Telephone Conference Research Articles

Strength in Numbers: A National Monthly Case Conference Series for Fellows.

Small fellowship programs face challenges in providing learners with sufficiently diverse experiences and patient populations. The Fellows Most Difficult Case Conference is designed to broaden geriatric medicine fellows' exposure to cases and to faculty and fellows from around the country through a monthly telephone conference. We describe this innovative approach to a national monthly complex case conference that fellows from almost one-third of geriatrics fellowship programs attend, including its value to geriatric fellows and faculty and administrative costs. Once per month, a fellow presents a case, a moderator leads the discussion, and 2 faculty members provide teaching points during the 60-minute session. Participants rated the conference's value using an 11-item on-line survey followed by a debriefing held during a regularly scheduled 2017 monthly conference. Thirty-six percent of eligible participants responded to the survey (67/186), with 75% of respondents reporting that they applied knowledge gained from the conferences to their patient care at least 1 or 2 times per month and 41% that they applied it at least once per week. Participants appreciated the inclusion of multiple programs, the duration of the conference, and the interactive approach. Our administration time was less than 5 hours per month, plus a few additional hours annually to create the academic year schedule. We believe that this national case conference, the first of its kind in the country, involving almost one-third of geriatrics fellowship programs, is an innovative and valuable way for fellows to explore complex cases and variations in regional perspectives and to connect with additional colleagues.

Exploring the thesis experience of Master of Health professions education graduates: a qualitative study.

ObjectivesTo explore the thesis experience of recent Master of Health Professions Education (MHPE) graduates in the University of Illinois at Chicago (UIC) program. MethodsThis is a qualitative case study exploring the experience of MHPE graduates between 2014 and 2016 (n=31). Using convenience sampling, all graduates with an email address (n=30) were invited to participate in an online survey and semi-structured interviews. Interviews were completed in-person or via telephone or video conference; interviewers collected detailed notes and audio recordings. Two authors independently analyzed the data iteratively using thematic analysis and discrepancies were discussed and resolved. ResultsSurvey results (n=20, 67%) revealed an average graduation of 5.1 years; 10 graduates (33%) were interviewed. Three themes related to the thesis experience were identified: success factors, challenges, and outcomes. Success factors, when present, promoted completion of a thesis; these included: a supportive program environment, time management, available resources, MHPE foundational coursework, aligning theses with career goals, and identifying a project with limited scope. Challenges made thesis completion more difficult for graduates; these included: institutional factors, personal or professional responsibilities, burnout, externally-imposed deadlines, and barriers in the research process. Despite these challenges, completing the thesis resulted in many professional or personal benefits (outcomes). ConclusionsMultiple success factors and challenges were identified in the master’s thesis process among MHPE graduates at UIC. These findings can help students conducting education-based scholarship through the master’s thesis process. This study also informs program evaluation and improvements and outlines personal and professional outcomes of completing a master’s thesis.

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians.

Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when and how to assess and address cognitive impairment. The task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face-to-face meeting, telephone conference call and email exchanges. Consensus-based recommendations were achieved through these exchanges with no need for formal consensus methods. The identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment is detected? (IV) What are the treatment perspectives? Key recommendations are that clinicians: (I) formally screen cognition in partially or fully remitted patients whenever possible, (II) use brief, easy-to-administer tools such as the Screen for Cognitive Impairment in Psychiatry and Cognitive Complaints in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current evidence-based treatments but intense research efforts are underway to identify new pharmacological and/or psychological cognition treatments. This task force paper provides the first consensus-based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients' functional recovery and improve their quality of life.

Commentary on "Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force".

Objectives To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus-based guidance paper for the methodology and design of cognition trials in bipolar disorder. Methods The task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face-to-face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved. Results Key methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non-study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach. Conclusions This ISBD task force guidance paper provides the first consensus-based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies.

Seminar program for postgraduate specialty training in general practice: proposal for a 5-year thematic catalogue.

