Gaps in pediatric clinician communication and opportunities for improvement.

Teamwork and good communication are central to the provision of high-quality care. A standardized focus-group protocol was used. Analysis assessed emergent themes of patient safety-related effective and problematic clinician communication. Sixty-three focus groups were conducted with clinicians from five Chicago Pediatric Patient Safety Consortium hospitals. Effective and problematic clinician-to-clinician communication themes were described in all focus groups and at each participating hospital. Problematic communication contexts included the communication process for orders, consultations, acuity assessment, management of surgical and medical patients, and the discharge process. Organizational policies and systems leading to patient safety risk included a lack of clear responsibilities and expectations for clinicians and for clinical communication, as well as a lack of a clear chain of responsibility for communication when hierarchical communication barriers affected safe patient care. Results of this investigation highlighted gaps in pediatric clinician communication and opportunities for improvement.

Food allergy knowledge, attitudes and beliefs: focus groups of parents, physicians and the general public.

BACKGROUND: Food allergy prevalence is increasing in US children. Presently, the primary means of preventing potentially fatal reactions are avoidance of allergens, prompt recognition of food allergy reactions, and knowledge about food allergy reaction treatments. Focus groups were held as a preliminary step in the development of validated survey instruments to assess food allergy knowledge, attitudes, and beliefs of parents, physicians, and the general public. METHODS: Eight focus groups were conducted between January and July of 2006 in the Chicago area with parents of children with food allergy (3 groups), physicians (3 groups), and the general public (2 groups). A constant comparative method was used to identify the emerging themes which were then grouped into key domains of food allergy knowledge, attitudes, and beliefs. RESULTS: Parents of children with food allergy had solid fundamental knowledge but had concerns about primary care physicians' knowledge of food allergy, diagnostic approaches, and treatment practices. The considerable impact of children's food allergies on familial quality of life was articulated. Physicians had good basic knowledge of food allergy but differed in their approach to diagnosis and advice about starting solids and breastfeeding. The general public had wide variation in knowledge about food allergy with many misconceptions of key concepts related to prevalence, definition, and triggers of food allergy. CONCLUSION: Appreciable food allergy knowledge gaps exist, especially among physicians and the general public. The quality of life for children with food allergy and their families is significantly affected.

Oscillatory correlates of the primacy effect in episodic memory.

Both intracranial and scalp EEG studies have demonstrated that oscillatory activity, especially in the gamma band (28 to 100 Hz), can differentiate successful and unsuccessful episodic encoding [Sederberg, P.B., Kahana, M.J., Howard, M.W., Donner, E.J., Madsen, J.R., 2003. Theta and gamma oscillations during encoding predict subsequent recall. Journal of Neuroscience, 23(34), 10809-10814; Fell, J., Klaver, P., Lehnertz, K., Grunwald, T., Schaller, C., Elger, C.E., Fernandez, G., 2001. Human memory formation is accompanied by rhinal-hippocampal coupling and decoupling. Nature Neuroscience, 4 (12), 1259-1264; Gruber, T., Tsivilis, D., Montaldi, D., and Müller, M. (2004). Induced gamma band responses: An early marker of memory encoding and retrieval. Neuroreport, 15, 1837-1841; Summerfield, C., Mangels, J.A., in press. Dissociable neural mechanisms for encoding predictable and unpredictable events. Journal of Cognitive Neuroscience]. Although the probability of recalling an item varies as a function of where it appeared in the list, the relation between the oscillatory dynamics of successful encoding and serial position remains unexplored. We recorded scalp EEG as participants studied lists of common nouns in a delayed free-recall task. Because early list items were recalled better than items from later serial positions (the primacy effect), we analyzed encoding-related changes in 2 to 100 Hz oscillatory power as a function of serial position. Increases in gamma power in posterior regions predicted successful encoding at early serial positions; widespread low-frequency (4-14 Hz) power decreases predicted successful memory formation for later serial positions. These results suggest that items in early serial positions receive an encoding boost due to focused encoding without having to divide resources among numerous list items. Later in the list, as memory load increases, encoding is divided between multiple items.