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PubMed2005

A new curriculum for hysteroscopy training as demonstrated by an objective structured assessment of technical skills (OSATS).

OBJECTIVE: The purpose of this study was to develop an effective curriculum to teach hysteroscopy, as well as to develop an objective assessment instrument (OSATS). STUDY DESIGN: All 24 residents in our training program attended a 3-hour hysteroscopy curriculum in each of 3 years. Each year after the curriculum, an OSATS was administered consisting of an assembly and operative task. Each task was evaluated with a task-specific checklist and a previously validated global assessment form. Twenty-four residents from an outside institution served as controls. All residents were examined by blinded and unblinded examiners. RESULTS: The reliability coefficient was .7857 for the checklist and .9763 for the global scale. Interrater reliability for the checklist was .7478 and ranged from .4222 to .9329 for the global instruments. Evaluation of construct validity revealed that the junior residents at both locations did significantly worse on the checklist and global scale than the senior residents for all 3 years of the study (P < .001). Those residents provided the curriculum did significantly better on both the checklist and the global scale than the resident controls with a mean of 45% versus 63% for the checklist and 18.3 versus 24.9 for the global score. (P = .001 checklist, P = .007 global scale). CONCLUSION: This curriculum is an effective way to impart knowledge and skill in the assembly and use of the operative hysteroscope. The checklist developed for this OSATS has excellent reliability and construct validity.

Clinical Competence↗
PubMed2003

Psychologic profile of tinnitus patients using the SCL-90-R and Tinnitus Handicap Inventory.

OBJECTIVE: To correlate the Tinnitus Handicap Inventory and the Symptom Checklist-90-R results on a group of tinnitus patients and to compare the average scores of the Tinnitus Handicap Inventory and SCL-90-R for help-seeking and non-help-seeking patients with tinnitus. STUDY DESIGN: A prospective study in which tinnitus patients were administered the Tinnitus Handicap Inventory and the Symptom Checklist-90-R. SETTING: Tertiary referral center. PATIENTS: Patients with tinnitus seeking audiological services. INTERVENTIONS: Rehabilitative. MAIN OUTCOME MEASURES: Results of Tinnitus Handicap Inventory and Symptom Checklist-90-R. RESULTS: Fifty-three consecutive patients having tinnitus were administered the Tinnitus Handicap Inventory and the Symptom Checklist-90-R. There was a significant correlation between the Symptom Checklist-90-R and the Tinnitus Handicap Inventory (rs = 0.43). Furthermore, 25% of these patients scored abnormally high on the Symptom Checklist-90-R, which is substantially more than the general medical population of patients. CONCLUSIONS: Based on this sample of 53 patients, the Symptom Checklist-90-R does seem to be a useful tool in identifying distress among tinnitus patients. The Global Severity Index of the Symptom Checklist-90-R has a defined cutoff score indicating significant distress levels, which makes it a useful screening tool for identifying those who would benefit from psychologic or psychiatric intervention.

Adult↗
PubMed2001

The ability of naive participants to report symptoms of post-traumatic stress disorder.

OBJECTIVE: Research suggests that naive participants can simulate PTSD (post-traumatic stress disorder) using a symptom checklist. Is successful faking of DSM-IV criteria B-D on PTSD checklists due to prior knowledge of PTSD, the leading nature of symptom checklists, or a combination? DESIGN: Between-groups design. METHOD: Naïve participants self-generated PTSD symptoms from a vignette. They were then randomly assigned to groups given a standard symptom checklist or a checklist containing bogus items not normally associated with PTSD. RESULTS: Less than 1% self-generated symptoms that met DSM-IV criteria B-D for PTSD. It was found that 94% of participants satisfied these criteria using the standard checklist and 90% on the modified checklist. Participants incorrectly identified 38% of bogus symptoms as symptoms of PTSD. CONCLUSIONS: Despite poor prior knowledge of PTSD, 94% of participants fulfilled diagnostic criteria using a standard checklist. This is probably due to symptom 'guessing'.

Adult↗
PubMed2005

Knowledge of post-concussional syndrome in naïve lay-people, general practitioners and people with minor traumatic brain injury.

