respondents strongly agreed that they felt adequately trained to prescribe medications in their intern year and 84% would have liked to have more training in pharmacology as medical students. Conclusions: Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school. [source] The successful management of organisational change in tourism SMEs: initial findings in UK visitor attractionsINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 4 2008Rune Todnem By Abstract Organisational change management theory for small and medium-sized enterprises (SMEs) within the tourism industry is an under-researched field. Changing political, economic, social and technological factors can leave unprepared SMEs exposed to external as well as internal pressures, which can lead to underperformance, or in worst case scenario, business failure. This paper, reporting on the findings of exploratory research of nine UK-based visitor attractions, all qualifying as SMEs, suggests that the successful management of change is crucial for SMEs' survival and success. The findings argue that the current approach taken to organisational change management within the industry is bumpy incremental, bumpy continuous and planned. Hence, the paper provides a framework for managing organisational change based on eight critical success factors identified by the study: adaptability and flexibility, commitment and support, communication and co-operation, continuous learning and improvement, formal strategies, motivation and reward, pragmatism, and the right people. Copyright © 2008 John Wiley & Sons, Ltd. [source] Socioeconomic Status and Belief in a Just World: Sentencing of Criminal Defendants,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 10 2006Naomi J. Freeman The present study investigated whether defendants' socioeconomic status (SES) and jurors' beliefs in a just world affected punishment and blame decisions. The study's 273 participants completed the Just World Scale (Rubin & Peplau, 1975) and read a case scenario describing an aggravated murder. Participants rendered a verdict and answered questions concerning confidence, responsibility, and degree of guilt. Analyses partially supported the hypothesis. High believers in a just world were more likely to assign higher degrees of guilt and to sentence low SES defendants more severely than high SES or no SES information defendants. [source] NGRI Revisited: Venirepersons' Attitudes Toward the Insanity Defense,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2006Brooke Butler Three hundred venirepersons from the 12th Judicial Circuit in Sarasota, Florida completed the following booklet of stimulus materials: one question measuring participants' level of support for insanity defense; a 16-item measure assessing participants' attitudes toward the myths associated with the insanity defense, the legal definitions of insanity, and mental illness; a case scenario; verdict preference; and standard demographic questions. Level of support for the insanity defense was significantly related to participants' attitudes toward legal standards of insanity, mental illness, and the myths associated with the insanity defense. In addition, results indicated that level of support for the insanity defense, age, educational level, occupation, type of prior jury service, and political views were significantly related to verdict preference. Notably, three factors that have been found to impact verdict preference in previous research failed to do so in the current study: participants' experience with psychological disorders; participants' exposure to psychotropic medications; and participants' experience with psychologists or psychiatrists. The findings both replicate and extend earlier findings by suggesting that attitudes toward the insanity defense are more complex than previously imagined. [source] Is Defibrillation Testing Still Necessary?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008A Decision Analysis, Markov Model Objective: To assess the impact of defibrillation threshold (DFT) testing of implanted cardioverter-defibrillators (ICDs) on survival. Background: DFT testing is generally performed during implantation of ICDs to assess sensing and termination of ventricular fibrillation. It is common clinical practice to defibrillate ventricular fibrillation twice at an output at least 10 J below the maximum output of the device, providing a 10 J safety margin. However, there are few data regarding impact of DFT testing on outcomes. Methods: Decision analysis and Monte Carlo simulation were used to assess expected outcomes of DFT testing. Survival of a hypothetical cohort of patients was assessed according to two strategies,routine DFT testing at time of ICD implant versus no DFT testing. Assumptions in the model were varied over a range of reasonable values to assess outcomes under a variety of scenarios. Results: Five-year survival with DFT and no-DFT strategies were similar at 59.72% and 59.36%, respectively. The results were not sensitive to changing risk estimates for arrhythmia incidence and safety margin. Results of the Monte Carlo simulation were qualitatively similar to the base case scenario