Introduction: In different German regions, seminar programs have been conducted for General practice residents. In each region, selection and teaching of learning content is conducted in a different manner. So far, no structured, standardized curriculum has been implemented nationwide. We have investigated, if the development of a common 5-year program of learning topics is conceivable between the different university departments of General practice in Germany.Method: The seminar program working group of the DEGAM (German College of General Practitioners and Family Physicians) has conducted an online survey based on information gathered via preliminary telephone conference (n=7; physicians with postgraduate teaching experience) among all German university departments of General Practice and two non-university teaching institutions, identified via the internet. 884 topics were extracted from 14 Seminar programs. The topics were entered in a database, discussed and categorized: Practice management/practice work flow/standardized documentation forms/quality management (n=33 topics), common acute and chronic diseases, including disease management programs (n=29 topics), communication, neurological, psychological and psychiatric consultations (n=24 topics), common medical problems, including eye, ear, nose, throat, skin and pediatric problems (n=99 Topics) family physicians general approach, including epidemiology, shared decision making, test of time (n=42 Topics). These topics have been rated for priority and desirable number of teaching-units.Results: A catalogue of 111 topics was designed, encompassing 160 teaching units. There is a suggestion of wide topics collections plus an add-on catalogue.Conclusion: A proposal for a 5-year-thematic catalogue for postgraduate training of general practice residents in Germany has been developed. This newly developed curriculum has the potential to improve knowledge and skills that have not been covered during in-house and ambulatory general practice residencies.

Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force.

ObjectivesTo aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus‐based guidance paper for the methodology and design of cognition trials in bipolar disorder.MethodsThe task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face‐to‐face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved.ResultsKey methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non‐study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach.ConclusionsThis ISBD task force guidance paper provides the first consensus‐based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies.

Pre-surgery evaluations by telephone decrease travel and cost for families of children with cerebral palsy.

Introduction:Children with cerebral palsy need highly specialized care. This can be very burdensome for families, particularly in large rural states, due to the need for long-distance travel to appointments. In this study, children undergoing the selective percutaneous myofascial lengthening surgery utilized a telephone-based telemedicine evaluation to assess for surgical eligibility. The goal was to avoid a separate preoperative clinic visit weeks before the surgery. If possible, eligibility was determined by telephone, and then, the patient could be scheduled for a clinic visit and possible surgery the next day, saving the family a trip. The purposes of the study were to calculate estimated reductions in miles traveled, in travel expenses, and in carbon emissions and to determine whether the telephone assessment was accurate and effective in determining eligibility for surgery.Methods:From 2010 to 2012, 279 patients were retrospectively reviewed, and of those, 161 mailed four-page questionnaire and anteroposterior pelvis X-ray followed by a telephone conference. Geographic information system methods were used to geocode patients by location. Savings in mileage and travel costs were calculated. From 2014 to 2015, 195 patients were additionally studied to determine accuracy and effectiveness.Results:The telephone prescreening method saved 106,070 miles in transportation over 3 years, a 38% reduction with US$55,326 in savings. Each family saved an average of 658 (standard deviation = 340) miles of travel and US$343.64 (standard deviation = US$178) in travel expenses. For each increase of 10 miles in distance from the health center, the odds of a patient utilizing telephone screening increased by 10% (odds ratio: 1.101, 95% confidence interval: 1.073–1.129, p < 0.001). After the telephone prescreening, 86% were determined to be likely candidates for the procedure. For 14%, a clinic visit only was scheduled, and they were not scheduled for surgery.Conclusion:Families seeking specialized surgical care for their disabled children particularly benefited from this approach.

In the Chair: How to Guide Groups and Manage Meetings, Andrew Green, Parthian Books, 2014, £10.99, pb, 192 pp. ISBN: 9781909844780

