Long-menu questions in computer-based assessments: a retrospective observational study.

BACKGROUND: Computer based assessments of paediatrics in our institution use series of clinical cases, where information is progressively delivered to the students in a sequential order. Three types of formats are mainly used: Type A (single answer), Pick N, and Long-menu. Long-menu questions require a long, hidden list of possible answers: based on the student's initial free text response, the program narrows the list, allowing the student to select the answer. This study analyses the psychometric properties of Long-menu questions compared with the two other commonly used formats: Type A and Pick N. METHODS: We reviewed the difficulty level and discrimination index of the items in the paediatric exams from 2009 to 2015, and compared the Long-menu questions with the Type A and Pick N questions, using multiple-way analyses of variances. RESULTS: Our dataset included 13 exam sessions with 855 students and 558 items included in the analysis, 212 (38 %) Long-menu, 201 (36 %) Pick N, and 140 Type A (25 %) items. There was a significant format effect associated with both level of difficulty (p = .005) and discrimination index (p < .001). Long-menu questions were easier than Type A questions(+5.2 %; 95 % CI 1.1-9.4 %), and more discriminative than both Type A (+0.07; 95 % CI 0.01-0.14), and Pick N (+0.10; 95 % CI 0.05-0.16) questions. CONCLUSIONS: Long-menu questions show good psychometric properties when compared with more common formats such as Type A or Pick N, though confirmatory studies are needed. They provide more variety, reduce the cueing effect, and thus may more closely reflect real life practice than the other item formats inherited from paper-based examination that are used during computer-based assessments.

Delayed recognition of Guillain-Barré syndrome in a child: a misleading respiratory distress.

BACKGROUND: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in childhood. Respiratory symptoms can mask neurologic signs, leading to a delay in diagnosis. OBJECTIVES: We report this case to highlight the diagnostic difficulty in children suffering from GBS who have respiratory involvement as the main clinical findings on presentation. CASE REPORT: This case report describes a 9-year-old girl presenting with respiratory distress, weakness, limb pain, and hypertension. The severe respiratory involvement due to a Mycoplasma pneumoniae lung infection led to a delay in diagnosing GBS in this child. CONCLUSION: Unexplained weakness, together with respiratory involvement and associated dysautonomia, should support the possibility of GBS.

Expert panel diagnosis demonstrated high reproducibility as reference standard in infectious diseases.

OBJECTIVE: If a gold standard is lacking in a diagnostic test accuracy study, expert diagnosis is frequently used as reference standard. However, interobserver and intraobserver agreements are imperfect. The aim of this study was to quantify the reproducibility of a panel diagnosis for pediatric infectious diseases. STUDY DESIGN AND SETTING: Pediatricians from six countries adjudicated a diagnosis (i.e., bacterial infection, viral infection, or indeterminate) for febrile children. Diagnosis was reached when the majority of panel members came to the same diagnosis, leaving others inconclusive. We evaluated intraobserver and intrapanel agreement with 6 weeks and 3 years' time intervals. We calculated the proportion of inconclusive diagnosis for a three-, five-, and seven-expert panel. RESULTS: For both time intervals (i.e., 6 weeks and 3 years), intrapanel agreement was higher (kappa 0.88, 95%CI: 0.81-0.94 and 0.80, 95%CI: NA) compared to intraobserver agreement (kappa 0.77, 95%CI: 0.71-0.83 and 0.65, 95%CI: 0.52-0.78). After expanding the three-expert panel to five or seven experts, the proportion of inconclusive diagnoses (11%) remained the same. CONCLUSION: A panel consisting of three experts provides more reproducible diagnoses than an individual expert in children with lower respiratory tract infection or fever without source. Increasing the size of a panel beyond three experts has no major advantage for diagnosis reproducibility.

Communication of Children Symptoms in Emergency: Classification of the Terminology.

The significant part of non-urgent visits to the emergency highlight the necessity to advise people on the actions to take according to their symptoms. Although information sources are accessible through different channels their content often employs medical terminologies that are difficult to understand by laypersons. Our goal is to provide a terminology of the most common symptoms in pediatric emergency adapted to laypersons. This terminology is organized in a hierarchy by the mean of a card-sorting study. The resulting classification separates the symptoms into two main categories: "accident" and "illness" that are subdivided in 9 and 10 sub-categories. The study also revealed that some symptoms were not understood by the participants and had to be reformulated, confirming the importance of user-centered method. The classification resulting from this study will be evaluated through a tree-test.

Connecting Parents to a Pediatric Emergency Department: Designing a Mobile App Based on Patient Centred Care Principles.

INTRODUCTION: Patient centred care fosters a holistic approach of care switching the focus from a disease perspective to a patient's experience perspective. Patient centred care is of particular importance in the context of paediatric emergency medicine. Indeed, parents entering a paediatric emergency department (PED) are usually under stress caused by their children's illness, the unfamiliar setting of the PED and delays of care. All these factors can deteriorate their experience as well as the relationships between healthcare providers, the patients and their parents. METHODS: We explore potential areas to improve the patient experience during his journey into PED. The dimensions of the picker's patient centred care are used to guide observations, conduct interviews and focus groups. The areas of improvement are then operationalized through their translation into app functionalities. RESULTS: Our novel application allows supporting users on 7 of the 8 dimensions of picker's patient centred care model. The app supports parents in their decision-making to consult a PED, it provides relevant medical information to avoid unrealistic expectations and accompany the family after discharge thanks to tailored information sheets about diagnostics. CONCLUSION: Our mobile app allows to make a big step toward the improvement of the patient-caregiver relationship. The direct benefits will be shared by patients and caregivers, as well as the institution.