and consistent with a small and nonsignificant survival advantage with routine DFT testing. Conclusions: The impact of DFT testing on 5-year survival in ICD patients, if it exists, is small. Survival appears higher with DFT testing as long as annual risk of lethal arrhythmia or the risk of a narrow safety margin is at least 5%, although the incremental benefit is marginal and 95% confidence intervals cross zero. A prospective randomized study of DFT testing in modern devices is warranted. [source] A systematic review on communicating with patients about evidenceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2006Lyndal J Trevena MBBS (Hons) MPhilPH Abstract Objective, To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice., ,Data sources, Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. Review methods, Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation., ,Results, We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. Conclusion, There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice. [source] Environmental Impact and Added Value in Forestry Operations in NorwayJOURNAL OF INDUSTRIAL ECOLOGY, Issue 1 2008Ottar Michelsen Summary The forestry sector is experiencing an increasing demand for documentation about its environmental performance. Previous studies have revealed large differences in environmental impact caused by forestry operations, mainly due to differences in location and forestry practice. Reliable information on environmental performance for forestry operations in different regions is thus important. This article presents a case study of forestry operations in Norway. Environmental impact and value added of selected operations were assessed. This was done with a hybrid life cycle assessment (LCA) approach. Main results, including a sensitivity analysis, are presented for a set of four impact categories. The production chain assessed included all processes from seedling production to the delivery of logs to a downstream user. The environmental impact was mainly caused by logging, transport by forwarders, and transport by truck. These three operations were responsible for approximately 85% of the total environmental impact. The contribution to value added and total costs were more evenly distributed among the processes in the value chain. The sensitivity analysis revealed that the difference in environmental impact between the worst case scenario and the best case scenario was more than a factor of 4. The single most important process was the transport distance from the timber pile in the forest to the downstream user. The results show that the environmental impact from forestry operations in boreal forests was probably underreported in earlier studies. [source] Assessing quality of life in paediatric clinical practiceJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2010Angela M Morrow The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome. [source] Transportation demand for petroleum products in Indonesia: a time series analysisOPEC ENERGY REVIEW, Issue 2 2009Suleiman Sa'ad This paper used annual time series data for the period 1973 to 2007 in two econometric techniques [the structural time series model (STSM) and unrestricted error correction model (UECM)] developed to estimate petroleum products (gasoline and diesel) and demand functions for the transportation sector of Indonesia and make a forecast of per capita consumption of the total products until the year 2030 under three scenarios. The results from both models revealed that the demand for petroleum products are price inelastic, with an estimated long-run price elasticity of ,0.19 in the STSM and ,0.16 in the UECM. However, total petroleum is income elastic in the long run with a long-run income elasticity of 0.97 under the STSM and 0.88 in the UECM. The estimated demand functions are used to construct a projection of future transportation demand for petroleum products until 2030 under three alternative scenarios: business as usual, low case scenario and high case scenario. The results of this exercise suggests that by 2030, the demand for total petroleum products per capita for Indonesia will increase to about 0.498 toe in the STSM and 0.476 toe in the UECM under the baseline scenario, 0.197 toe in the STSM and 0.186 toe in the UECM under low case scenario and finally, 0.976 toe in the STSM and 0.886 toe under high case scenario. [source] Die Herausforderung globaler KlimawandelPERSPEKTIVEN DER WIRTSCHAFTSPOLITIK, Issue 2010Mojib Latif The climate problem is therefore closely linked to the way we produce energy. Climate models predict a massive warming by the end of the century should global greenhouse gas emissions not be strongly reduced. The Intergovernmental Panel on Climate Change (IPCC) reports that the warming can amount to up to 4°C in a worst case scenario, which would be unprecedented in speed and extent in man's history. This can lead to an increase of extreme weather events and a rise of global sea level by up to 1m. A less known impact of increasing atmospheric carbon dioxide is ocean acidification, as the oceans take up large amounts of carbon dioxide. Ocean acidification potentially threatens