Patient feedback in revalidation: an exploratory study using the consultation satisfaction questionnaire

Background

Revalidation is the UK process forthe review of doctors to ensure they are fit to practise. Revalidation will include patient feedback.

Aim

To investigate the role of patient feedback on GPs'' consultations in revalidation.

Design and setting

Cross-sectional survey of patients consulting 171 GPs.

Method

A total of 6433 patients aged 16 years or over completed the consultation satisfaction questionnaire (CSQ). Generalisability analysis was undertaken, scale scores calculated, and outliers identified using two and three standard deviations from the mean as control limits. Comments made by patients were categorised into positive, neutral, or negative.

Results

After averaging each scale for each doctor, mean scores (standard deviation), out of a possible score of 100, were: general satisfaction 78.1 (7.2); professional care 82.1 (6.1); relationship 71.2 (7.1); perceived time 65.7 (7.6). A D-study (which enables estimation of the reliability from 0-1 of the CSQ scores for different numbers of responders for each doctor), indicated that ratings by 19 patients would achieve a generalisability coefficient of 0.80 for the combined score. Fifteen GPs had one or more scale scores below two standard deviations of the mean. Comments were more often negative for GPs with scores below two standard deviations of the mean.

Conclusion

Most patients of most GPs are satisfied with their experience of consultations, and ways to make patient feedback formative for these doctors is required. For a few GPs, most patients report some dissatisfaction. Patient feedback may identify doctors who need educational support and possibly remediation, but agreed questionnaire score thresholds are required, and agreement is needed on the weight to be attached to patient experience in comparison with other aspects of performance.     

Intrusive images in grief: an exploratory study

The relevance of intrusive mental imagery to the understanding and treatment of psychological disorders is increasingly acknowledged. Little research has been done on intrusive imagery in grief. Using a sample of 131 mourners, recruited from professional and lay mental health care workers, the current study examined the frequency and correlates of four specific intrusive images: (a) positive intrusive memories of the lost person; (b) intrusive images of the death event; (c) re‐enactment fantasies; and (d) negative images of the future. Findings revealed that these intrusions were common and that the occurrence of these intrusions hardly varied across subgroups of mourners. All four intrusions were correlated with the severity of complicated grief symptoms, and intrusions (b), (c) and (d) were also correlated with the severity of symptoms of depression and anxiety. Findings have potential theoretical and clinical implications and indicate that a more comprehensive study of intrusions among bereaved people is warranted. Copyright © 2008 John Wiley & Sons, Ltd.     

Attributions and misconceptions in angina: an exploratory study

Although there have been a number of studies regarding attributions and misconceptions in people following a heart attack, there have been no comparable studies in people with angina. Semi-structured interviews were held with 20 people suffering from angina to discover their beliefs about angina, particularly those that may be misconceived or associated with maladaptive coping. Nineteen of the 20 participants held such beliefs. Stress was the most frequent causal attribution and misconceived angina avoidance strategies were cited by the majority. The beliefs about angina held by this sample may have implications for their health-related quality of life, if their experience mirrors that found within heart attack populations.     

Neptune: an environment for the delivery of genomic medicine

PurposeGenomic medicine holds great promise for improving health care, but integrating searchable and actionable genetic data into electronic health records (EHRs) remains a challenge. Here we describe Neptune, a system for managing the interaction between a clinical laboratory and an EHR system during the clinical reporting process.MethodsWe developed Neptune and applied it to two clinical sequencing projects that required report customization, variant reanalysis, and EHR integration.ResultsNeptune has been applied for the generation and delivery of over 15,000 clinical genomic reports. This work spans two clinical tests based on targeted gene panels that contain 68 and 153 genes respectively. These projects demanded customizable clinical reports that contained a variety of genetic data types including single-nucleotide variants (SNVs), copy-number variants (CNVs), pharmacogenomics, and polygenic risk scores. Two variant reanalysis activities were also supported, highlighting this important workflow.ConclusionMethods are needed for delivering structured genetic data to EHRs. This need extends beyond developing data formats to providing infrastructure that manages the reporting process itself. Neptune was successfully applied on two high-throughput clinical sequencing projects to build and deliver clinical reports to EHR systems. The software is open source and available at https://gitlab.com/bcm-hgsc/neptune.     

Array comparative genomic hybridization for diagnosis of developmental delay: an exploratory cost-consequences analysis

A major application of array comparative genomic hybridization (aCGH) is to define a specific cause in children with undiagnosed learning and developmental disability (LDD). Medical notes for 46 consecutive patients selected for aCGH analysis by clinical dysmorphologists were abstracted for clinical investigations related to LDD and a cost-consequences analysis was performed. aCGH analysis was completed in 36 cases and five diagnostic chromosomal anomalies were identified (13.8%). The number of investigations undertaken on each child varied. With aCGH estimated to cost 590 British Pound per case, if aCGH had been undertaken after negative standard initial tests for LDD investigation, the additional cost would be 2399 British Pound per positive case. If the cost of aCGH was reduced to 256 British Pound per case (approximately 350 Euro), aCGH becomes cost neutral. All chromosomal anomalies detected by aCGH had a de Vries score of > or =5. If aCGH had only been used for individuals with a score of > or =5, the sensitivity increased to 21.7% yielding a cost of 1087 British Pound per positive case identified. Pre-selection of cases for aCGH based on de Vries criteria has a major economic impact on introducing aCGH into clinical practice. Prospective studies are required to explore the long-term costs and consequences of aCGH and identify when aCGH may provide the most benefit at least cost.     