BACKGROUND: Expectations about effects of minor traumatic brain injury (MTBI) may play a role in maintaining symptoms, the ability to simulate post-concussion syndrome (PCS) and the extent to which professionals might associate patient complaints with MTBI. In turn, expectations will be related to knowledge about MTBI. This study investigates knowledge of PCS in people with MTBI compared with general practitioners (GPs) and lay-people, using recall (a vignette) and symptom guessing or recognition (checklists). METHODS: Thirty GPs, 30 people with MTBI, and 30 lay-people generated symptoms from a vignette describing a MTBI. They then completed a PCS checklist or a checklist containing PCS and 'bogus' items pertaining to the vignette. RESULTS: Only 1 of 90 participants reported enough PCS symptoms to indicate 'caseness' from the vignette alone. Using checklists, more GPs (60%) than controls (20%) ticked enough symptoms to attain PCS 'caseness'. Few people with MTBI who did not themselves achieve PCS 'caseness' by self-report using checklists achieved 'caseness' using the vignette and checklists. The frequency of non-physical symptom reporting was higher than for physical symptom reporting. The addition of 'bogus' items to checklists did not affect responding. CONCLUSIONS: It is unlikely that pre-injury expectations about MTBI maintain PCS symptoms. PCS was difficult to simulate without prompting, even by GPs and PCS 'cases'. The use of 'caseness', rather than simple symptom scores, and further development of checklists with 'bogus' items may provide a more valid assessment of MTBI effects. GPs may benefit from further information about PCS and available treatments.

Adult↗
PubMed1988

[Fatigue and low-back pain of freight-container tractor drivers. Correlation with ergonomic factors].

An ergonomic checklist was prepared to examine safety and comfort of freight-container tractors. With this checklist, 533 tractor drivers were asked to evaluate the tractors to which they were exclusively assigned. In order to check the objectivity and the validity of the results, the correlation between the evaluation of the items on the checklist and the corresponding dimensions on 10 tractors was studied. Also, a multivariate analysis based on quantification theory was done to examine the correlation between the ergonomic items on the checklist and the drivers' low-back pain or fatigue symptoms of the upper and lower extremities. The main results were as follows: 1) A high correlation was observed between the evaluation of items on the checklist and the corresponding dimensions of the tractors. 2) Many items on the checklist received a poor evaluations, indicating that there are many ergonomic problems with freight-container tractors. 3) The analysis by the quantification theory showed high correlation ratios between the items in the checklist and the drivers' fatigue symptoms of the upper and lower extremities. These correlation ratios were: arm fatigue when holding the steering wheel (0.51), arm fatigue in operating the gearshift lever (0.65), arm fatigue from opening and closing the windows (0.46), leg fatigue from operating the pedals (0.58), and low-back pain during the last two months (0.31). These showed that more than 50% of the fatigue symptoms could be explained by the ergonomic aspects of the tractors. 4) The rate of dissatisfaction with the current tractors was 82.9%. According to the analysis by the quantification theory, the correlation ratio between the items in the checklist and the rate of dissatisfaction for the current tractors was 0.66. 5) The foregoing results indicate that ergonomic improvement of the freight-container tractors is a matter of urgency. This should reduce the drivers' fatigue and elevate the rate of satisfaction with the tractors. 6) However, for the prevention of the drivers' low-back pain and fatigue symptoms, improvement of the ergonomic conditions of the tractors and the drivers' working conditions must be undertaken at the same time.

Adult↗
PubMed2000

Parents on the web: risks for quality management of cough in children.

