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R. Duffin, E. Bayliss, M. Everard. Sheffield Children's Hospital, Sheffield, UK
IntroductionThe busy health professional requires quick and easy access to high quality information. Increasingly clinicians are using online resources. But where to start when using the internet? The Child Health Specialist Library is a free, NHS‐funded service providing access to evidence based information which will become a core resource supporting the National Care Record Service. It has over 3000 professionally indexed items including national guidelines, evidenced base resources and an increasing number of electronic journals.
MethodsThe ease by which key information was accessed using the NLH was compared with a similar search using Google.
ResultsA Google search for “Asthma” produced 1.2 million results with “sponsored links” being prominent. Refining the search using the “Health Professionals” option and only pages from the UK generated 1020. The BTS/SIGN guidelines were found on page 2 below BUPA, the BBC, commercial and pharmaceutical sites. One of the two NICE publications relating to inhaler use in children was on page 5 (result No 46) and the other did not make the top 100. There was no reference to Cochrane or other resources. The Child Health Specialist Library displays the SIGN and NICE guidance together with Prodigy on page 1 of Guidelines and has access to 92 evidence‐based resources including all relevant Cochrane reviews.
ConclusionsThe Child Health NLH appears to be a more effective way to access clinically relevant information and is likely to become increasingly important as it develops and is integrated into the national care records service (http://www.library.nhs.uk/childhealth).
K. Whyte, L. Reynolds. Royal Hospital for Sick Children, Glasgow, UK
AimsTo evaluate the satisfaction of parents and professionals in regard to written reports from a Consultant Community Paediatrician, with a view to improving report structure and content as necessary.
MethodsAnonymous questionnaires were distributed to the parents/guardians and professionals who had received a report for all children attending appointments over a 4‐month period. The main issues explored were in regard to report sending, content, format and clarity. There was also the opportunity for free comments and suggestions for improvements.
ResultsForty five questionnaires were sent to parents and 166 to professionals, with a response rate of 53% and 68% respectively. The majority of parents and professionals responding remembered getting a report, felt it arrived in good time and were happy to be receiving the same report. 86% of those parents responding stated that the whole report was easy to understand. They all stated that the report described their child's difficulties well and how it was planned to help the child. In most cases, the report was read by other family members, not just the parent attending clinic. 93% of those professionals who responded stated that it was clear in the report what the child's problems and management plan were. Additional free comments were made on 58 questionnaires and 78% of these were of a positive nature in respect to report content, format and usefulness. Negative comments were generally in relation to late reports. Overall, 86% of responding parents and 89% of responding professionals were satisfied with the report in the current format.
ConclusionsThe results of this study support this consultant continuing with current practice in terms of format and distribution of reports. It also demonstrates that reports are frequently read by the wider family and support network, not just the parent attending clinic. It is already considered best practice to copy reports to parents, and this study further supports this.
M. Silver. Oxford University, Oxford, UK
A randomised controlled trial looked at the effect of the Emotion Trainer on able children with autism or Asperger's syndrome. Two groups of 11 children (age 12–18) at two special schools participated. Individuals in one group used the computer program for 10 half‐hour sessions and were compared to the other group who received no intervention. Data collected within the program showed a significant reduction in errors made from first to last use. Students were assessed pre and post intervention using facial expression photographs, cartoons depicting emotion‐laden situations, and non‐literal stories. Scores were not related to age or verbal ability. The experimental group made gains relative to the control group on all three measures, reaching significance on the cartoons and stories, despite the small sample size. Gains correlated significantly with the number of times the computer program was used. Results suggest strong positive effects of using the computer program.
A new enhanced version of the computer program has been developed, with greater interactivity and customisable options, such as a choice of animations themes rewarding to the child, and a choice of how many questions of each type to present at each session. Two further randomised controlled trials are underway: the first exploring whether results generalise to observable social skills, and whether results are maintained at follow‐up, the second exploring whether the program is effective in improving the social skills of children with poor early care and attachment disruption, who have lived in multiple placements.