marine life and global food production. [source] Can OECD Countries Afford Demographic Change?THE AUSTRALIAN ECONOMIC REVIEW, Issue 2 2007Ross Guest This article provides new calculations on the effects of demographic change on living standards in all 30 OECD countries using the latest demographic projections up to 2050 from the United Nations, World Population Prospects, 2004 Revision. The calculations include several potential dividends that could offset, at least in part, the costs of a lower working age population share. The effects of demographic change calculated here are mechanical in that there is no explicit optimising behaviour. In the worst case scenario, which assumes zero potential dividends and no increase in labour force participation rates, the negative effect of demographic change on living standards among OECD countries over the whole period from 2006 to 2050 ranges from zero to 28 per cent, with an average over all countries of 15.5 per cent. In the best case scenario the average effect is zero. About half of the difference between the best and worst case scenarios is accounted for by higher labour force participation and about half by the potential dividends from demographic change. [source] Hybrid Simulation Combining a High Fidelity Scenario with a Pelvic Ultrasound Task Trainer Enhances the Training and Evaluation of Endovaginal Ultrasound SkillsACADEMIC EMERGENCY MEDICINE, Issue 5 2009Daniel V. Girzadas Jr MD Abstract Objectives:, In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills. Methods:, A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings. Results:, Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (, VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (, VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (, VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (, VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053). Conclusions:, Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents. [source] A beginner's guide to radiation damageJOURNAL OF SYNCHROTRON RADIATION, Issue 2 2009James M. Holton Many advances in the understanding of radiation damage to protein crystals, particularly at cryogenic temperatures, have been made in recent years, but with this comes an expanding literature, and, to the new breed of protein crystallographer who is not really interested in X-ray physics or radiation chemistry but just wants to solve a biologically relevant structure, the technical nature and breadth of this literature can be daunting. The purpose of this paper is to serve as a rough guide to radiation damage issues, and to provide references to the more exacting and detailed work. No attempt has been made to report precise numbers (a factor of two is considered satisfactory), and, since there are aspects of radiation damage that are demonstrably unpredictable, the `worst case scenario' as well as the `average crystal' are discussed in terms of the practicalities of data collection. [source] Prospects for inferring pairwise relationships with single nucleotide polymorphismsMOLECULAR ECOLOGY, Issue 4 2003Jeffrey C. Glaubitz Abstract An extraordinarily large number of single nucleotide polymorphisms (SNPs) are now available in humans as well as in other model organisms. Technological advancements may soon make it feasible to assay hundreds of SNPs in virtually any organism of interest. One potential application of SNPs is the determination of pairwise genetic relationships in populations without known pedigrees. Although microsatellites are currently the marker of choice for this purpose, the number of independently segregating microsatellite markers that can be feasibly assayed is limited. Thus, it can be difficult to distinguish reliably some classes of relationship (e.g. full-sibs from half-sibs) with microsatellite data alone. We assess, via Monte Carlo computer simulation, the potential for using a large panel of independently segregating SNPs to infer genetic relationships, following the analytical approach of Blouin et al. (1996). We have explored a ,best case scenario' in which 100 independently segregating SNPs are available. For discrimination among single-generation relationships or for the identification of parent,offspring pairs, it appears that such a panel of moderately polymorphic SNPs (minor allele frequency of 0.20) will provide discrimination power equivalent to only 16,20 independently segregating microsatellites. Although newly available analytical methods that can account for tight genetic linkage between markers will, in theory, allow improved estimation of relationships using thousands of SNPs in highly dense genomic scans, in practice such studies will only be feasible in a handful of model organisms. Given the comparable amount of effort required for the development of both types of markers, it seems that microsatellites will remain the marker of choice for relationship estimation in nonmodel organisms, at least for the foreseeable future. [source] A cost-effective simulation curriculum for preclinical endodonticsEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2004Roberta Pileggi A challenge in contemporary dental education is to