Biomedical subjects

Helena Davies

Publications and source records attributed to Helena Davies.

13 recordsLinked to original sources

PubMed2006

mini-PAT (Peer Assessment Tool): a valid component of a national assessment programme in the UK?

PURPOSE: To design, implement and evaluate a multisource feedback instrument to assess Foundation trainees across the UK. METHODS: mini-PAT (Peer Assessment Tool) was modified from SPRAT (Sheffield Peer Review Assessment Tool), an established multisource feedback (360 degrees ) instrument to assess more senior doctors, as part of a blueprinting exercise of instruments suitable for assessment in Foundation programmes (first 2 years postgraduation). mini-PAT's content validity was assured by a mapping exercise against the Foundation Curriculum. Trainees' clinical performance was then assessed using 16 questions rated against a six-point scale on two occasions in the pilot period. Responses were analysed to determine internal structure, potential sources of bias and measurement characteristics. RESULTS: Six hundred and ninety-three mini-PAT assessments were undertaken for 553 trainees across 12 Deaneries in England, Wales and Northern Ireland. Two hundred and nineteen trainees were F1s or PRHOs and 334 were F2s. Trainees identified 5544 assessors of whom 67% responded. The mean score for F2 trainees was 4.61 (SD = 0.43) and for F1s was 4.44 (SD = 0.56). An independent t test showed that the mean scores of these 2 groups were significantly different (t = -4.59, df 390, p < 0.001). 43 F1s (19.6%) and 19 F2s (5.6%) were assessed as being below expectations for F2 completion. The factor analysis produced 2 main factors, one concerned clinical performance, the other humanistic qualities. Seventy-four percent of F2 trainees could have been assessed by as few as 8 assessors (95% CI +/-0.6) as they either scored an overall mean of 4.4 or above or 3.6 and below. Fifty-three percent of F1 trainees could have been assessed by as few as 8 assessors (95% CI +/-0.5) as they scored an overall mean of 4.5 or above or 3.5 and below. The hierarchical regression when controlling for the grade of trainee showed that bias related to the length of the working relationship, occupation of the assessor and the working environment explained 7% of the variation in mean scores when controlling for the year of the Foundation Programme (R squared change = 0.06, F change = 8.5, significant F change <0.001). CONCLUSIONS: As part of an assessment programme, mini-PAT appears to provide a valid way of collating colleague opinions to help reliably assess Foundation trainees.

Clinical Competence↗

PubMed2006

Follow-up after childhood cancer: evaluation of a three-level model.

INTRODUCTION: Follow-up for cancer survivors is recommended to detect recurrence; monitor late-effects; record toxicity and provide care and education. We describe our experience with a three-level model developed to guide decisions about intensity and frequency of follow-up [Wallace WHB, Blacklay A, Eiser C, et al. Developing strategies for the long term follow-up of survivors of childhood cancer. BMJ 2001;323:271-274]. PROCEDURE: One hundred and ninety eight survivors (52% male) recruited over 12-months: (mean age=23.8 years, range=16-39 years; mean time since diagnosis=16.2 years, range 2.4-32.7 years) reported their number of symptoms and late-effects. Information was taken from the medical records to assign each survivor to the appropriate levels by six clinic staff independently. RESULTS: The survivors were assigned to level 1 (n=8), level 2 (n=97) and level 3 (n=93). There were seven cases of disagreement. Level 3 survivors self-reported more symptoms and late-effects than level 2 survivors. CONCLUSIONS: Coding was relatively simple for experienced clinic staff, although there were some disagreements for the survivors of ALL. The relationship between assigned level and self-reported symptoms and late-effects provides some evidence for validity of the model. We conclude that it is important to maintain flexibility to allow movement between levels for individual patients and that the default should always be to the higher level.

Adolescent↗

PubMed2006

Predictors of clinic satisfaction among adult survivors of childhood cancer.

Childhood cancer survivors experience a wide range of late-effects. As survival rates improve, follow-up in paediatric clinics becomes less feasible, and alternative models of care have been proposed. In this study, satisfaction among those attending a traditional paediatric late-effects clinic was compared with a multi-disciplinary clinic in an adult setting. Survivors (adult clinic n=93, paediatric clinic n=105, age 16-39 years) completed measures of symptoms, understanding of vulnerability to late-effects, purpose of follow-up, satisfaction and number of topics discussed. Predictors of satisfaction were: number of topics discussed, greater understanding of the purpose of follow-up and sex. Females, and those reporting longer waiting time were less satisfied. Aspects of clinic organisation, including shorter waiting times and opportunities to discuss health concerns, are more important in determining patient satisfaction than clinic type. Survivors' understanding of the purpose of follow-up is also integral in determining satisfaction.

Adolescent↗

PubMed2006

HRQOL implications of treatment with dexamethasone for children with acute lymphoblastic leukemia (ALL).