The Emotion Trainer computer program is based on psychological research about emotion recognition, Theory of Mind, and social skills acquisition. It is presented in multi‐media including photographs, animations, and voice samples, suitable for children with social skills difficulties, autistic spectrum disorder, or learning difficulty. Further information on the program can be found at http://www.emotiontrainer.co.uk where a copy of the software can be also be downloaded for review.
M. Chakraborty, presenting, S. Nirmal. James Paget University Hospital Foundation Trust, Great Yarmouth, Norfolk, UK
AimIn keeping with the concept of “Family Centred Care” as recommended in the recent National Service Framework for Children and young people, there is a need for effective communication with patients and parents. One approach was to send a copy of the clinic letter to parents. This survey was to receive feedback from them and assess our performance.
MethodsNew patients over a period of three months from October to December 2005 were identified from clinic lists. A covering letter and questionnaire were drafted and approved by the hospital Patient Advice and Liaisons Service (PALS). Both of them were sent to all parents with a request to indicate their responses within a timeframe of four weeks and to send it back in pre‐addressed and stamped envelopes. All children 8 years of age and above were also requested to respond to the standard questions as well as whether they would prefer a separate letter from the standard one.
ResultsTotal number of subjects in the chosen period was 159. Number of respondents was 59 (37%). Questionnaire was filled out by mothers in 78% of cases. 46% of children were 8 years while 51% were <8 years of age. 67% of children 8 years read the clinic letter while 26% did not. 39% of children who read it wanted a separate letter. 44% did not opt for a separate letter. None among those who did not read it wanted a separate letter. 84% of parents' response was positive (range 69–91%) while 69% (range 61–77%) of children had a similar response (p=0.36). Only 3.6% of parents and 5.1% of children had a negative experience to the letters (p=0.04).
ConclusionsCopying clinic letters is a very effective way of communicating with parents and children. We feel that more children would be satisfied if a separate letter is personally addressed to them.
M. Sawal, A. Hall, S. Philip, E. Wassmer, D. Peake, R. Gupta. Birmingham Children's Hospital, Birmingham, UK
IntroductionAn answering phone message service was introduced in our neurology department for dealing with non‐urgent queries from parents of neurology patients. The service has been previously audited and found to be a lot more time efficient from the doctors' and secretaries' perspectives. This audit was devised to evaluate the success from the parents' perspective.
MethodsWe kept a record of every message received between February and October 2006. We randomly selected 20% of these messages. Small proportions of the calls were not left by parents and were therefore analysed separately. We attempted to contact each of the patients at least once and asked them to complete a short questionnaire over the telephone. We asked about the quality of the response they received, the usefulness of the service, whether their problem had been solved and whether they would use the service again in the future.
ResultsWe received 528‐answer phone messages in the 8‐month period analysed. We randomly selected 105 and we contacted 50 parents (response rate 53%). Most parents received a response from a doctor the next day (48%). Eight (16%) never received a response. 32% queries were concerning a medication change, 34% wanted advice, 16% concerned an ongoing prescription, 16% wanted lab or radiology results and 2% were concerning an outpatient appointment. The majority of parents rated the service as good or excellent. However, 8 parents (16%) rated it as poor, correlating to the 8 parents that received no response. 70% of parents said that their problem was solved. Almost all parents (92%) would use it again in the future.
RecommendationsWe recommend that the answering message that the parents listen to asks to leave the child's full name, hospital number, DOB and phone number(s). The message should state that the answering machine is for non‐urgent queries only and is checked once daily and only on Monday to Friday. We suggest a rota and allocated time may aid more efficient answering of the messages amongst the doctors in the department. There should be an alternative method for secretaries, pharmacy and other related healthcare professionals to contact the department.
S. A. Spencer1, S. Ordish2, J. Gardosi2. 1University Hospital North Staffordshire, Stoke‐on‐Trent, UK; 2Perinatal Institute, Birmingham, UK
IntroductionA web‐based neonatal data collection system, serving multiple units, is only able to feed raw data back to submitting units on a spreadsheet. This is difficult to check for quality and time consuming to analyse.
AimsTo develop a method of providing feedback to submitting units on their local data; to facilitate data checking and to provide standardised analysis.
MethodsAn Access database was developed, distributed by email and set up in each collecting unit. On a monthly basis the database accepts a download from the core database by email. A user‐friendly interface provides a range of commonly required analyses.