BACKGROUND: Health information on the Internet, with respect to common, self-limited childhood illnesses, has been found to be unreliable. Therefore, parents navigating on the Internet risk finding advice that is incomplete or, more importantly, not evidence-based. The importance that a resource such as the Internet as a source of quality health information for consumers should, however, be taken into consideration. For this reason, studies need to be performed regarding the quality of material provided. Various strategies have been proposed that would allow parents to distinguish trustworthy web documents from unreliable ones. One of these strategies is the use of a checklist for the appraisal of web pages based on their technical aspects. OBJECTIVE: The purpose of this study was to assess the quality of information present on the Internet regarding the home management of cough in children and to examine the applicability of a checklist strategy that would allow consumers to select more trustworthy web pages. METHODS: The Internet was searched for web pages regarding the home treatment of cough in children with the use of different search engines. Medline and the Cochrane database were searched for available evidence concerning the management of cough in children. Three checklists were created to assess different aspects of the web documents. The first checklist was designed to allow for a technical appraisal of the web pages and was based on components such as the name of the author and references used. The second was constructed to examine the completeness of the health information contained in the documents, such as causes and mechanism of cough, and pharmacological and nonpharmacological treatment. The third checklist assessed the quality of the information by measuring it against a gold standard document. This document was created by combining the policy statement issued by the American Academy of Pediatrics regarding the pharmacological treatment of cough in children with the guide of the World Health Organization on drugs for children. For each checklist, the web page contents were analyzed and quantitative measurements were assigned. RESULTS: Of the 19 web pages identified, 9 explained the purpose and/or mechanism of cough and 14 the causes. The most frequently mentioned pharmacological treatments were single-ingredient suppressant preparations, followed by single-ingredient expectorants. Dextromethorphan was the most commonly referred to suppressant and guaifenesin the most common expectorant. No documents discouraged the use of suppressants, although 4 of the 10 web documents that addressed expectorants discouraged their use. Sixteen web pages addressed nonpharmacological treatment, 14 of which suggested exposure to a humid environment and/or extra fluid. In most cases, the criteria in the technical appraisal checklist were not present in the web documents; moreover, 2 web pages did not provide any of the items. Regarding content completeness, 3 web pages satisfied all the requirements considered in the checklist and 2 documents did not meet any of the criteria. Of the 3 web pages that scored highest in technical aspect, 2 also supplied complete information. No relationship was found, however, between the technical aspect and the content completeness. Concerning the quality of the health information supplied, 10 pages received a negative score because they contained more incorrect than correct information, and 1 web page received a high score. This document was 1 of the 2 that also scored high in technical aspect and content completeness. No relationship was found, however, among quality of information, technical aspect, and content completeness. CONCLUSIONS: As the results of this study show, a parent navigating the Internet for information on the home management of cough in children will no doubt find incorrect advice among the search results. (ABSTRACT TRUNCATED)

Antitussive Agents↗
PubMedDate not supplied

Validity of the Composite International Diagnostic Interview (CIDI) psychosis module in a psychiatric setting.

This study aimed to test the procedural validity of the psychosis module of the Composite International Diagnostic Interview (CIDI) by comparing it with diagnostic checklists completed by experienced clinicians. Seventy-five subjects were interviewed using the interviewer-administered version of the CIDI. Their clinician(s) then completed diagnostic checklists for DSMIV and ICD10 diagnoses of schizophrenia. Agreement was measured at the diagnostic, criterion and subcriterion levels. The validity standard (diagnostic checklist) was shown to be reliable with interrater agreement between the clinicians for the diagnosis of schizophrenia being excellent (kappa = 0.82 for DSMIV and kappa = 0.71 for ICD10). The agreement between the CIDI and the clinician checklists varied with sensitivities for DSMIV subcriteria ranging from 0.18 (negative symptoms) to 0.93 (bizarre delusions) and specificities ranging from 0.38 (catatonia) to 0.95 (disorganised speech). A similar pattern was found for ICD10 subcriteria: sensitivity varied from 0.19 (neologisms) to 0.90 (persistent delusions) and specificity varied from 0.39 (catatonia) to 0.95 (negative symptoms). The poorest levels of agreement were found for symptoms requiring interviewer judgement. The CIDI showed good agreement with clinician checklist diagnoses when the criteria were based on questions asked of the subjects. When the interviewer was required to make judgement of behaviours, the agreement between the CIDI and the clinician checklists was lower, resulting in overall poor agreement between the CIDI and the clinician checklists. Suggestions for improving the validity of the psychosis module of the CIDI are made.

Adult↗
PubMedDate not supplied

Postpartum issues for expectant mothers and fathers.

OBJECTIVE: To investigate the postpartum psychosocial and infant care topics that women and men who attend preparation for parenthood classes have been thinking or worrying about during the pregnancy. Furthermore, to compare the rates of endorsement of such issues for women and men so that clinicians can use this information to help plan which topics to include in preparation for parenthood classes. DESIGN: A survey of expectant parents attending preparation for parenthood classes at a local public hospital. Participants completed a 17- to 19-item postpartum issues checklist devised for the study. SETTING: Preparation for parenthood classes conducted in a public hospital in South Western Sydney, Australia. PARTICIPANTS: People attending the session were in their 2nd to 3rd trimester, of low to middle socioeconomic status, and 95% were expecting their first child. Eighty-five percent of women were accompanied by their male partner at the session. Data are reported from 201 women and 182 men. MEASURE: A 17-item issues checklist was devised initially and later expanded to 19 items. The initial checklist covered three psychosocial issues: interpersonal, intrapersonal, and parental competency. The expanded checklist also included items on infant care issues. Participants rated each item as to the extent to which they had been thinking or worrying about it over the past few weeks. RESULTS: More than half of the men and women had been thinking or worrying about their ability to cope as new parents; just less than half of both men and women endorsed the item regarding the effect having a baby would have on their relationship with their partner; approximately 40% of women had thought that they might get bored or lonely when at home with the baby, and an equal rate of men reported that their partner experiencing this sense of boredom-or loneliness was an issue for them. There were few differences between the genders in the rate of endorsement on the issues checklist. CONCLUSION: That many of the issues on the checklist are prevalent in both women and men at this time in the pregnancy would suggest that these are topics that would be pertinent for inclusion at preparation for parenthood classes. Although the checklist is not exhaustive, the data reported give empirical justification for inclusion of these topics in such classes.

