Integration of patient and clinician narratives into systematic reviews: An applied proof of concept.

Health systems currently underutilize systematic reviews. Here, we describe a proof of concept project designed to augment the standard systematic review process by presenting qualitative information as a companion to a review on deprescribing interventions. We conducted a thematic analysis of semi-structured interviews with Veterans Health Administration clinicians and Veterans to describe first-hand experiences of engaging in the deprescribing process.

Applying the Effective Technology Use Model to Implementation of Electronic Consult Management Software.

Theoretical models of technology acceptance are critical to scope projects, select interventions, and measure adoption. We describe use of the Effective Technology Use (ETU) model in the design and deployment of software supporting electronic consult management. We applied the model to four project phases: (1) needs assessment; (2) software design; (3) deployment; and (4) uptake assessment.

Implementation of a Medication Reconciliation Assistive Technology: A Qualitative Analysis.

: To aid the implementation of a medication reconciliation process within a hybrid primary-specialty care setting by using qualitative techniques to describe the climate of implementation and provide guidance for future projects. : Guided by McMullen et al's Rapid Assessment Process, we performed semi-structured interviews prior to and iteratively throughout the implementation. Interviews were coded and analyzed using grounded theory and cross-examined for validity.

Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection.

Background: The Veterans Affairs Portland Healthcare System developed a medication history collection software that displays prescription names and medication images.

Objective: This article measures the frequency of medication discrepancy reporting using the medication history collection software and compares with the frequency of reporting using a paper-based process. This article also determines the accuracy of each method by comparing both strategies to a best possible medication history.

Naturalistic Usability Testing of Inpatient Medication Reconciliation Software.

Medication history errors are common at admission, but can be mitigated through the implementation of medication reconciliation (MR). We designed multi-media software to assist clinicians with collection of an admission history. This manuscript describes a naturalistic usability study conducted on the hospital wards.

Usability Evaluation of a Medication Reconciliation and Allergy Review (MRAR) Kiosk: A Methodological Approach for Analyzing User Interactions.

Internationally, major efforts are underway to improve medication safety and reduce medication errors during transitions of care. One strategy that has emerged to improve data accuracy and close information gaps is the introduction of software applications and workflow models that allow patients to review, enter, and modify their own patient data (e.g.

Design of admission medication reconciliation technology: a human factors approach to requirements and prototyping.

Objective: Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design.

Background: Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission.

Conflicting messages: examining the dynamics of leadership on interprofessional teams.

Purpose: Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system.

Method: Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada.

When is a phaeo not a phaeo? Depression in an adolescent leading to a phaeochromocytoma-like biochemical profile.

A pheochromocytoma was suspected in a 14 year old boy. Elevated urinary and plasma catecholamines as well as clonidine test were consistent with the diagnosis. However, imaging studies were negative, and biochemical abnormalities normalized with treatment of concomitant depression.

Pediatric residents' decision-making around disclosing and reporting adverse events: the importance of social context.

Purpose: Although experts advise disclosing medical errors to patients, individual physicians' different levels of knowledge and comfort suggest a gap between recommendations and practice. This study explored pediatric residents' knowledge and attitudes about disclosure.

Method: In 2006, the authors of this single-center, mixed-methods study surveyed 64 pediatric residents at the University of Toronto and then held three focus groups with a total of 24 of those residents.

Residents as health advocates: The development, implementation and evaluation of a child advocacy initiative at the University of Toronto (Toronto, Ontario).

Background And Objective: Advocacy is an integral part of a paediatrician's role. The Royal College of Physicians and Surgeons of Canada has identified advocacy as one of the essential Canadian Medical Education Directives for Specialists competencies, and participation in child advocacy work as an important component of paediatric residency training. The objective of the present paper was to describe the development, implementation and evaluation of the first four years of the child advocacy initiative at the University of Toronto (Toronto, Ontario).

A comparison of Canadian pediatric resident career plans in 1998 and 2006.

Objectives: Studies of pediatric resident career plans and preferences help to forecast changes in the demographic profile and practice patterns of North American pediatricians, providing insights that can guide child health care and medical education policy making. With this study we aimed to compare 4 aspects of Canadian pediatric resident career plans in 1998 and 2006: (1) weekly work hours; (2) scope of practice; (3) professional activities; and (4) community size.

Methods: Canadian pediatric residents were invited to participate in a national cross-sectional survey to explore career plans and preferences in 1998 (mailing) and 2006 (on-line).

Measuring educational workload: a pilot study of paper-based and PDA tools.

Background: Teaching is an important professional role for most faculty members in academic health sciences centres. Careful delineation of educational workload is needed to foster and reward teaching efforts, and to facilitate equitable allocation of resources.