My introduction to ward meetings at Claybury Hospital and departmental and staff meetings during my psychiatric training were negative experiences. I soon came to the view that these activities were largely unproductive and best avoided. In contrast, as a young consultant I soon realised that to enjoy a full professional life, participating effectively in, influencing the outcome of and chairing meetings were essential skills. I acquired several standard texts on committee work and the art of being a good chairman but they were not very useful. The bulk of their contents were about rules of etiquette and procedure based on the British parliamentary system. This model is now arcane and outmoded as the Westminster bubble remains in a time warp, while the world outside has moved on so that now committees and meetings are conducted in a more informal and relaxed way. In addition, these old texts had few useful tips about how to manage a big problem in committees – the difficult disruptive individual with an axe to grind. Andrew Green's new book is very welcome. It is an excellent guide to those who perform a very important but underrated role of chairing groups and committees. Furthermore, it deals with how groups, committees and meetings should be run and how individuals can participate effectively. The author is well placed to write this book. From 1998 to 2013 he was head librarian and chief executive of the National Library of Wales, one of the five legal deposit libraries in the UK and a major archive repository. He has acted as chair of a large number of voluntary, public sector and official bodies. He has also been able to observe at first hand the technique of others chairing committees and meetings. To be a member of a committee with a superb chair can be a real pleasure and I regret that for me this did not occur more often. The book deals in detail with the responsibilities of the chair for planning meetings, the task of chairing a board of a public body or company and the relationship between the chair and the chief executive. It also covers annual meetings, appointment panels and those quasi-judicial meetings: disciplinary and grievance hearings. Green is good on the two sections dealing with the mechanics and dynamics of conducting meetings. He places great emphasis on thorough preparation, the value of background work and of taking up issues with individuals outside the meeting itself. There are useful tips about how to steer a meeting through a period of turbulence and how to deal with the awkward committee member who starts up, ‘with great respect Mr Chairman’, clearly bristling for a fight. It is a practical, comprehensive guide with a good index and references for further reading. I would strongly recommend it as essential reading for a young consultant psychiatrist who wants to establish a sound foundation for an important component of a rewarding professional career. In addition, it acts as a manual to be kept at hand for guidance when one is asked to accept a new responsibility such as attending an advisory appointments committee. Recently, it was mooted that I would have to participate in a telephone conference call about my long-term research project. This would be a new experience for me and I was glad to dip into this book for some helpful advice.

Voice over quantum IP routing based on least relay node constrained optimization strategy

Quantum communication is the interdisciplinary science of quantum mechanics and telecommunication theory. It has advantages of perfect information security and high efficiency in transmission. In recent years, the theoretical and experimental results show that quantum communication systems have the superiority over the traditional communication systems. Quantum communication systems are hopeful for solving the information security problems that everyone is facing today, therefore, they possess broad application prospects and are forming a research hotspot of the telecommunications field currently. On the other hand, Voice over Internet Protocol (VoIP) is the method to transmit the digitized packet voice in Internet around the world. The advantages of VoIP are that it can carry voice, data, video, telephone conference, electronic commerce, and electronic mail economically. VoIP can realize the information storage and retransmission easily and flexibly. However, VoIP also encounters the problem of information security. We are trying to combine the quantum communications network and the VoIP system together and build a brand new network named quantum VoIP network which combines the advantages of both quantum communications and VoIP. The data packets may be delayed and lost in a queue up with a router due to the congestion and link failure during the transmission of quantum information. In order to ensure the performance of quantum VoIP system, the routing optimization strategies are proposed in the paper. The relay technology based on entanglement swapping is adopted. The multiuse quantum communications are realized by giving priority to the quantum channels with the least relay nodes. Theoretical analysis and simulation results show that when the data transmission links are fail to work properly and routers are in congestion, adopting the routing optimization strategies in M/M/m queuing system with the bit error rate (BER) of quantum bit setting to be 0.2 and the number of common channels increasing from 4 to 8,, the percentage of call failure in quantum communication network decreases from 0.25 to 0.024, and the maximum throughput of quantum networks increases from 64 kbps to 132 kbps. In comparison, when the number of common channels is set to be 4 andthe BER of the quantum bit is from 0.3 to 0.1, the maximum throughput of quantum networks increases from 41 kbps to 140 kbps. Thus it can be concluded that the routing optimization strategies proposed in this paper can improve the performance of quantum VoIP system significantly.

A General Purpose Connection CTI Server Based on the SIP Protocol and Its Implementation

SUMMARYIn this paper, we propose a general purpose connection Computer Telephony Integration (CTI) server that provides various CTI services such as voice logging where the CTI server communicates with IP‐PBX using the Session Initiation Protocol (SIP), and accumulates voice packets of external line telephone calls flowing between an IP telephone for extension and a VoIP gateway connected to outside line networks. The CTI server realizes CTI services such as voice logging, telephone conference, or interactive voice response (IVR) with accumulating and processing voice packets sampled. Furthermore, the CTI server incorporates a web server function which can provide various CTI services such as a Web telephone directory via a Web browser to PCs, cellular telephones or smart‐phones in mobile environments.

