Assessing the inter-rater reliability and agreement of a hybrid assessment framework in the Emergency Department.

OBJECTIVE: There is often little consensus on the levels of trainees' performances, given the varied expertise and experience of the assessors, different tasks to be assessed and dynamic circumstances. Consequently, assessors are considered to be a major source of measurement error in workplace assessment. The aim of this pilot study is to assess the inter-rater reliability and agreement of a hybrid framework for assessment of nonspecialist doctors in our Emergency Department. METHODS: A hybrid framework was used to evaluate two core competencies of medical knowledge and patient care of nonspecialist doctors in our Emergency Department. Pre and post scores of these doctors were obtained at the end of their posting. RESULTS: The inter-rater agreement and reliability was markedly higher for the group of nonspecialist doctors with previous Emergency Medicine experience, with fair-to-good reliability of the ratings among the assessors after application of the framework. CONCLUSION: The use of our hybrid framework improved the inter-rater reliability and agreement in our Emergency Department for a specific group of learners who have had previous Emergency Medicine experience. To improve the reliability of ratings, faculty development has to address how observations and assessments should be synthesized into an overall rating.

Demographics of toxic exposures presenting to three public hospital emergency departments in Singapore 2001-2003.

BACKGROUND: The demographics of poisoned patients and the circumstances of toxic exposure have not been evaluated in Singapore for the last 10 years. AIM: This study aims to give an estimate of the burden of poisoning in Singapore from the emergency department's (ED) perspective. METHOD: A retrospective study of toxic exposure was conducted over a period of 3 years from 2001 to 2003 at the ED of three public hospitals, one being a paediatric hospital. RESULTS: There were 9,212 cases of toxic exposures during the study period, which constituted 0.94% of total ED attendances. The poison exposure rate was 1.7 per 1,000 population and the estimated case fatality rate was 0.8 per 1,000 ED attendances for poisoning. The mean age of patients was 29 years and the majority were male (63.3%). Non-accidental injuries constituted 60% of the cohort. Alcohol was the commonest toxin involved (26%), but paracetamol (acetaminophen) was the most common pharmaceutical agent (33%). The mean time of exposure to ED presentation was 3.3 h. About one third of the patients were admitted of whom 157 patients (4.7% of admitted cases) required intensive care management. CONCLUSION: The patients were predominantly young adults. This may suggest a need for poison prevention and chemical safety education to reduce the impact on this high-risk group. Although poisoning accounts for only 1% of the total ED attendance, a sizable proportion of them required inpatient care (36.1%) with a significant proportion requiring intensive care management. However, it was also noted that a third of those who were admitted stayed for less than 24 h, and hence a short-stay ward in the ED might be a cost-effective strategy to consider.

Antioxidant capacity and phenolic content of selected commercially available cruciferous vegetables.

Antioxidant activity, free radical scavenging activity and phenolic content of red cabbage (Brassica oleracea var. capitata rubra), Chinese cabbage (Brassica rapa pekinensis var cylindrica), green cabbage (Brassica oleracea var capitata), mustard cabbage (Brassica juncea var rugosa) and Chinese white cabbage (Brassica rapa var chinensis), grown in Malaysia, were evaluated. Red cabbage had the highest antioxidant activity and phenolic content compared to the other cruciferous vegetables studied (p < 0.05). The contributions of all cruciferous vegetables to the antioxidant activity was >79%. The radical scavenging activity was in the order of Chinese white cabbage > red cabbage > mustard cabbage > Chinese cabbage > green cabbage. There was a significant difference (p < 0.05) in the means of scavenging activity observed between cabbage, Chinese cabbage and Chinese mustard. Phenolic content was significantly different (p < 0.05) among all the cruciferous vegetables studied, and was in the order of red cabbage > Chinese white cabbage > green cabbage > Chinese cabbage >mustard cabbage. The study indicated that red cabbage possessed the highest antioxidant capacity and phenolic compounds concentration among all the cruciferous vegetables studied.

Antioxidant capacity and phenolic content of selected commercially available cruciferous vegetables

Antioxidant activity, free radical scavenging activity and phenolic content of red cabbage (Brassica oleracea var. capitata rubra), Chinese cabbage (Brassica rapa pekinensis var cylindrica), green cabbage (Brassica oleracea var capitata), mustard cabbage (Brassica juncea var rugosa) and Chinese white cabbage (Brassica rapa var chinensis), grown in Malaysia, were evaluated. Red cabbage had the highest antioxidant activity and phenolic content compared to the other cruciferous vegetables studied (p 79%. The radical scavenging activity was in the order of Chinese white cabbage > red cabbage > mustard cabbage > Chinese cabbage > green cabbage. There was a significant difference (p Chinese white cabbage > green cabbage > Chinese cabbage >mustard cabbage. The study indicated that red cabbage possessed the highest antioxidant capacity and phenolic compounds concentration among all the cruciferous vegetables studied.