Aims: To promote recognition in teaching and facilitate equitable resource allocation, we developed, piloted, and qualitatively assessed a tool for delineating the educational workload of pediatric faculty in an academic health sciences centre.

Patterns of parental bereavement following the loss of a child and related factors.

This study investigated the patterns of parental bereavement in 20 parents who have lost a child to cancer, congenital heart disease, meningitis, or drowning in the last 19 months, using semi-structured interviews and standardized questionnaires of depression and grief. Qualitative content analysis of interviews identified three bereavement patterns: The majority of parents (65%) presented uncomplicated, Integrated Grief five mothers were Consumed by Grief and one mother and one father expressed Minimal Grief. Quotes from parents exemplified these patterns.

Performance of a career development and compensation program at an academic health science center.

Objective: The academic physicians of our department developed a novel Career Development and Compensation Program to outline job expectations, enhance career development, and provide a peer-review process to assess performance. The Career Development and Compensation Program was founded on the principle that sustained achievement in education, clinical care, or research should be valued, supported, and rewarded in an equivalent manner and that reward for clinical work should not be limited by the focus of the university on research and education. The objective of this study was to determine whether the principles of the Career Development and Compensation Program were sustained during the initial 7 years of its implementation.

Clinical and education workload measurements using personal digital assistant-based software.

Objective: There are no accepted and practical measures of the relative clinical and educational activities of pediatricians who work in an academic health science center. Such measures are necessary for justification of existing and future human resource plans and evaluation of the activities and performance of physicians. The limited literature on the measurement of physician workload usually focuses on a specific subspecialty group and does not account for such issues as indirect patient care, such as telephone calls or e-mail consultations; variables that affect the delivery of clinical care, including patient acuity and complexity; and the presence of students during the patient care activities.

Are children with Kawasaki disease and prolonged fever at risk for macrophage activation syndrome?

Kawasaki disease (KD) patients are known to be at increased risk for coronary artery lesions. We present evidence of another possible complication associated with KD: macrophage activation syndrome (MAS). In this case, a patient with KD and prolonged fever developed MAS.

Brief psychoeducational parenting program: an evaluation and 1-year follow-up.

Objective: Despite recognition of the need for parenting interventions to prevent childhood behavioral problems, few community programs have been evaluated. This report describes the randomized controlled evaluation of a four-session psychoeducational group for parents of preschoolers with behavior problems, delivered in community agencies.

Method: In 1998, 222 primary caregivers, recruited through community ads, filled out questionnaires on parenting practices and child behavior.

Culture and physician-patient communication: a qualitative exploration of residents' experiences and attitudes.

Background: Increasing evidence suggests that communication plays a central role in effective clinical care. To facilitate effective instruction in this domain, this study seeks to understand how pediatric residents approach the challenge of cross-cultural communication.

Methods: A convenience sample of 29 pediatric residents participated in five focus groups that were jointly facilitated by a clinical and a process expert.

Evaluation of a peer-reviewed career development and compensation program for physicians at an academic health science center.

Objective: The Department of Pediatrics at the Hospital for Sick Children, which is funded by an alternative payment plan, has implemented a novel career development and compensation program (CDCP). Job activity profiles were used to more clearly define job expectations, benchmarks guided career development, and peer review was used to assess performance. The objective of this study was to evaluate the departmental pediatricians' satisfaction with the CDCP.

Typical and atypical Carney's triad presenting with malignant hypertension and papilledema.

This report encourages clinicians to consider a diagnosis of Carney's triad in patients with multifocal gastric stromal sarcoma, extraadrenal paraganglioma (predominantly mediastinal), or pulmonary chondroma. The authors conducted a retrospective 20-year survey at the Hospital for Sick Children and identified two children with Carney's triad. One child, presenting atypically with papilledema and fundal hemorrhages from malignant hypertension and benign intracranial hypertension from chronic iron-deficiency anemia, is the second patient ever to date be described with the complete Carney's triad of neoplasms at diagnosis.

Conversations with parents of medically ill children: a study of interactions between medical students and parents and pediatric residents and parents in the clinical setting.

Background: The traditional remedies applied by medical schools to the perennial problem of teaching "caring competence" have been unsuccessful.

Purpose: Our purpose was to design and evaluate a simple and effective method for helping students maintain affective contact with their patients.

Methods: Third-year medical students and pediatric residents were given the opportunity to talk informally with parents of medically ill children and reflect on the value of this experience for their learning.

A review of the evaluation of clinical teaching: new perspectives and challenges.

Purpose: This article discusses the importance of the process of evaluation of clinical teaching for the individual teacher and for the programme. Measurement principles, including validity, reliability, efficiency and feasibility, and methods to evaluate clinical teaching are reviewed.

Context: Evaluation is usually carried out from the perspective of the learner.