A Pilot Study Using Nominal Group Technique to Assess Residents’ Perceptions of Successful Attending Rounds

BACKGROUND  Ward attending rounds are fundamental for internal medicine residency training. An improved understanding of interns’ and residents’ perceptions of attending rounds should inform training programs and attending physicians. OBJECTIVES  The aim of this study was to assess residents’ perceptions of successful attending rounds. DESIGN  We convened two groups of interns and two groups of residents, to elicit their perceptions on attending rounds. SUBJECTS  Participants were recruited by e-mail and conference announcements from the 49 interns and 80 residents in the internal medicine and medicine-pediatrics residency programs. MEASUREMENTS  The nominal group technique (NGT) uses a structured group process to elicit and prioritize answers to a carefully articulated question. MAIN RESULTS  Seven interns (14%) identified 27 success factors and ranked attending approachability and enthusiasm and high quality teaching as most important. A second group of six (12%) interns identified 40 detractors and ranked having “mean attendings,” receiving disrespectful comments, and too long or too short rounds as the most significant detractors. Nine (11%) residents identified 32 success factors and ranked attention to length of rounds, house staff autonomy, and establishing goals/expectations as the most important success factors. A second group of six (8%) residents identified 34 detractors and ranked very long rounds, interruptions and time constraints, and poor rapport between team members as the most significant detractors). CONCLUSIONS  Although there was some overlap in interns’ and residents’ perceptions of attending rounds, interns identified interpersonal factors as the most important factors; whereas residents viewed structural factors as most important. These findings should assist attending physicians improve the way they conduct rounds targeting both interns and residents needs. Presented in part at the Southern Regional Meeting of the Society of General Internal Medicine in New Orleans, LA, in February 2005 and the Society of General Internal Medicine Annual Meeting in New Orleans, LA, in May 2005.     

Mandatory Procedures and Fairness in Mental Impairment Hearings

Uncertainty has attended procedures for adjudging unfitness to stand trial in Victoria pursuant to the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Vic) and how “special hearings” should be conducted when a person is determined to be unfit to stand trial but does not wish to pursue the defence of not guilty because of mental impairment. In R v Langley [2008] VSCA 81, (2009) 19 VR 90 the Victorian Court of Appeal clarified the procedures to be employed at jury trials on such matters and quashed a decision not in conformity with proper procedures, making clear that denial of fairness to such accused persons has the potential to result in appealable error.     

Development of a balance,safe mobility and falls management programme for people with multiple sclerosis

Abstract

Purpose: To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme.

Materials and methods: Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n?=?15) and providers (n?=?19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically.

Results: Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time.

Key recommendations were:

Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important.

Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy.

Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential.

Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience.

Conclusions: Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach.

• Implications for Rehabilitation

• People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls.

• Programme design should support self-efficacy and flexible engagement.

• Adequate support and funding are seen as essential by both service users and providers.

     

Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents. Immunomodulatory drugs are used frequently in its treatment. Using the nominal group technique (NGT) and Delphi method, we created a multidisciplinary, evidence- and consensus-based treatment guideline for JIA based on a systematic literature analysis and three consensus conferences. Conferences were headed by a professional moderator and were attended by representatives who had been nominated by their scientific societies or organizations. 15 statements regarding drug therapy, symptomatic and surgical management were generated. It is recommended that initially JIA is treated with NSAID followed by local glucocorticoids and/or methotrexate if unresponsive. Complementing literature evidence with long-standing experience of caregivers allows creating guidelines that may potentially improve the quality of care for children and adolescents with JIA.     

Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud

Objectives

To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government.

Material and methods

A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods.

Results

The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high.

Conclusions

There are several opportunities to improve the efficiency of the Spanish NHS beyond the “anticrisis” measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.     

Identification of Barriers to Adherence to a Weight Loss Diet in Women Using the Nominal Group Technique

Background: At any given time, a majority of women are engaged in some type of weight loss diet; however, these efforts are difficult to sustain for long-term weight control. Because women are more likely to develop obesity and suffer a greater severity of obesity-related health and economic consequences, we sought to identify the key factors that make adhering to a weight loss diet difficult for overweight/obese women. Methods: Ten nominal group technique (NGT) sessions aimed at identifying perceived barriers to adherence to a weight loss diet were conducted as part of a weight loss study for overweight/obese women (n = 33) during the controlled feeding weight loss phase. Results: Individual-level barriers to emerge from the sessions included knowing when to stop eating, being able to control cravings and emotional eating, and sustaining healthier dietary habits. Environmental-level barriers included family/social events that bring people together, especially those centered around food and drink, eating out, cost, and busy schedules. Conclusions: These findings offer a deeper understanding of barriers women find most salient to adhering to a weight loss diet, providing direction for the clinical application of weight loss programs.     

Assessing the Educational Needs of Mental Health Nurses Working in an Adolescent Inpatient Psychiatric Ward in Japan

PROBLEM: In Japan, preregistration education is not sufficient to prepare nurses to work as child adolescent mental health nurses. METHODS: Nominal group technique (NGT) using focus group discussions, and Knowles' Adult Learning Theory, were used to examine the continuing educational needs of nurses in a Japanese adolescent mental health unit. FINDINGS: Nurses caring for adolescent patients with mental health issues need continuing education. This research demonstrates the utility of nominal group technique in needs analysis in this context. CONCLUSIONS: Educational priorities include instruction on patients' developmental stage, promoting patient self‐sufficiency, and strategies for meeting the needs of families. A family‐centered care approach is recommended.