achieve a smooth transition from preclinical teaching environments to patient-care clinics in a cost-effective manner. The preclinical endodontic courses at The University of Texas, Dental Branch at Houston provide a unique learning environment that enables the student to perform endodontic treatment on extracted teeth in a typodont, and be involved in diagnosis and treatment-planning discussions. The specially designed stone typodont used has built-in radiographic capability, and is mounted at each chair in the clinic. During each preclinical session, students are assigned clinical cubicles and proper aseptic protocol is followed. Students are required to wear gloves, masks and eyewear, and place a rubber dam during treatment. Written self-assessment evaluations based upon prescribed criteria are utilised; feedback is given by faculty composed of both full-time endodontists and graduate students who periodically rotate and are calibrated on a regular basis. In the lecture phase, clinical case scenarios are presented to reinforce concepts of diagnosis and emergency care and to help integrate endodontics with other disciplines; a Socratic-like teaching style is established by the faculty facilitator to create an environment for developing critical-thinking and problem-solving skills. The overall feedback from graduating students has been very positive. Advantages of this format are an easier transition to patient management, a more keen interest in specialsation and a perceived increase in levels of confidence. [source] Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and hematologist perspectivesEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 3 2009Jacqueline A. Guidry Abstract Objectives:, The purpose of this study was to examine hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient's risk for bleeding. The specific aim was to compare patient and hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than hematologists. Methods:, We surveyed 80 patients in the Oklahoma ITP Registry and all 83 hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results:, Response rates were 80% (patients) and 71% (hematologists). Responses of patients and hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000/,L and 5000/,L (P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been <10 000/,L. Conclusion:, Awareness of the different opinions about corticosteroid side-effects and risk for bleeding between ITP patients and hematologists may improve management decisions. [source] Low cycle thermo-mechanical fatigue: damage operator approachFATIGUE & FRACTURE OF ENGINEERING MATERIALS AND STRUCTURES, Issue 3 2010M. NAGODE ABSTRACT The strain-life approach is standardized and widely accepted for determining fatigue damage under strain-controlled low cycle fatigue (LCF) loading. It was first extended to non-isothermal cases by introducing an equivalent temperature approach (ETA). The paper presents its extension that is the damage operator approach (DOA) enabling online continuous damage calculation for isothermal and non-isothermal loading with mean stress correction. The cycle closure point, cycle equivalent temperature, threshold temperature and separate rainflow counting obligatory for the ETA are not necessary for the DOA any more. Both approaches are equivalent for the second and subsequent runs of block loading if temperature is constant. However, for non-isothermal cases, the DOA is within the worst and the best case scenarios of the ETA. The approaches are compared to the simple stress histories and several thermo-mechanical fatigue (TMF) cycle types. [source] Menstrual Migraine: Case Studies of Women with Estrogen-Related HeadachesHEADACHE, Issue 2008Susan L. Hutchinson MD This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms. [source] Distinguishing Between Damage to Clothing as a Result of Normal Wear and Tear or as a Result of Deliberate Damage: A Sexual Assault Case StudyJOURNAL OF FORENSIC SCIENCES, Issue 2 2009Dyan J. Daly Ph.D. Abstract:, This paper focuses on bra damage, specifically damage observed in hook and eye fasteners that are generally located at the backstraps of bras. We describe bra design including the method by which hook and eye fasteners are generally constructed. We assess bra damage in two situations where the damage observed was unexpected given the case scenarios. These were: (i) the complainant of an alleged rape attributed damage to her bra hooks to force during a struggle and (ii) the complainant had earlier manipulated her bra hooks in an incident not related to her complaint. Steriomicroscopy and reconstruction experimentation were necessarily used to assess the bra damage. A systematic approach to damage analysis was employed by the forensic practitioners to correctly identify damage as being a result of mechanical manipulation and therefore as falsified. This paper suggests that more examples of falsified damage should be documented. [source] Evaluation of first unprovoked seizures in children by general paediatricians in New ZealandJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2006Rachel E Johnson Aim: To determine current practice of general paediatricians in