ResultsEach unit is now able to obtain an up‐to‐date analysis of all important variables such as mortality, head scan outcomes and respiratory care. Each variable is presented in monthly tables according to gestational age or birth weight. A subanalysis lists the patients included in any box in any table. A patient summary is only one further click away. These functionalities facilitate data checking and analysis. The system will be demonstrated.
ConclusionLocal ownership of the web‐based neonatal data collection system has been substantially improved by the provision of a local data analysis tool The data analysed provides each unit with facilities to produce a standardised annual report with minimum effort. Further enhancements can easily be implemented.
J. Robertson, C. Barton, R. Cooke, M. Turner. Liverpool Women's Hospital, Liverpool, UK
AimInternet searches by parents can be haphazard. The website yourchildshealth.nhs.uk provides links to high quality websites that have been vetted for accuracy and suitability. The aim of this study was to examine the priority given to a selection of these high quality websites by standard search engines and to assess the extent to which searches generated by search engines are contaminated by commercial sites.
MethodsWe examined key phrases referring to 10 common childhood conditions. For each condition we defined the index site as the site suggested by yourchildshealth.nhs.uk. For each search term we recorded the number of sites above the index site and how many of the sites that ranked higher than the index sites were commercial sites. We repeated this exercise on 5 consecutive days using 5 search engines.
ResultsThe number of sites generated by specific search terms varied from a few hundred to over a million. Over the 50 searches on any day the index site was not found on 14 occasions. Results were consistent from day to day and one day is shown in the table. The position of the index site for each condition was consistent between search engines (Kendall's coefficient of concordance =0.545, p<0.005). The median number of sites above the index site for each key phrase was: Pyloric stenosis (0), CT scan (2), Labial adhesions (2), Dyslexia (3), Down's support group (3), Guthrie test (6), tonsillitis (10), precocious puberty (11), athlete's foot (12), Turner's support group (20).
ConclusionsWhen using search engines, parents would have to review many websites before encountering the link we deem optimal for a UK audience. Some distraction sites will be commercial sites with vested interests. We recommend that parents are directed to a single portal that gives validated links to high quality information.
J. Sheppard, L. Weidner, S. Zakai, S. Fountain‐Polley, J. Williams. Heartlands Hospital, Birmingham, UK
AimsEffective communication is vital in clinical decision making. With the change to shift‐work and repeated handovers, written patient information plays a crucial role. Concerns have been expressed about abbreviation use in the medical records; therefore a survey of paediatric medical records was conducted to assess the frequency, nature and understanding of abbreviations.
MethodsA two‐stage survey of paediatric medical records was conducted in a district general teaching hospital. Firstly, all abbreviations in paediatric handover sheets were identified. Comparison against two standards (Mosby's Medical Dictionary ‐ MMD/Trust Intranet Medical Dictionary ‐ TID) determined whether they were officially accepted definitions and if alternative interpretations existed. Secondly, a survey of paediatric medical notes was conducted. A random selection of abbreviations was shown to health care professionals involved with children to determine their interpretation of them.
Results2286 abbreviations were used on 25 handover sheets; there were 221 different abbreviations averaging 91 per sheet. On handover sheets 14% (TID) and 20% (MMD) of abbreviations were identified as standard. 3668 abbreviations were used in the 168 sets of medical notes; 479 different abbreviations were used, averaging 21 per set; between 15% (TID) and 17% (MMD) were identified as standard abbreviations. Some words were shortened in different forms, for example, normal (N, Nl, NAD) and some abbreviations had multiple interpretations, for example, TOF (tetralogy of Fallot, tracheoesophageal fistula). For abbreviations presented to non‐paediatric healthcare professionals, 48% were recognised, while paediatric doctors recognised 75%.
ConclusionThis study confirms the widespread use of abbreviations in written medical information. There is no systematic approach to abbreviation use. Abbreviations allow large quantities of information to be conveyed concisely, however, difficulties in interpretation remain. As a result of this study a list of official abbreviations was developed locally. The use of standardised abbreviations to avoid confusion, errors in patient management and medico‐legal complications is strongly suggested.