National delivery of a valid and reliable method of carer feedback is feasible. The scores received and acceptability in these self-selected doctors was high. Confounding variables may influence feedback, so guidance on interpretation may be needed.
Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms. However, there have been only isolated reports of these cases presenting as acute pancreatitis. While the majority of acute pancreatitis cases can be explained by common causes, it is important that clinicians be aware of and should consider investigating for other more unusual possibilities, such as pancreatic herniation, before labelling an episode as ‘idiopathic’.
A patient taking regular flecainide for paroxysmal atrial fibrillation presented with broad complex tachycardia and circulatory compromise. With no history of pacemaker insertion and no pacing spikes visible on the ECG, this was presumed to be ventricular tachycardia and treated with electrical cardioversion, leading to p-wave asystole. An indwelling pacemaker was now recognised and ventricular capture was eventually attained by significantly increasing ventricular lead output. Invasive haemodynamic support was required due to new ventricular systolic dysfunction. Pacing thresholds and ventricular function normalised within 72 h consistent with flecainide toxicity; levels were shown to be toxic. Pacemaker interrogation revealed evidence of an undiagnosed atrial flutter, at presentation this was likely slowed by flecainide toxicity to a rate below the pacemaker mode switch, such that it was tracked in the ventricle at the upper tracking rate (120 bpm). Cardioversion terminated the arrhythmia but raised the capture threshold of the ventricle above the maximum lead output.
Aims Having already demonstrated that the Paediatric Carers of Children Feedback (PaedCCF) tool is reliable and valid in a national pilot study with consultant paediatricians 1 the aim of this second pilot was to determine if the tool is also useful with SSASG doctors not on the specialist register. Methods Self-selecting participants were each sent 35 forms to be distributed locally to carers of children for completion following outpatient consultations. RCPCH-analysed feedback returned to doctors included self assessment scores, carer scores, and overall cohort scores for each question. Qualitative comments were also included. Paediatricians' views on feasibility were sought before and after receiving feedback by online survey. Results 58 consultants returned 1512 forms (mean 26 per doctor). All doctors scored highly (mean ratings >4.1 out of 5). Aggregate whole-instrument rating was 4.42 (SD = 0.63). Self assessment scores (mean 3.71, SD 0.45) were lower than carer scores (mean 4.42, SD 0.63) p<0.001. White doctors scored more highly than non white doctors (p<0.001) but the difference in the mean was small. Carers who had seen the doctor more than 10 times rated doctors higher than those that had seen the doctor 1-4 times (p<0.001); scores across individual questions were highly correlated (reliability of 0.97 using Cronbach's Alpha) which justifi es the use of an aggregate score. Fewer than 25 consultation ratings were needed for good reliability (D-study). 93.4% of consultants found the tool acceptable as evidence for revalidation. Use of pre-paid envelopes assisted some doctors but concerns continue to be expressed about need for administrative support for a paper based feedback tool. Conclusion This second pilot extends the range of the use of PaedCCF as evidence to support revalidation. Data from this pilot has also allowed a revision of the number of forms required for reliability to be reduced to 20.
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