Abstract NS20: Improving Stroke Evidenced-Based Best Practices Across a Multi-State Healthcare System

Background and Purpose: As a National effort to provide a framework to improve stroke best practices, a multi- center healthcare system with 48 hospitals across ten states established a stroke collaborative working group. The purpose was to develop a forum to standardize and improve stroke evidenced-based best practices with sister facilities. Methods: A questionnaire was developed and distributed to the stroke collaborative group. A telephone conference was held to review survey results and organizational trends from the 2010 Get With The Guidelines (GWTG) stroke quality metrics. Three quality metrics, dysphagia screening, patient education and door to needle (DTN) were initially identified along with establishing three subcommittees to focus upon improving best practices for each of these measures. Educational webinars, best practice successes and barriers were shared on monthly conference calls as well as a development of an email stroke distribution list serve to improve communication. Results: The three chosen GWTG stroke quality metric score aggregates from 2010 to 2013 second quarter were: dysphagia screen 78.8% to 85.7%, patient education 86% to 94.6%, DTN 60 minutes or less 31% to 72.8% with a mean DTN time of 91 minutes to 68.8 minutes. Conclusion: Formation of a stroke collaborative group for this organization had a positive effect on improving stroke best practices. Areas of focus identified were standardized best practice processes which included creation of system-wide electronic stroke order sets, development of staff and patient educational materials, implementation of templates and development of a DTN challenge. As the Stroke Collaborative expanded three additional working subcommittees were established, Patient Satisfaction, Emergency Medical Service collaboration and Stroke Support Group Development. In conclusion facilitation of communication and collaboration utilizing individual talents and resources is an effective way to improve stroke evidenced-based best practice across a multi-state healthcare system.

A dynamic multi-channel speech enhancement system for distributed microphones in a car environment

Supporting multiple active speakers in automotive hands-free or speech dialog applications is an interesting issue not least due to comfort reasons. Therefore, a multi-channel system for enhancement of speech signals captured by distributed distant microphones in a car environment is presented. Each of the potential speakers in the car has a dedicated directional microphone close to his position that captures the corresponding speech signal. The aim of the resulting overall system is twofold: On the one hand, a combination of an arbitrary pre-defined subset of speakers’ signals can be performed, e.g., to create an output signal in a hands-free telephone conference call for a far-end communication partner. On the other hand, annoying cross-talk components from interfering sound sources occurring in multiple different mixed output signals are to be eliminated, motivated by the possibility of other hands-free applications being active in parallel. The system includes several signal processing stages. A dedicated signal processing block for interfering speaker cancellation attenuates the cross-talk components of undesired speech. Further signal enhancement comprises the reduction of residual cross-talk and background noise. Subsequently, a dynamic signal combination stage merges the processed single-microphone signals to obtain appropriate mixed signals at the system output that may be passed to applications such as telephony or a speech dialog system. Based on signal power ratios between the particular microphone signals, an appropriate speaker activity detection and therewith a robust control mechanism of the whole system is presented. The proposed system may be dynamically configured and has been evaluated for a car setup with four speakers sitting in the car cabin disturbed in various noise conditions.

Readiness Leads to Fast MH Response at Navy Yard

Readiness Leads to Fast MH Response at Navy Yard

Perspectives on the Use of English as a Business Lingua Franca in Hong Kong

This article presents the findings of a large-scale, multifaceted investigation into the use of English as a business lingua franca in Hong Kong’s key service industries. The findings were derived from four sources: semistructured interviews with 28 Chinese professionals; four “week-in-the-life” case studies, which include an all-day office observation; analyses of telephone conference recordings and email chains; and a questionnaire survey involving more than 2,000 respondents. The evidence suggests that English, particularly its written form, plays a crucial role in business communication, although the nature and extent of its use vary according to an array of institutional and individual factors, such as a company’s ownership and a professional’s duties. The qualitative data illustrate the interplay between the two written (English, Chinese) and three spoken codes (English, Cantonese, Putonghua) in workplace communication, and particularly the symbiotic relationship between written English and Cantonese.

Collaboration processes, outcomes, challenges and enablers of distributed clinical communities of practice

Modern healthcare's need for knowledge sharing and bridging the research–practice gap requires new forms of collaboration, in which clinicians of varying clinical and research expertise work together over geographical and organisational borders. To support such distributed communities of practice (CoPs), an understanding of their collaboration processes, outcomes, challenges and enablers is needed. The article examines these issues through a case study of a long-running CoP, the Swedish Oral Medicine Network (SOMNet). SOMNet's main form of collaboration is monthly telephone conference meetings centred on case consultations. Cases are submitted by the clinicians via a Web-based system. The methods used were interviews, observations, and a questionnaire. The work adds to previous research by studying a distributed CoP explicitly focused on supporting the transfer of scientific results from researchers to practitioners. We found that the regular meetings give a rhythm to the community. The centrality of cases means an immediate benefit for the submitter while the community is provided an authentic context for learning. SOMNet yields opportunities for help and learning for diverse expertise levels; the type of benefits is affected by the participant's degree of oral medicine knowledge and collaboration involvement. There are challenges in accommodating varying levels of expertise and encouraging those less experienced to participate. Enablers of the collaboration include the participation of experts, meeting facilitators and well-adapted ITs.