Stigma and self-esteem in manic depression: an exploratory study

BACKGROUND: As part of a larger study on coping styles in manic depressive patients, it was felt that self-esteem and stigmatisation, two areas that have received little attention in connection with this illness, warranted investigation. METHOD: A questionnaire on self-esteem and feelings of stigmatisation was piloted. The rationale of the questionnaire is explained and data on its reliability and validity are presented. RESULTS: This pilot study suggests a relationship between mood and self-esteem, while feelings of stigmatisation seem to be relatively independent of mood. However, some relationship between self-esteem and stigmatisation is suggested. LIMITATIONS: This study focused on an atypical group of patients, and the questionnaire had never been used before. For this reason, the results can be best seen as suggesting further research. CONCLUSIONS: We believe that issues of self-esteem and stigmatisation can have considerable clinical significance in this client group. For this reason, we hope this paper will stimulate interest in these areas.     

Reflex penile erection in anesthetized mice: an exploratory study

Ejaculatory-like rhythmic contractions of the bulbospongiosus (BS) muscle and penile erection can be elicited in the urethane-anesthetized rat, following spinal cord transection, upon electrical stimulation (ES) of the dorsal penile nerve (DPN). The aim of this work was to investigate this reflex in anesthetized mice. Adult C57BL6 mice were anesthetized with isoflurane. The BS muscle and corpus cavernosum were instrumented to allow quantification of the BS muscle electromyographic activity (BS EMG) and intracavernosal pressure respectively. The femoral artery and jugular vein were catheterized to allow measurement of blood pressure and compound administration. ES of the DPN, via bipolar silver electrodes, reliably evoked erectile responses in mice with intact spinal cords. The overall amplitude of the erectile response was frequency- and pulse duration-dependent. Erectile responses were abolished by bilateral cut of the sensory branch of the pudendal nerve. Transection of the spinal cord potentiated the erectile responses and increased the area under the curve of the BS EMG when compared with those animals with intact spinal cords. However, no coordinated rhythmic contractions of the BS muscle during or after the ES could be observed, with or without spinal transection. Melanotan-II failed to enhance the erectile response induced by ES of the DPN, in mice with intact spinal cords. ES of the DPN in isoflurane-anesthetized mice could be a useful model in which to study the interplay between brain and spinal cord in the control of reflex penile erection, and could take advantage of knockout mice models. However, the lack of efficacy of Melanotan-II suggests that further experiments are necessary to confirm the future utility of this model. In contrast to rats, the expulsion reflex could not be reliably elicited in mice with or without spinal transection. This latter finding suggests the existence of fundamental differences in the organization of the spinal network controlling sexual reflexes between rats and mice.     

Getting synchronised in the mirror game: an exploratory study

ABSTRACT

This exploratory study aimed to disassemble interpersonal movement synchrony by looking at the different elements that comprise this kind of interaction. For this purpose, we used the mirror-game (MG)- an imitation movement technique commonly used in drama and dance/movement therapy. Forty-eight participants (mean age = 33.2) played the MG with same gender-matched expert players. All MGs were recorded and later observed. We used in-depth observation of the MG and created the MG-Synchrony-Scales (MGSS), which identify eight parameters: Reference to the other, Adopting the suggestions, Complexity of the participant’s movement, Sync time, Entering synchrony, Complexity of synchronised dyadic movement, Exiting synchrony, and Non-jittery motion. We explored statistically the links between these different elements of movement synchrony. Using the MGSS showed that the qualities one needs to synchronise with the other are a combination of paying attention to the other and readiness to freely explore a variety of movements and roles.     

Texas physicians' perceptions of genomic medicine as an innovation

Primary care providers (PCPs) are believed to be the professionals who, in the near future, will be responsible for incorporating genomic medicine (GM) into primary care. Given the dearth of empirical data describing PCPs' beliefs about GM and the relationship between beliefs and the incorporation of GM into practice, this study assessed whether (and to what extent) PCPs' perceptions of GM as an innovation influence their likelihood of adopting this innovation into primary care. The study utilized diffusion of innovations theory as a framework. A state-wide representative sample of PCPs practicing in Texas responded to a mailed survey. The survey measured PCPs' perceptions of five characteristics of GM as an innovation. Findings suggest that among the five characteristics examined GM's relative advantage, compatibility with current practice, its complexity, and observability were the strongest predictors of likelihood to adopt GM tasks into primary care practice.     

Building an infrastructure to enable delivery of genomic medicine

To meaningfully address health disparities in access to genomic testing, major developments in the infrastructure to support delivery of care are needed. The current value chain for delivering genomic medicine is fragmented, with poor communication between the stakeholders who order, perform, and reimburse for genetic tests. Standards, connectivity, and scaled expertise are needed to reach more people equitably and achieve healthcare returns on society's investments in genomics. As the costs of genetically‐targeted therapeutics and treatments rise, a mature infrastructure to support the delivery of genetic tests becomes critical.     

Professional attitudes to patient participation groups: an exploratory study

An exploratory study of the development of patient participation groups in general practice and general practitioners' attitudes towards them suggests that many general practitioners may not yet be aware of this innovation and may at first react negatively to the idea. This response stems in part from misconceptions about the origins and functions of these groups, a failure to see their relevance to professional objectives, and a fear that they will threaten general practitioners' autonomy and status. In contrast, general practitioners who have formed groups believe they have an important contribution to make to their developing role and have been encouraged by their experience so far. Therefore, at present, patient participation groups should neither be rejected out of hand, nor welcomed as a panacea.