New Zealand in the investigation and management of a first unprovoked seizure in childhood. Methods: A self-administered questionnaire was emailed to 109 general paediatricians in New Zealand. The questionnaire presented the participant with three hypothetical case scenarios representing a generalised tonic clonic seizure, a complex partial seizure and an episode of non-specific collapse. The participant was asked to indicate what investigations and course of management was required. Results: Forty-seven questionnaires were returned. Primary investigations included an electroencephalogram (EEG) in 47% of cases after a first generalised tonic clonic seizure increasing to 89% after a second. Ninety-one per cent of paediatricians were likely to request an EEG after a complex partial seizure. No paediatrician would request neuroimaging following a first generalised tonic clonic seizure. Neuroimaging was requested by 10% of paediatricians following a second generalised tonic clonic seizure and by 47% following a complex partial seizure. No paediatrician elected to initiate antiepileptic drugs after a first generalised tonic clonic seizure, but 49% would initiate treatment after a second generalised tonic clonic seizure. Eleven per cent of paediatricians would start treatment after a single complex partial seizure. Conclusion: Less than 50% of general paediatricians would request an EEG after a first unprovoked seizure. This is an unexpectedly low rate that may reflect accessibility. New Zealand paediatricians had an appropriately low rate of requesting neuroimaging. As currently recommended no general paediatricians began antiepileptic drugs in the scenario of a single uncomplicated seizure in the absence of other risk factors. [source] The quality of a simulation examination using a high-fidelity child manikinMEDICAL EDUCATION, Issue 2003T-C Tsai Purpose, Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. Method, Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, ,working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. Results, The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. Conclusions, With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations. [source] The transition from knowing to doing: teaching junior doctors how to use insulin in the management of diabetes mellitusMEDICAL EDUCATION, Issue 8 2003Jennifer J Conn Objective To develop and evaluate a short education programme to improve the skills and confidence of junior doctors in managing the glycaemic control of inpatients with diabetes mellitus. Methods A total of 15 junior doctors completed two 1-hour workshops on the practical skills required to manage the glycaemic control of insulin-treated patients. The workshops were based on simulated case scenarios presented in a workbook format. Pre-workshop performance and levels of confidence were tested, using a set of tasks matched to the learning objectives. Participants were re-tested immediately after the second workshop and again after 3 months. Results There was a significant overall effect for time of testing for performance and confidence considered together, F(4,11) = 12.67, P = 0.000, power = 1.00. The mean score for performance for the intermediate and 3-month post-tests combined was significantly higher than the mean performance score for the pre-test (11.00 < [17.53 + 15.80]), t(56) = ,6.50, P = 0.000 (95% CI ,6.15, ,3.10). The mean score for confidence for the intermediate and 3 month post-tests combined was higher than the mean for the pre-test (13.20 < [15.33 + 15.20]), t(56) = 2.95, P = 0.011 (95% CI 2.19, 0.46), although this result must be treated with caution. Conclusions A brief educational intervention can improve and maintain the performance and confidence of junior doctors in managing patients with insulin-treated diabetes in a simulated environment. [source] What adjustments, if any, do UK optometrists make to the subjective refraction result prior to prescribing?OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2010Chris Howell-Duffy Abstract Aim:, To determine whether UK optometrists routinely prescribe the subjective refraction result, or whether adjustments are made to aid patient comfort and adaptation. Method:, A questionnaire was distributed by post and via the internet to UK optometrists. It incorporated eight case scenarios that included information regarding a patient's age, symptoms, habitual refractive correction, subjective refraction and any other pertinent clinical information. For each case, they were asked to indicate what refractive correction they would prescribe. Results:, A total of 426 questionnaires were completed. In three cases with asymptomatic patients with negligible changes in visual acuity, about 45% of respondents indicated that they would prescribe the subjective refraction result and about 40% would prescribe the habitual correction. In a further case involving a 75 year-old asymptomatic patient, 55% prescribed the habitual correction. In two cases with large cylinder power changes, about 40% of respondents indicated they would partially prescribe the cylinder power. However, there was a large variation in the suggested