Identification of Significant Barriers to Accrual (BtA) to NCI Sponsored Multiple Myeloma – Clinical Trials (MM-CT): A Step towards Improving Accrual to Clinical Trials.

AbstractAbstract 3165 Background:Accrual to large oncology group studies in the United States is often slower than planned, especially in less common malignancies such as Multiple Myeloma (MM). To improve the treatment of patients with MM, it is essential that we address the barriers to accrual (BtA) to national clinical trials. The NCI Myeloma Steering Committee (MYSC) formed the Accrual Working Group (AWG), charged to analyze this problem. Methods:The members of the MYSC have developed a list of 10 potential BtA to NCI MM-CT under the leadership of the AWG at meetings conducted in person and by monthly telephone conference. This list was distributed via Survey Monkey among investigators and research staff of the SWOG, ECOG/ACRIN and Alliance research bases for the purpose of ranking the perceived importance of the 10 selected BtA. Responses based on a 0–5 Likert Scale were analyzed as continuous and categorical. For the latter, responses were grouped: Impedes Accrual – No (0,1), Yes (2–5); Significantly Impedes Accrual – No (0–3), Yes (4,5). Results:246 survey responses were received. 50 participants who indicated that they had never attempted to or actually never enrolled a patient into a MM-CT were excluded. Of 196 responders, 61% had enrolled at least 5 patients, 43% practiced in academic centers (A) and 57% in community centers (C). 26% identified themselves as research staff, 74% as primarily physician investigators including Principal Investigators (12%). 78% have current access to NCI MM-CT. 46% identified their research base affiliation with SWOG, 20% with ECOG/ACRIN, 17% with Alliance, 17% as CTSU, NRG and other.The majority of survey responders confirmed agreement in the perception that all 10 identified BtA impede accrual, ranging from 60–84% depending on the specific barrier identified, while significant impediment to accrual ascribed to these BtA ranged from 22–47%. The perceived barriers most often cited as impeding accrual were (1) spectrum of available treatment options, (2) level of reimbursement for clinical trial related expenses and (3) patient‘s need for prompt treatment intervention (84%, 80%, 76% respectively).The first two barriers along with the requirement that patients receive their treatment exclusively at the NCI designated treatment site were rated most often as significantly impeding accrual (37%, 47%, 34% respectively). The first two were also identified most often as perceived BtA independent of practice setting (A, C), type of research engagement (physician investigator, research staff) and level of experience with MM-CT. Interestingly, the perception that patients must receive their treatment at the NCI designated treatment site and competing industry sponsored clinical trials were substantially more often cited as impeding accrual in academic centers compared to community centers and by physician investigators compared to research staff. The complexity of required diagnostic work up and the complexity of the treatment protocol and follow up testing were substantially more often cited as BtA in the community setting and by research staff compared to their peers in the academic setting and by physician investigators.The NCI MYSC AWG has proposed specific solutions to potentially lower perceived BtA. These include guidelines to allow protocol specific administration of commercially available agents by the patient‘s local oncologist, a simplified diagnostic work up and treatment plan and eligibility inclusion of patients who have received up to one cycle of specified urgent therapy prior to enrollment in MM-CT. Conclusions:We have queried experienced clinical investigators and research staff on 10 potential MM-CT specific BtA and found substantial consensus among responding participants in this survey. There are apparent differences in perceived BtA between the respondents from academic and community centers as well as between research staff and physician investigators. These data suggest that a structured approach to identification of BtA to clinical trials is feasible and creates opportunities to overcome them. This may have application to clinical trials across other diseases and may also lead to improvements in accrual. Disclosures:Barlogie:Celgene, IMF, MMRF, Millennium, Genzyme: Consultancy; Celgene, IMF, Millennium: Honoraria; Celgene, Novartis, NCI, Millennium, Onyx, Icon: Research Funding; GEP: Patents & Royalties.

