This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Aims To determine the risk of age-related macular degeneration (AMD) progression posed by the presence of each early AMD characteristic. Methods A prospective cohort study of 254 participants aged 50 years and older, all with early AMD features at their baseline visit followed for an average of 7 years. Stereoscopic colour fundus photographs were graded for early AMD features using the International Classification System. AMD status was stratified into six exclusive levels along a continuum of disease severity according to drusen type, pigmentary abnormalities, or late AMD. Progression was assessed according to three definitions: a change between or within a severity level, or by side by side grading. Results The progression rate of early AMD ranged between 3.4 and 4.67% per annum depending upon the definition used. In total, 15 (6%) cases progressed from early AMD to the late complication of AMD. After controlling for age and smoking, cases with soft indistinct drusen at baseline were at a greater risk of progressing from early to late AMD than were cases without this characteristic (OR ¼ 3.72, 95%CI 1.20-11.54; P ¼ 0.02). Conclusion Our proposed definitions of AMD progression give rates that are consistent with current knowledge of progression and its determinants. Each early AMD characteristic conveys its own risk of progression to an eye, with soft indistinct drusen carrying the greater risk. An international consensus on what defines AMD progression would greatly help the research community when trying to assess the importance of new risk factors and the effectiveness of novel interventions.

Individuals with light iris colour or of Anglo-Saxon ethnic origin had a strong tendency to greater progression of AMD. A larger sample is required to confirm these clinically important, but statistically non-significant, associations.

The aim of the study was to examine the mediating role of workplace bullying in how supervisor support and belief in a just world (BJW) are related to emotional exhaustion. A cross-sectional quantitative study using anonymous self-report questionnaires was conducted with 434 workers in France. The model was tested using a path analysis. First, the results revealed that BJW and support from the hierarchy were negatively related to emotional exhaustion. BJW and supervisor support were also negatively related to workplace bullying. Finally, harassment at work was positively related to emotional exhaustion. More generally, the results showed that social support from one’s superior and BJW were directly and indirectly related to emotional exhaustion via bullying at work. Our model thus suggests that BJW and supervisor support can be protective resources against bullying and exhaustion. We discuss the theoretical and practical implications of the present study, as well as some avenues for future research.

Our findings demonstrate inconsistencies in the accuracy and reliability in which sick children presenting to EDs receive triage scores both within and across hospitals. These results suggest the need for improvements either in current triage nurse training or training resources. Use of the ETEK alone has not resulted in high levels of paediatric triage accuracy or reliability.

Objective: To compare ED efficiency measures between a trial period using an accelerated diagnostic pathway (ADP) for chest pain evaluation, and a control period using a traditional diagnostic pathway (TDP). Methods: The TDP used cardiac Troponin I assays at arrival and 6 h. The ADP used point‐of‐care multimarker (myoglobin, creatine kinase‐MB fraction and cardiac Troponin I) assays at arrival and 2 h. Outcomes for consecutive eligible patients included ED length of stay (LOS), discharges and admissions within 4 and 8 h, ED occupancy and cardiac cubicle throughput. Results: There were 413 and 258 eligible patients during the 81 day TDP and 66 day ADP periods. The ED LOS for chest pain patients was reduced in the ADP period for both discharged patients (median 297 [interquartile range {IQR} 230–437]vs 545 [IQR 457–677] min, P < 0.0001) and admitted patients (median 609.5 [IQR 464–857]vs 733.5 [IQR 532–1070] min, P= 0.007). For the whole ED, the percentage of patients discharged or admitted within 4 or 8 h and ED occupancy were similar between periods. Cardiac cubicle throughput increased during the ADP period (217 [95% confidence interval 209.6–224.4]vs 188 [95% confidence interval 174.5–201.8] patients per week, P= 0.005). Conclusions: The ADP utilizing point‐of‐care multimarkers led to significantly shorter ED LOS for both discharged and admitted chest pain patients. This was associated with increased cardiac cubicle throughput, but improvements in other whole ED performance indicators were not demonstrated.

The aim of the present study is to describe ACEM trainees' perspectives on assessment and feedback during their training. From May to July 2009, an anonymous Web-based survey on training and supervision in emergency medicine was conducted, addressing trainees' perceptions of mandatory assessments (primary examination, fellowship examination and mandatory trainee research requirement) and feedback at work. Qualitative data were analysed using grounded theory methodology--themes were identified by close examination of full text responses. In total, 622 trainees responded to the survey (response rate of 37%). Trainees report that general clinical supervision is adequate; however, direct supervision at the bedside and feedback could be significantly improved. They perceive that the primary examination is necessary, although they feel it is irrelevant to their development as emergency trainees and are keen for more clinically applied knowledge to be tested. They dislike mandatory trainee research, feel inadequately supported and distracted from other aspects of their training. The fellowship examination was overall thought to be fair; however, there were concerns with the time pressures and restrictions to the written component of the examination. Additionally, the structured clinical examination was popular, whereas short cases and long cases were very unpopular. ACEM trainees' views of training may help inform curriculum development, and might assist those providing education to improve local training programs.