Adaptation, Psychological↗
PubMed1991

Screening for dysfunction in the children of outpatients at a psychopharmacology clinic.

OBJECTIVE: The goals of this study were 1) to determine whether the use of the Pediatric Symptom Checklist in an adult-oriented psychiatric practice was feasible, 2) to determine if scores indicative of dysfunction on the Pediatric Symptom Checklist were associated with parental or background factors, 3) to determine whether children flagged by their scores on the Pediatric Symptom Checklist were receiving psychiatric services, and 4) to compare the psychosocial dysfunction in this group of children with that found in children screened as part of routine pediatric visits. METHOD: Adult outpatients in a hospital's clinical psychopharmacology unit were asked to complete the Pediatric Symptom Checklist regarding their children. These patients were the parents of 100 school-aged children. Factors such as the parents' diagnoses and demographic variables were also examined. RESULTS: The Pediatric Symptom Checklist was readily accepted by parents and fit easily into the routine of general psychiatric practice. Significantly more of the children of these outpatients than of children in comparable pediatric offices had scores indicative of psychiatric dysfunction (scores above the cutoff). Children of parents who were single, of low socioeconomic status, or with a diagnosis of personality (especially borderline) or mood disorder were more likely to have scores above the cutoff. More than a third of the children who had scores above the cutoff on the Pediatric Symptom Checklist were not currently receiving psychiatric services. CONCLUSIONS: The Pediatric Symptom Checklist provided a rapid and simple method for general psychiatrists to identify psychosocial dysfunction in their patients' children.

Adult↗
PubMed2006

Mental health screening in pediatric practice: factors related to positive screens and the contribution of parental/personal concern.

OBJECTIVES: The goals were to examine factors related to positive Pediatric Symptom Checklist scores in an urban practice and to examine the relative contribution of parental/personal concern about emotional and behavioral problems to mental health problem identification. METHODS: Annual screening using the Pediatric Symptom Checklist was implemented in Cambridge Pediatrics (Cambridge, MA). A social worker was colocated in the clinic to provide therapeutic interventions for patients. A sample of 1668 screened patients between 4 years 11 months and 19 years of age was used for analysis. Bivariate and multivariate analyses were conducted to determine factors predictive of positive Pediatric Symptom Checklist scores, including demographics, socioeconomic indicators, enrollment in counseling, and parental/personal concern. Parental/personal concern, counseling, and positive Pediatric Symptom Checklist scores were examined to determine their efficacy as screening methods. RESULTS: Six percent of the population had positive Pediatric Symptom Checklist scores. There were statistically significant relationships between a positive score and being in counseling, parental/personal concern, having public insurance, and living in an area with median household incomes of less than 50,000 dollars. Parental/personal concern was 40% sensitive for a positive score. A positive Pediatric Symptom Checklist score with or without parental/personal concern identified 3.8% of the population; parental/personal concern with or without a positive Pediatric Symptom Checklist score identified 4.5%. CONCLUSIONS: Mental health screening can be effectively implemented in a pediatric practice. Colocated mental health professionals provide additional support. The combination of a screening tool and questions about parental/personal concern and present counseling can provide critical information about a child's mental health.

Adolescent↗
PubMed2002

Assessing adolescent mental health in war-affected societies: the significance of symptoms.