Causality assessment of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS)

Adverse events following immunization (AEFI) reported to the national Vaccine Adverse Event Reporting System (VAERS) represent true causally related events, as well as events that are temporally, but not necessarily causally related to vaccine. ObjectiveWe sought to determine if the causal relationships between the vaccine and the AEFI reported to VAERS could be assessed through expert review. DesignA stratified random sample of 100 VAERS reports received in 2004 contained 13 fatal cases, 19 cases with non-fatal disabilities, 39 other serious non-fatal cases and 29 non-serious cases. Experts knowledgeable about vaccines and clinical outcomes, reviewed each VAERS report and available medical records. Main outcome measuresModified World Health Organization criteria were used to classify the causal relationship between vaccines and AEFI as definite, probable, possible, unlikely or unrelated. Five independent reviewers evaluated each report. If they did not reach a majority agreement on causality after initial review, the report was discussed on a telephone conference to achieve agreement. Results108 AEFIs were identified in the selected 100 VAERS reports. After initial review majority agreement was achieved for 83% of the AEFI and 17% required further discussion. In the end, only 3 (3%) of the AEFI were classified as definitely causally related to vaccine received. Of the remaining AEFI 22 (20%) were classified as probably and 22 (20%) were classified as possibly related to vaccine received; a majority (53%) were classified as either unlikely or unrelated to a vaccine received. ConclusionsUsing VAERS reports and additional documentation, causality could be assessed by expert review in the majority of VAERS reports. Assessment of VAERS reports identified that causality was thought to be probable or definite in less than one quarter of reports, and these were dominated by local reactions, allergic reactions, or symptoms known to be associated with the vaccine administered.

The Continuing Professional Development for Nurses and Allied Health Professionals Working Within Musculoskeletal Services: A National UK Survey

To explore the current UK status of continuing professional development (CPD) for nurses and allied health professionals (AHPs) working in musculoskeletal (MSK) services in the UK. A web-based survey was developed and used to collect data from service managers, nurses and AHPs who work with people who have MSK conditions, recruited through professional interest groups via email and website notices. The questionnaire was designed following focus groups and telephone conference calls with managers and AHPs from MSK services to ensure content validity. Results were collected online and analysed in SPSS PASW 17 using frequency data and χ² analyses. A total of 354 responses were analysed. The most frequently reported reason for undertaking CPD was to improve patient care. The level of staff experience made no significant difference to the CPD activities undertaken. The majority of respondents reported that their organization was supportive of CPD activities and in applying new knowledge to practice, but lack of funding and having too many other tasks to complete at work were the most frequently reported barriers to CPD. Many commented about the difficulty in accessing CPD in the face of increasing workload pressure and tightened budgets. The results indicate that despite the organizational support for CPD, respondents faced substantial challenges in accessing CPD when under pressure to achieve productivity targets, with little assistance in terms of funding. This discrepancy may indicate that greater support is required to meet MSK nurses' and AHPs' CPD needs.

Health outcomes of interest for evaluation in the Post-Licensure Rapid Immunization Safety Monitoring Program

Active vaccine safety surveillance systems commonly use computerized diagnostic codes to identify potential health outcomes of interest. Evidence concerning the accuracy of these codes is variable, and few systematic reviews are available. This project's aim was to select a list of health outcomes of interest most suitable for evaluation in the Food and Drug Administration's Post-Licensure Rapid Immunization Safety Monitoring (PRISM) program. We conducted an expert elicitation process to develop the list. A comprehensive list of potential health outcomes of interest was formed based on input from a wide variety of vaccine safety experts. We then selected five panelists with senior leadership roles in vaccine safety from both within and outside the FDA. We elicited the experts’ recommendations via a structured, iterative process that included an Internet-assisted telephone conference call and formal voting procedures. The expert panelists identified several criteria as important in their choices, including clinical severity, public health importance, rare or uncommon incidence, relevance to two or more vaccines, and historical association with vaccines. The list of 24 outcomes chosen by the experts and refined by the FDA included ten neurologic outcomes, two circulatory system outcomes, and two musculoskeletal outcomes. The PRISM program plans to conduct a set of evidence reviews on the positive predictive value and other characteristics of existing computerized codes and algorithms to identify these health outcomes of interest.

Making Publication Ethics Work

Making Publication Ethics Work