Letter: Comment on comments about reading.
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Adolescent↗
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[Minilaparotomy in colon surgery--a comment to a comment].
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Colectomy↗
The nature of qualitative comments in evaluating professionalism.
INTRODUCTION: We analysed written comments on clerkship evaluation forms to determine if they furthered our understanding of students' professional behaviour. METHODS: We transcribed all written comments related to professional behaviour for 1 medical school class in 4 major clerkships, then categorised the comments. Comments were coded into categories by two raters. They were also coded as positive, negative or equivocal. The 3 types of comments were each correlated with a Likert-type score for professionalism for each student in these same clerkships. RESULTS: Most comments covered initiative, working well with others, patient skills and working hard. Of the 1845 comments, 1721 were positive, 106 were negative and 18 were equivocal, neither wholly positive nor wholly negative. The total number of positive comments correlated with the students' numerical professionalism score (r = 0.29, P < 0.001); negative comments correlated negatively with the numerical professionalism score (r = -0.44, P < 0.001). Equivocal comments were significantly negative (r = -0.25, P = 0.002). Qualitative analysis revealed that equivocal comments were focused on maturity, initiative and teamwork. CONCLUSIONS: Written comments contain unique indicators of students' professional behaviour and are largely positive in nature; negative comments stand out by their rarity and intensity. There is a set of negative comments masked by evaluators in language that appears neutral or even partly positive that statistically resemble negative comments and should be regarded as such by students who receive this type of comments. Evaluators should be encouraged and trained to express their qualitative views of students.
Clinical Clerkship↗
Quality assessment of interpretative commenting in clinical chemistry.
BACKGROUND: Clinical interpretation of laboratory results is an integral part of clinical chemistry. However, the performance goals for assessing interpretative commenting in this discipline have not been as well established as for the quality of analytical requirements. METHODS: We present a review of the 10 case reports circulated in the 2002 Patient Report Comments Program by the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists Chemical Pathology Group of RCPA-Quality Assurance Programs Pty Ltd. Participants were expected to add an interpretative comment to a set of results accompanied by brief clinical details. Comments received were broken down into components that were translated into key phrases. An expert panel evaluated the appropriateness of the key phrases and proposed a suggested composite comment. A case summary/rationale was also returned to participants. RESULTS: There was considerable diversity in the range of interpretative comments received for each case report. Although the majority of comments received were felt to be acceptable by the expert panel, some comments were felt to be inappropriate, misleading, or in a few instances, dangerous. CONCLUSION: The golden rule in medicine is "do no harm". Although there is no objective evidence that interpretive comments help to improve patient outcomes, if comments are added to reports it is important that they reflect accepted practice and current guidelines. It is of concern that a large proportion of comments returned were considered to be inappropriate and/or misleading. The Patient Report Comments Program has highlighted the need to consider limiting commenting to persons with clear expertise.
Clinical Chemistry Tests↗
Review of a pilot quality-assessment program for interpretative comments.
BACKGROUND: Interpretative commenting constitutes an important aspect of the post-analytical phase in chemical pathology, but has only recently been the subject of quality assessment. The Royal College of Pathologists of Australasia (RCPA)-Australasian Association of Clinical Biochemists (AACB) Chemical Pathology Patient Report Comments Program is currently in its third year, having started in 2000 as a pilot program. We present a review of the pilot program. METHODS: The program is aimed at individuals rather than laboratories. Two cases were circulated to participants of the Chemical Pathology Quality Assurance Program every month over a 6-month period. The case report contained the age and sex of the patient, together with brief clinical notes, the biochemistry results for commenting and other information of relevance. Three lines of space were given for the comment. The comments received from participants were broken down into their components and translated into common key phrases for the purpose of summarization and analysis. A histogram of the frequency of use of the common key phrases was generated. The comments or the key phrases were not given scores or marks, nor was any other indication given as to the appropriateness of their comments. RESULTS: This approach of simple peer-group comparison of comments without any assessment of the appropriateness of the comments was found to be inadequate; thus, when the program continues, key phrases will be classified according to degree of appropriateness and a suggested comment for each case will be proposed by an 'expert' panel. CONCLUSIONS: The program can serve a useful role in continuing education. Clinical biochemists and trainees who add interpretative comments to results produced by their laboratory, or give interpretative advice over the telephone, may potentially benefit from participating in this program.
Aged↗
Comments heard by US medical students about family practice.