OBJECTIVE: To compare the use of self-report symptom checklists with qualitative methods for assessing adolescent psychological well-being in a war-affected society. METHOD: A school-based sample of three hundred and thirty seven 13- to 15-year-olds from two communities on opposite sides of the Bosnian conflict (183 from Gorazde, 154 from Foca) completed the Hopkins Symptoms Checklist and the Harvard Trauma Questionnaire. A gender balanced sub-sample of 40 adolescents was selected on the basis of their combined checklist scores, including equal numbers of high and low scorers from each side. Over the following 6 months this sub-sample was assessed (blind to checklist scores) with qualitative methods that included narrative interviews of child and parent, and participant observation. School marks were taken as a measure of social function. RESULTS: QUALITATIVE: Some children identified as "less well" by qualitative methods denied having symptoms. Some children identified as "well" had symptoms with no pathological significance for them. The lifeline revealed that feeling "less well" could be more related to post-war circumstances than war events. QUANTITATIVE: The two symptom checklist items have shown good internal consistency and discriminant validity. However, comparison with the overall well being revealed that still in 9/40 of cases the reported presence or absence of symptoms did not correspond to the well being of the child. Items of the two questionnaires did not discriminate reliably between children identified as "well" and "less well" by other means. CONCLUSIONS: Self-report checklists may be useful as a public health measure to assess the prevalence of psychological distress in war affected areas, but they are not an adequate means of clinical screening. Checklists used in combination with other qualitative approaches make it possible to identify those in need and avoid unnecessary pathologizing.

Adolescent↗
PubMedDate not supplied

Assessment of surgical skills in implant dentistry.

PURPOSE: This study aimed to (1) compare 2 scales in the assessment of first-stage implant surgery, (2) assess the interrater reliability of these scales, and (3) compare self-assessment with observer assessment. MATERIALS AND METHODS: Twenty-three patients underwent first-stage implant surgery. One assessor, an experienced dental surgeon, assisted and supervised the operator, while the second, a postgraduate trained in assessment, observed the procedure closely. The assessment scales consisted of a checklist and a global rating scale. RESULTS: A significant correlation was found between the checklist and the global rating scale scores (r = 0.47, P = .002). The British Standards Reproducibility Coefficients were 2.5 (checklist) and 7.4 (global rating scale) for interrater reproducibility and 7.0 (checklist) and 12.6 (global rating scale) for self-assessment versus assessor reproducibility. Finally, analysis of the intraclass correlation coefficients between the assessors (0.74 and 0.64 for the checklist and the global rating scale, respectively) and between the surgeons' and trainers' scores (0.09 for the checklist and 0.18 for the global rating scale) showed a much weaker agreement for the latter. DISCUSSION: There was good correlation between scores using the 2 different methods of assessment. The interrater reliability was substantial for both scales. However, training of assessors to ensure higher levels of interrater reliability may be necessary. These results also demonstrated the inability of some surgeons to assess their performance accurately. CONCLUSION: Both the checklist and the global rating scales provided useful assessment data, and both were considered of value by the assessors and surgeons in providing feedback. The development of assessment and self-assessment skills in implant surgery is necessary if we are to establish a culture of commitment to lifelong learning.

Clinical Competence↗
PubMed1998

The relationship between preceptor expectations and student performance on 2 pediatric objective structured clinical examination stations.

BACKGROUND: We designed 2 pediatric objective structured clinical examination stations, 1 anemia case associated with lead exposure and 1 failure-to-gain-weight case associated with extended breast-feeding, to evaluate third-year medical students who had studied in pediatric community preceptors' offices as part of a 12-week multidisciplinary ambulatory clerkship rotation. OBJECTIVE: To examine the relationship between preceptor expectations and student performance on these 2 objective structured clinical examination stations. METHODS: To elicit community preceptors' expectations of student performance, we constructed a 46-item survey replicating checklists filled out by simulated patients evaluating student performance on the objective structured clinical examination stations. The percentage agreement among preceptors for each checklist item as well as the percentage agreement between preceptor responses and student responses on each checklist item were calculated. A summary score of preceptor responses across all checklist items and a summary score for student responses across all checklist items on each station were calculated. The correlation coefficients between preceptor and student summary scores were then examined. RESULTS: Fifty-nine preceptor surveys were mailed and 38 were returned (64% response rate). Data were usable from 37 surveys. Eighty-nine percent (33 of 37)of the preceptors agreed that a third-year clerkship student should have the knowledge to care for the patient with anemia and 92% (34 of 37)of the preceptors agreed similarly for the growth-delay case. Agreement among preceptors on individual checklist items varied widely for both cases. Fifty-seven students studied at the anemia station and 34 students studied at the growth-delay station. The mean+/-SD agreement across the 26 items on the anemia case between preceptor responses and student responses was 62%+/-23% and, for the 21 items on the growth-delay case, 60%+/-17%. The mean+/-SD preceptor summary score for the anemia case was 17.4+/-3.8 (maximum, 26) and 16.0+/-3.6 (maximum, 21) for the growth-delay case. The mean student score on the anemia case was 15.5+/-3.7 (maximum, 26) and, for the growth-delay case, 10.0+/-4.5 (maximum, 21). The Pearson correlation coefficient between the preceptor and student scores on the anemia case was 0.19 (P=.15), and for the growth-delay case,-0.41 (P=.06). CONCLUSIONS: These data suggest community preceptors agree on topic areas in which students should be clinically competent. There was, however, considerable variation in agreement among preceptors about what preceptors believe students should be able to do and how the students actually perform. The overall percentage agreement between preceptor expectations and student performance appears to be no better than chance.