BACKGROUND: Dexamethasone is increasingly used as the steroid of choice in trials for standard risk children with acute lymphoblastic leukemia (ALL). Improvements in event-free survival (EFS) have been attributed to lower CNS relapse rates, However, there are concerns that dexamethasone may be more toxic than previous conventional therapy with prednisone. Such toxicity raises questions about the implications for child neuropsychological function and HRQOL. Patients participating in the UK ALL 99/01 trial were randomized to receive dexamethasone or prednisone as their steroid in induction and maintenance chemotherapy. We compared the HRQOL and behavior in children randomized to receive both these agents. PROCEDURE: Standardized questionnaires to assess parent and child HRQOL at 3-6 months after diagnosis (T1) and 1 year later (T2) completed by mothers in family homes. Forty-five mothers of a child with ALL (32 male, 13 female; average age at T1, 7 years 3 months; at T2, 8 years 3 months) completed HRQOL questionnaires. RESULTS: For the total group, child HRQOL scores improved and behavior problems decreased significantly from T1 to T2. Comparison of HRQOL scores between the 17 children randomized to dexamethasone and 28 children randomized to prednisone showed no significant differences. The rate of improvement in HRQOL from T1 to T2 did not differ between children randomized to dexamethasone or prednisone. CONCLUSIONS: Dexamethasone is increasingly used in the treatment of ALL and has been linked with improved survival rates. Long-term use of dexamethasone raises questions about neuropsychologic toxicity. Although HRQOL increased significantly over the year for all children, the extent of this increase did not differ by chemotherapy. These results should contribute to lessened concerns about use of dexamethasone in the treatment of ALL.

Anti-Inflammatory Agents↗

PubMed2005

Follow-up care for childhood cancer survivors: a focus group analysis.

Follow-up of survivors of childhood cancer is recommended to improve detection of late-effects, and provide individuals with information and advice. This study aimed to follow-up survivors of childhood cancer and report on their attitudes to current follow-up methods. Twenty-six survivors (13-25 years) of childhood cancer and their parent(s) attended focus groups (n = 7) to discuss views about follow-up care. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three themes were identified: strategies to achieve a normal life (through playing down possibility of late-effects or careful monitoring of health); expectations about follow-up (facts and information, advice about self-care, everyday living, and psychosocial consequences) and preferences for different models of care. Given that some families had reservations about the benefits of follow-up, it is important that services address survivors' interests and meet their expectations. Changes to service delivery must take account of individual needs and expectations. Possible limitations of focus group methods (recruitment, bias reduction, methods of analysis and influence of other participants' views) are discussed.

Adolescent↗

PubMed2005

Parental communication and children's behaviour following diagnosis of childhood leukaemia.

Many parents find decisions about what to tell their child with cancer difficult. Open communication is generally considered the best policy and most health care professionals encourage parents to talk openly and honestly about the illness. However, parents differ in their views about what to tell the child. In this study 55 parents of children (36 boys and 19 girls, mean age = 7.33 years) newly diagnosed with acute lymphoblastic leukaemia (ALL) were interviewed about (i) the child's reactions and behaviour following diagnosis, (ii) their views about what to tell their child and (iii) factors influencing parents' communication with the child. Interviews were analysed using thematic analysis. Most children showed behavioural and mood difficulties after diagnosis. Older children were given more information. In addition, parents' perceptions of childhood cancer affect the way they communicate with their child. These findings may be used to inform training packages in order to facilitate improved communication amongst health professionals.

Adaptation, Psychological↗

PubMed2005

Doctors' consultations with children and their parents: a model of competencies, outcomes and confounding influences.

CONTEXT: The clinical consultation is an important aspect of the doctor's role. However, there is a particular shortage of methods for assessing its quality, and its complexity makes it a considerable assessment challenge. RESEARCH QUESTION: What are the key components of consultations involving children? METHODS: (1) A content analysis of relevant published and unpublished literature. (2) A nominal group consensus exercise with experienced paediatricians. RESULTS: The content analysis and consensus exercise suggested similar lists of doctor's characteristics, tasks and outcomes as being important components of the consultation. Doctor's characteristics include: clinical judgement, clinical knowledge, physical examination, information gathering, clinical questioning, information giving, patient-centredness, parent-centredness, interpersonal skills, and consultation management. Important tasks include: organisation and efficiency, rapport, information gathering, getting the family perspective, examination and procedures, evaluation, medically appropriate plans, family appropriate plans, enhancing understanding and recall, achieving consensus, sharing responsibility, family knows how to get further help and liaison with other relevant health-care professionals. Important outcomes include: family satisfaction, family perceptions, compliance, health, health-related problems and doctor's satisfaction. The studies reviewed in the literature also provided a catalogue of factors that have been shown to influence the doctor-patient interaction that could potentially confound the assessment of a doctor's performance. These include the doctor's: age, gender, training, speciality, income, social class and politics; the patient's: age, gender, health, prognosis, social class, education, health beliefs and preferences about control and risk. The length of the acquaintance between doctor and patient, and the workload and case-mix in the clinic also affect the interaction. In several studies it is clear that particular combinations of doctor-type and patient-type have especially good or bad interactions. CONCLUSIONS AND FURTHER WORK: These components are synthesised in a single model of the doctor-patient interaction to guide the development and evaluation of assessment instruments aimed at consultations involving children.

Child↗

PubMed2005

Developing an education and assessment framework for the Foundation Programme.