BACKGROUND AND OBJECTIVES: This study was conducted to explore the hypothesis that negative comments from faculty and residents about family practice are related to the recent decline in student selection of this specialty. METHODS: A questionnaire was sent to all family physicians and an equal number of other primary care physicians who graduated from one of 24 medical schools in 1997-1999. Twelve schools had increasing proportions of graduates choosing family practice in the study period, and 12 had decreasing proportions. The questionnaire asked about negative comments heard about family practice and other primary care specialties. RESULTS: Most graduates heard negative comments about family practice during medical school, and many students heard these comments often. However, the frequency and content of negative comments was not related to increases or decreases in the proportion of students choosing family practice. Negative comments were heard more frequently about family practice than about other primary care specialties. Negative comments increased in frequency during the study period. The negative comments on the questionnaire heard most often were that family physicians cannot master the content of the specialty and that they are not as smart as other physicians. Compared to other graduates, those with an initial interest in family practice who chose another specialty more frequently reported hearing that family physicians can't master the specialty content. There was an inverse relationship between the number of groups (students, residents, and faculty) that negative comments were heard from and ranking of family medicine faculty on respectability, influence, and competence. CONCLUSIONS: After 3 decades of being an officially recognized specialty, family practice is not recognized by some other medical school faculty as an equal to other primary care disciplines, and these faculty frequently express this view to students. While the frequency of these negative comments is increasing and is related to trainees' perceptions of family medicine faculty, it does not explain the recent decline in student interest in family practice. There is some evidence that students who change their career plans away from family practice might be concerned with their ability to master the specialty content. The prevalence of negative comments is related to trainees' perceptions of family medicine faculty.
Attitude↗
Elevator talk: observational study of inappropriate comments in a public space.
OBJECTIVES: We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. METHODS: Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. RESULTS: We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. CONCLUSION: Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.
Confidentiality↗
The use of dedicated methodology and statistical reviewers for peer review: a content analysis of comments to authors made by methodology and regular reviewers.
STUDY OBJECTIVES: In 1997, Annals of Emergency Medicine initiated a protocol by which every original research article, in addition to each regular review, was concurrently evaluated by 1 of 2 methodology and statistical reviewers. We characterized and contrasted comments made by the methodology and regular peer reviewers. METHODS: After pilot testing, interrater reliability assessment, and revision, we finalized a 99-item taxonomy of reviewer comments organized in 8 categories. Two authors, uninvolved in the writing of reviews, classified each comment from a random sample of methodology reviews from 1999. For 30 of these reviews (15 for each methodology reviewer), the 2 authors also scored all (range 2 to 5) regular reviews. RESULTS: Sixty-five reviews by methodologist A, 60 by methodologist B, and 68 by regular reviewers were analyzed. Comments by methodologist A most frequently concerned the presentation of results (33% of all comments) and methods (17%). Methodologist B commented most frequently on presentation of results (28%) and statistical methods (16%). Regular reviewers most frequently made non-methodology/statistical comments (45%) and comments on presentation of results (18%). Of note, comments made by methodology and regular reviewers about methods issues were often contradictory. CONCLUSION: The distributions of comments made by the 2 methodology and statistical reviewers were similar, although reviewer A emphasized presentation and reviewer B stressed statistical issues. The regular reviewers (most of whom were unaware that a dedicated methodology and statistical reviewer would be reviewing the article) paid much less attention to methodology issues. The 2 dedicated methodology and statistical reviewers created reviews that were similarly focused and emphasized methodology issues that were distinct from the issues raised by regular reviewers.
Peer Review, Research↗
A discussion of cases in the 2001 RCPA-AQAP Chemical Pathology Case Report Comments Program.
AIM: We present a descriptive analysis of the 10 case reports distributed in the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) Chemical Pathology Patient Report Comments Program to assess the quality of interpretative commenting in clinical biochemistry in 2001. METHOD: Participants were asked to comment on a given set of biochemistry results attached with brief clinical details. All responses received were translated into key phrases and graphically presented on a histogram. An expert panel was asked to evaluate the appropriateness of the key phrases and to propose a suggested composite comment. RESULTS: While the majority of comments received were felt to be acceptable by the expert panel, some comments were felt to be inappropriate or misleading. As comments on laboratory reports may affect clinical management of patients, it is important that these comments reflect accepted practice and current guidelines. CONCLUSION: The Patient Report Comments Program may play an important role in continuing education and possibly in quality assurance of interpretative commenting.
Adult↗
The redundancy of student comments and numerical ratings in evaluations of teaching.