Attitude of Health Personnel↗
PubMed2002

Developing a scoring system to quality assess economic evaluations.

The number of economic evaluations is constantly increasing. The need to establish a framework with which to assess the validity of the studies has led to the development of checklists and scoring systems to compare the quality of different studies and ensure that decisions made by decision makers and researchers are based on solid evidence. The most prominent of these checklists is that produced by Drummond et al. Their checklist aims to answer two important questions: is the methodology employed in the study appropriate and are the results valid? In this paper three methods using the checklist of Drummond et al. are developed to assess the quality of a random sample of 50 papers selected from the NHS Economic Evaluation Database. Method 1, a direct application of the checklist calculates an average score with each of the ten items weighted equally, this method proves to be good at identifying low quality studies but is a rather a blunt tool for differentiating between high-quality studies. Method 2, also using an additive score, introduces a hierarchy of the effectiveness data and also adds a new item with respect to the transferability of the results. With this method the number of papers scoring top marks decreases dramatically in comparison to method 1. Method 3 involves a multiplicative rather than additive scoring system, which is better at distinguishing between good quality studies but appears to reduce discrimination between poor-quality studies. Overall, the ten-point checklist of Drummond et al. is a useful and quick tool with which to assess the quality of economic evaluations and to enable decision makers and researchers to focus upon the most relevant studies.

Journal Article↗
PubMedDate not supplied

Objective assessment of manual skills and proficiency in performing epidural anesthesia--video-assisted validation.

BACKGROUND AND OBJECTIVES: Demand is growing for objective assessment of manual skills and competencies of invasive procedures. The aim of this study was to validate an objective tool for assessing residents' skill in performing epidural anesthesia by use of a global assessment scale and a 3-scale, 27-stage checklist. We wish to demonstrate that this tool can differentiate operators with different levels of training. METHODS: Second-year anesthesia residents were recruited. Their previous experience was assessed by questionnaire. They were repeatedly videotaped performing epidural anesthesia over a 6-month period. Videotaping was done in a blinded manner that masked the identity and level of training of the residents. Three blinded, independent examiners evaluated each session by use of a specifically devised assessment tool that consisted of a global rating scale and a 3-scale, 27-stage checklist to judge the skill level and grade the videotaped sessions. RESULTS: Twenty-one sessions by 6 residents were videotaped over 6 months. Interrater reliability for the different checklist and global-rating form items shows moderate to high degree of agreement for most stages. Total scores demonstrate almost perfect agreement (kappa/ICC +/- SE = 0.90 +/- 0.03 and 0.83 +/- 0.13, respectively; P < .0001) between examiners. To test whether higher total scores are associated with greater experience, a series of repeated-measures ANCOVAs were performed. In both the global-rating form and the checklist, a significant relation between total scores and epidurals done was found to exist (checklist: P < .0001; global rating: P < .0001). CONCLUSIONS: The results of our study show that scores on a system that consists of a global-rating form and a task-specific checklist had a significant relation to the number of epidural insertions performed (i.e., experience). The interrater reliability of these assessment tools was very strong. Evaluation of technical skills by an objective tool under direct observation, as opposed to laboratory setting, may create a more reliable standard of assessment. Furthermore, residency programs could use these evaluations to identify deficiencies in teaching programs and trainees who require extra instruction.

Analysis of Variance↗
PubMed2004

On the enhancement of efficiency in care for cancer patients in outpatient clinics: an instrument to accelerate psychosocial screening and referral.