AIM: To develop an education and assessment framework for the second year of the Foundation Programme (F2). METHODS: A total of 23 PRHOs were recruited to the F2 pilot in August 2003. The training posts included a variety of specialties at 2 hospital trusts plus primary care. Trainee expectations and satisfaction were evaluated using questionnaires administered before and at the end of the pilot. At the end of the pilot, 10 trainees participated in a focus group and 19 trainers participated in a semistructured telephone interview. RESULTS: The majority of trainees (78%) felt that their expectations of the F2 pilot were met and all felt that they had improved their generic skills. Attendance at the generic education programme was 95%. The majority of trainees found the assessment framework useful. The percentage of undecided trainees in terms of career aspirations dropped from 48% to 13%. Trainees valued the breadth of experience provide by the year and the support provided by the programme directors and each other. A need for better communication, administrative support and time for assessment was highlighted by the trainers. CONCLUSIONS: Early, focused education on generic skills will benefit both doctors and their patients. More varied career experience will help to ensure that doctors make appropriate and timely career decisions. Pilots are identifying good practice and areas that need improvement.

Attitude↗

PubMed2004

Clinical management. Where medicine meets management. On reflection.

There is an urgent need for validated, feasible tools to assess doctors' performance. A peer-rating tool mapped to good medical practice (SPRAT) is feasible, valid and reliable. SPRAT is ideal for revalidation purposes and performs particularly well in areas that are traditionally difficult to assess. It can also inform personal development planning.

Employee Performance Appraisal↗

PubMed2004

Long-term follow-up of survivors of childhood cancer in the UK.

BACKGROUND: Childhood cancer is rare, but there are now good survival prospects and in the UK approximately 1 in 1,000 young adults is a survivor of childhood cancer. There are many adverse health outcomes associated with the treatment of childhood cancer often arising several years after completion of treatment. The aim of this study was to quantify the long-term clinical follow-up practices concerning survivors of childhood cancer. PROCEDURE: A cross-sectional postal survey of 22 treatment centres of the United Kingdom Children's Cancer Study Group (UKCCSG) clinicians was carried out as well as a cross-sectional postal survey of general practitioners of most adult survivors of childhood cancer in Britain. RESULTS: Subsequent to 5 years after the end of treatment: 52% of UKCCSG clinicians follow-up all survivors for life, while 45% discharge some patients. Of those clinicians discharging: over 50% discharged benign, stage I or tumors treated with surgery alone, in contrast 16% reported discharging all or most patients; almost all (97%) clinicians discharged to a general practitioner. Only 14% of clinicians reported nurses undertook a specialist role. Sixty-five percent of the 10,979 general practitioners reported that their patient was not on regular hospital follow-up. CONCLUSIONS: There are wide variations in the extent to which survivors of childhood cancer are discharged from hospital follow-up. There is a need for regularly updated national guidelines concerning the levels of follow-up required for specific groups of survivors defined principally by the treatment they received.

Adolescent↗

PubMed2004

Health promotion for survivors of childhood cancer: a minimal intervention.

We report the evaluation of an information booklet aimed to explain the purpose of follow-up to survivors of childhood cancer. Evaluations drew on theoretical concepts in the elaboration likelihood and stages of change models. We predicted that survivors who adopt central rather than peripheral processing would show greater understanding and increased readiness to change health behaviour. Forty-eight survivors were shown an example page of the booklet in the clinic and then completed questionnaires about attitude to clinic, readiness to change behaviour, and the importance and scariness of the information. They were then given the whole booklet and asked to complete a second questionnaire at home. After reading the booklet, survivors reported a more positive attitude to clinic. Survivors using central processing rated information as more important and were more ready to change health behaviour than peripheral processors. We recommend that methods to encourage central processing should be routinely included when providing children with health information.

Adolescent↗

PubMed2003

Reproductive medicine in a late effects of cancer clinic.

This review discusses the most commonly observed problems in young people who have survived childhood cancer, with particular emphasis on the issues of fertility. It also describes the role of the late effects clinic in transitional care and the multidisciplinarity of the clinicians required to meet the needs of these young people. There is a need for evidence-based guidelines for management of long-term survivors.

Adolescent↗

PubMed2002

Generalisability: a key to unlock professional assessment.

CONTEXT: Reliability is defined as the extent to which a result reflects all possible measurements of the same construct. It is an essential measurement characteristic. Unfortunately, there are few objective tests for the most important aspects of the professional role because they are complex and intangible. In addition, professional performance varies markedly from setting to setting and case to case. Both these factors threaten reliability. AIM: This paper describes the classical approach to evaluating reliability and points out the limitations of this approach. It goes on to describe how generalisability theory solves many of these limitations. CONDITIONS: A G-study uses variance component analysis to measure the contributions that all relevant factors make to the result (observer, situation, case, assessee and their interactions). This information can be combined to reflect the reliability of a single observation as a reflection of all possible measurements - a true reflection of reliability. It can also be used to estimate the reliability of a combined sample of several different observations, or to predict how many observations are required with different test formats to achieve a given level of reliability. Worked examples are used to illustrate the concepts.

Analysis of Variance↗