Student evaluation of teaching effectiveness is widely used in undergraduate institutions as one element of determining overall faculty effectiveness. The evaluation format typically consists of (1) a number of questions the student answers by indicating a numerical rating and (2) an open-ended section for written comments. Some faculty members believe that the numerical ratings are not taken seriously by the students, and that the written comments impose greater accountability on the part of students. On the other hand, numerical ratings are necessary to minimize the fear that unfavorable written comments will be taken out of context in promotion decisions. Tabulation of numerical ratings is essential if a computerized data base for faculty evaluation is to be established. This study was designed to examine the relationship between student's numerically based ratings and written comments by evaluating allied health instructors using a standard, schoolwide evaluation form. Written comments were categorized according to a five-point scale and compared to mean values obtained from numerical ratings. Twenty-two faculty and 1,311 student evaluations were included. Significant positive correlations were found between the numerical student ratings and the written comments. The highest correlations were between student comments and two items related to overall teaching effectiveness. Students who evaluated instructors at either extreme on the spectrum of effectiveness were most likely to include written comments. Based on the consistency of numerical ratings and written comments we recommend that only the numerical ratings be used as part of the promotion and tenure decision-making process.(ABSTRACT TRUNCATED AT 250 WORDS)
Allied Health Personnel↗
A pleasure to work with--an analysis of written comments on student evaluations.
OBJECTIVE: Studies assessing rating scales on student evaluations are available. However, there are no data related to the written comments on these evaluations. This study was designed to evaluate these comments. METHODS: A content analysis was performed on the narrative section of pediatric clerks' evaluations. Final evaluations were obtained from 10 outpatient clinical sites staffed by full-time faculty over 14 months. A coding dictionary containing 12 categories (7 linked to clinical skills) was used. RESULTS: One thousand seventeen comments on 227 evaluations were coded. The mean number of comments per evaluation was 4. Learner and personal characteristics were the largest categories. Normative comments, such as "good physical exam," as opposed to more specific comments, such as "complete presentation," predominated in all categories. CONCLUSIONS: Evaluation comments were infrequently related to basic clinical skills and were not often specific enough to lead to effective change in a student's performance. Faculty development is needed to make final evaluation comments more useful for students.
Clinical Clerkship↗
Medicare program; changes to the hospital outpatient prospective payment system and calendar year 2005 payment rates. Final rule with comment period.
This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. In addition, the final rule with comment period describes final changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2005. In this final rule with comment period, we are responding to public comments received on the January 6, 2004 interim final rule with comment period relating to MMA provisions that were effective January 1, 2004, and finalizing those policies. Further, we are responding to public comments received on the November 7, 2003 final rule with comment period pertaining to the ambulatory payment classification assignment of Healthcare Common Procedure Coding System (HCPCS) codes identified in Addendum B of that rule with the new interim (NI) comment indicators (formerly referred to as condition codes).
Centers for Medicare and Medicaid Services, U.S.↗
Are the characteristics of narrative comments related to improvement in multirater feedback ratings over time?
Researchers have paid almost no attention to the narrative comments that typically accompany multirater feedback reports despite the fact that both anecdotal and empirical evidence suggest that feedback recipients devote considerable attention to such comments. The authors examined improvement in upward feedback ratings over a 1-year period for 176 managers as a function of (a) the number of narrative comments each manager received, (b) whether those comments were favorable (vs. unfavorable), and (c) whether the comments were behavior/task focused (vs. trait focused). The authors found that managers who received a small number of unfavorable, behavior/task-focused comments improved more than did other managers, whereas managers who received a large number of unfavorable, behavior/task-focused comments declined more than did other managers.
Administrative Personnel↗
The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders.
OBJECTIVE: Our purpose with this work was to examine the relationship between negative comments about weight, shape, and eating and social adjustment, social support, self-esteem, and perceived childhood abuse and neglect. METHODS: A retrospective study was conducted with 455 college women with high weight and shape concerns, who participated in an Internet-based eating disorder prevention program. Baseline assessments included: perceived family negative comments about weight, shape, and eating; social adjustment; social support; self-esteem; and childhood abuse and neglect. Participants identified 1 of 7 figures representing their maximum body size before age 18 and parental maximum body size. RESULTS: More than 80% of the sample reported some parental or sibling negative comments about their weight and shape or eating. Parental and sibling negative comments were positively associated with maximum childhood body size, larger reported paternal body size, and minority status. On subscales of emotional abuse and neglect, most participants scored above the median, and nearly one third scored above the 90th percentile. In a multivariate analysis, greater parental negative comments were directly related to higher reported emotional abuse and neglect. Maximum body size was also related to emotional neglect. Parental negative comments were associated with lower reported social support by family and lower self-esteem. CONCLUSIONS: In college women with high weight and shape concerns, retrospective reports of negative comments about weight, shape, and eating were associated with higher scores on subscales of emotional abuse and neglect. This study provides additional evidence that family criticism results in long-lasting, negative effects.