modification of sphere powers to accompany the partial cylinder changes. Conclusion:, A large sample of UK optometrists indicated that they would prescribe the subjective refraction result regardless of patient age, symptoms and difference between habitual correction and subjective refraction. Optometrists who partially prescribe, employ a wide variety of techniques including some that conflict with conventional teaching. [source] THE INCREMENTAL VALIDITY OF INTERVIEW SCORES OVER AND ABOVE COGNITIVE ABILITY AND CONSCIENTIOUSNESS SCORESPERSONNEL PSYCHOLOGY, Issue 2 2000JOSE M. CORTINA Recent research has suggested that scores on measures of cognitive ability, measures of Conscientiousness, and interview scores are positively correlated with job performance. There remains, however, a question of incremental validity: To what extent do interviews predict above and beyond cognitive ability and Conscientiousness? This question was addressed in this paper by (a) conducting meta-analyses of the relationships among cognitive ability, Conscientiousness, and interviews, (b) combining these results with predictive validity results from previous meta-analyses to form a "meta-correlation matrix" representing the relationships among cognitive ability, Conscientiousness, interviews, and job performance, and (c) performing 9 hierarchical regressions to examine the incremental validity of 3 levels of structured interviews in best, actual, and worst case scenarios for prediction. Results suggested that interview scores contribute to the prediction of job performance over and above cognitive ability and Conscientiousness to the extent that they are structured, with scores from highly structured interviews contributing substantially to prediction. Directions for future research are discussed. [source] Can OECD Countries Afford Demographic Change?THE AUSTRALIAN ECONOMIC REVIEW, Issue 2 2007Ross Guest This article provides new calculations on the effects of demographic change on living standards in all 30 OECD countries using the latest demographic projections up to 2050 from the United Nations, World Population Prospects, 2004 Revision. The calculations include several potential dividends that could offset, at least in part, the costs of a lower working age population share. The effects of demographic change calculated here are mechanical in that there is no explicit optimising behaviour. In the worst case scenario, which assumes zero potential dividends and no increase in labour force participation rates, the negative effect of demographic change on living standards among OECD countries over the whole period from 2006 to 2050 ranges from zero to 28 per cent, with an average over all countries of 15.5 per cent. In the best case scenario the average effect is zero. About half of the difference between the best and worst case scenarios is accounted for by higher labour force participation and about half by the potential dividends from demographic change. [source] Reliability and Validity of the Emergency Severity Index for Pediatric TriageACADEMIC EMERGENCY MEDICINE, Issue 9 2009Debbie A. Travers PhD Abstract Objectives:, The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites. Methods:, Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay. Results:, Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi-square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67). Conclusions:, Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric-specific ESI educational materials to strengthen reliability and validity for pediatric triage. [source] The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological reportARTHRITIS & RHEUMATISM, Issue 9 2010Tuhina Neogi Objective The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that should contribute to the final criteria set. Methods Twenty-four expert RA clinicians (12 from Europe and 12 from North America) participated in Phase 2. A consensus-based decision analysis approach was used to identify factors (and their relative weights) that influence the probability of "developing RA," complemented by data from the Phase 1 study. Patient case scenarios were used to identify and reach consensus on factors important in determining the probability of RA development. Decision analytic software was used to derive the relative weights for each of the factors and their categories, using choice-based conjoint analysis. Results The expert panel agreed that the new classification criteria should be applied to individuals with undifferentiated inflammatory arthritis in whom at least 1 joint is deemed by an expert assessor to be swollen, indicating definite synovitis. In this clinical setting, they identified 4 additional criteria as being important: number of joints involved and site of involvement, serologic abnormality, acute-phase response, and duration of symptoms in the involved joints. These criteria were consistent with those identified in the Phase 1 data-driven approach. Conclusion The consensus-based, decision analysis approach used in Phase 2 complemented the Phase 1 efforts. The 4 criteria and their relative weights form the basis of the final criteria set. [source] | ||||||||||||||||||||||