Many cancer patients experience psychosocial problems that go unnoticed by caregivers. To improve this situation, an instrument has been developed and tested to identify such problems. This instrument, the integral checklist, was put to the test in two outpatient departments of different hospitals with an intervention and a control group (105 and 124 patients, respectively). To evaluate the efficiency of the checklist, both groups had to complete a questionnaire after consultation. Results showed that the checklist assisted specialists to be more often pro-active in discussing psychosocial problems with their patients, and more patients with psychosocial problems were referred. Most of the patients appreciated going through the checklist with their specialist. The checklist proves to fit in well with hospital routines and using it costs the specialist no extra time. It appears to be an instrument which improves efficiency of consultation. Moreover, the checklist is turned out to be useful as a management tool to divert patients' attention away from the waiting time.

Adaptation, Psychological↗
PubMedDate not supplied

Assessment of pragmatic difficulties and socio-emotional adjustment in practice.

BACKGROUND: In professional practice, psychologists and other professionals such as therapists and teachers receive referrals of many children who present with social, emotional and behavioural difficulties that are difficult to understand and assess. The problems of some of these children may stem from pragmatic difficulties in communication. This paper reports the results of a study on the use of checklists in professional practice to assist in the identification of these difficulties. AIMS: (1) To ascertain whether two checklists, Bishop's (1998) Children's Communication Checklist and Goodman's (1997) Strengths and Difficulties Questionnaire, would discriminate between groups of children diagnosed as having autism, autistic spectrum disorder/Asperger's syndrome, pragmatic difficulties and children with other types of specific language impairment. (2) To investigate whether specific aspects of pragmatic difficulties can be identified as relating to difficulties in peer relationships. (3) To investigate whether ratings of pragmatic difficulties are related solely to difficulties in social relations or whether other aspects of socio-emotional adjustment are also affected. METHODS & PROCEDURES: The Children's Communication Checklist and the Strengths and Difficulties Questionnaire were completed by the teachers and other professionals working with a sample of children (n = 38) with a range of types of communication difficulty and being educated in schools run by one English Local Education Authority. OUTCOMES & RESULTS: Analyses of variance indicated that the scores for pragmatic competence and socio-emotional adjustment difficulties were useful in discriminating between groups of children with diagnoses of autism or autistic spectrum disorder, Asperger's syndrome, and other types of language impairment. No specific pragmatic correlates of social interactional difficulties were found, but ratings of hyperactivity were significantly correlated with pragmatic difficulties. CONCLUSIONS: The two checklists if used together provide useful information on the profiles of strengths and weaknesses of children with a range of communication and or emotional/behavioural difficulties. The use of both checklists in this study demonstrated the differential profiles of pragmatic competence and socio-emotional adjustment of children with different types of communication difficulty.

Affective Symptoms↗
PubMed2006

A decision aid for GPs for the treatment of elderly male patients with lower urinary tract symptoms (LUTS).

BACKGROUND: GPs have four main treatment options for lower urinary tract symptoms (LUTS): watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors or (referral for) surgery. Guidelines do not provide clear cut-off values for (combinations of) symptoms and physical examination results to decide which treatment is best. OBJECTIVE: (i) To develop a decision aid ('checklist') for GPs for the treatment of patients with LUTS. (ii) To assess its value for use in a primary care population. Materials and methods. Population-based cross-sectional study. Included were subjects with uncomplicated LUTS for whom treatment in primary care may be appropriate. [International Prostate Symptom Score (IPSS) > or = 8, no prior prostate surgery, prostate-specific antigen (PSA) value < 10 ng/ml]. For each subject the appropriateness of surgery and alpha-blocker treatment was determined using a previously validated formalized international expert panel judgement. Regression models using data available in primary care were constructed to predict the panel judgement. Subsequently these models were transformed into simple checklists. Finally, the efficiency of these checklists was calculated. RESULTS: The best checklists consisted of age, symptoms severity, type of symptoms, a quality of life score and PSA value. Assuming one would like to provide at least 95% of the subjects for whom a certain treatment is appropriate with this treatment (i.e. 'sensitivity' of the checklist > or = 95%), one can reach a positive predictive value of 50-60%. CONCLUSION: Simple checklists based on the judgement of experts regarding the most appropriate therapy can help GPs to advise their patients of a rational treatment strategy.

Adrenergic alpha-Antagonists↗