Adult↗
Medicare program; changes to the hospital outpatient prospective payment system and calendar year 2006 payment rates. Final rule with comment period.
This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. In addition, the final rule with comment period describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. This final rule with comment period also changes the requirement for physician oversight of mid-level practitioners in critical access hospitals (CAHs). In this final rule with comment period, we also are responding to public comments received on the November 15, 2004, final rule with comment period pertaining to the ambulatory payment classification (APC) group assignment of Healthcare Common Procedure Coding System (HCPCS) codes identified in Addendum B of that rule with the new interim (NI) comment indicator. These changes are applicable to services furnished on or after January 1, 2006.
Ambulatory Care↗
PDA comments: SUPAC-IR, ICH Q1C, FDA draft guideline. Parenteral Drug Association.
Following are comments prepared by PDA on three draft regulatory documents all relating to stability for post-approval changes, new dosage forms and related issues. The comments on SUPAC-IR and ICH Q1C were submitted to FDA on February 10, 1995. The comments on the December 12, 1994 draft guideline were submitted on March 10, 1995. The documents have different sources and content, however, there is some overlap between the three. Readers may wish to peruse the table attached to the March 10, 1995 PDA comments for a graphic analysis of the contents of the three documents. Readers are cautioned that these comments are based on draft proposals by FDA and/or the International Conference on Harmonization. More recent drafts may be available. Copies of all three documents are available from PDA (SUPAC-IR: Document #FDA 79; ICH Q1C: #FDA 93; December 12, 1994 guideline: #FDA 77). See the PDA Letter or contact the PDA staff for additional information. Further clarifying comments can be found in the January, March and April 1995 issues of the PDA Letter. Staff contact is James Lyda. PDA expresses thanks to the working group which drafted the comments on very short notice: Raymond Shaw, Jr. Ph.D., Merck (now of Wyeth-Ayerst) (Chair); Robert Barraza, Burroughs Wellcome; Fred Gustafson, Abbott; Paulette Kosmoski, and Russel Madsen and James Lyda, PDA.
Dosage Forms↗
Nurses' concerns about using information systems: analysis of comments on a computerized nursing care plan system in Taiwan.
AIMS AND OBJECTIVES: The purpose of this study was to pursue a deeper understanding of nurses' perceptions of a computerized nursing care plan as written in comments on a survey. BACKGROUND: Studies have examined nurses' perceptions of computer use, but comments written on surveys of computerized nursing care planning have never been reported and the pattern and meaning of such feedback have not been systematically analysed. DESIGN: Of 738 nurses in Taiwan who completed a two-part survey to evaluate a computerized nursing care plan, 202 responded on part II to an open-ended question about overall perceptions of a nursing information system. METHODS: A sample of 10 questionnaires with comments was subjected to qualitative content analysis. Key words and phrases were identified, then grouped into categories, which were used to code the remaining respondents' comments. Another 20 were used to pilot test these coding categories. The final coding categories were applied to all 202 questionnaires with comments for data analysis. RESULTS: Nurses were concerned about inconvenient access to computers; reduced work efficiency; inability to individualize patient care and nursing specialty deficiencies; poor content design, system function, and system integration; using the system as a policy requirement; and privacy and legal issues. CONCLUSIONS: Hardware availability, content design and user training/education programmes are critical issues that affect nurses' use of computers in their daily practice. RELEVANCE TO CLINICAL PRACTICE: These comments can be applied in strategic planning and staff development programmes to further use of information systems in patient care.
Adult↗
Provision of interpretative comments on biochemical report forms.
Providing interpretative comments on reports, particularly those for primary care physicians is an important part of our job. Few clinical biochemists (whether medical or scientific) receive significant training for this. Most work in isolation, and few receive feedback on the utility of their comments. Surveys show an extremely wide divergence of opinion and comment even on apparently straightforward sets of abnormal results. Some comments are regarded as highly inappropriate when assessed by peer review. There is a need for further education and training in this area, concentrating as much on 'how to comment' as on 'what to comment'. There is also a need to establish some form of quality assurance for this important part of the post-analytical phase. A pilot External Quality Assurance Scheme (EQAS) is now being established.
Biochemistry↗