Daniel McLinden

Image Gently: A Web-Based Practice Quality Improvement Program in CT Safety for Children

OBJECTIVE Radiologists want to improve quality and safety to benefit their pediatric patients and to comply with new requirements of the American Board of Radiology for maintenance of certification. The purpose for this article is to describe the development, construction, and content of a free, Web-based practice quality improvement (PQI) module in CT safety for children. CONCLUSION We describe an online tutorial accessible on the Image Gently Website that enables radiologists nationwide to perform PQI in CT safety for pediatric patients.

The Use of Concept Mapping to Identify Community-Driven Intervention Strategies for Physical and Mental Health:

Research that partners with youth and community stakeholders increases contextual relevance and community buy-in and therefore maximizes the chance for intervention success. Concept mapping is a mixed-method participatory research process that accesses the input of the community in a collaborative manner. After a school-wide health needs assessment at a low-income, minority/immigrant K–8 school identified bullying and obesity as the most important health issues, concept mapping was used to identify and prioritize specific strategies to address these two areas. Stakeholders including 160 K–8 students, 33 college students working in the school, 35 parents, 20 academic partners, and 22 teachers/staff brainstormed strategies to reduce and prevent obesity and bullying. A smaller group of stakeholders worked individually to complete an unstructured sorting of these strategies into groups of similar ideas, once for obesity and again for bullying. Multidimensional scaling and cluster analysis was applied to the sorting data to produce a series of maps that illustrated the stakeholders’ conceptual thinking about obesity and bullying prevention strategies. The maps for both obesity and bullying organized specific strategies into themes that included education, parental role, teacher/school supervision, youth role, expert/professional role, and school structure/support.

Concept maps as network data: Analysis of a concept map using the methods of social network analysis

Concept mapping is a method that creates a visual representation that illustrates the thoughts, ideas, or planned actions that arise from a group of stakeholders on a particular issue. Social network analysis is a method that likewise creates a visual representation of data; a network map typically represents people and the connections, or lack thereof, between these people regarding a particular issue. While the goals of these two methods differ, the underlying data structures are similar; a network of relationships between data elements. Social network analysis is explored here as a supplement to concept mapping. A secondary analysis of a concept map to define to leadership needs was conducted using social network analysis. The methods and the implications for supplementing the analysis of concept maps and debriefing results with stakeholders are discussed.

Allergen sensitization profiles in a population-based cohort of children hospitalized for asthma.

RATIONALE Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown. OBJECTIVES We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors. METHODS This population-based cohort study includes data for 478 children, aged 4-16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE ≥ 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracks or holes in the walls or ceiling. Presence of carpeting and furry pets was also assessed. MEASUREMENTS AND MAIN RESULTS More than 50% of included patients were sensitized to each of Alternaria, Aspergillus, dust mite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse. Roughly 68% were sensitized to three or more allergens with evidence of clustering. African American children, compared with white children, were more likely to be sensitized to Alternaria, Aspergillus, cockroach, and dust mite (all P<0.01). White children were more likely to be sensitized to mouse, cat, and dog (all P<0.01). Lower income was associated with cockroach sensitization whereas higher income was associated with dog and cat sensitization (all P<0.01). Atopic history was associated with sensitization to three or more allergens (P<0.01). Although 42% reported exposure to at least one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weak relationships were seen between reported exposures and sensitizations. CONCLUSIONS Most children admitted to the hospital for asthma exacerbations are sensitized to multiple indoor allergens. Atopy on the inpatient unit serves as a potential target for improvement in chronic asthma management.

Introduction to a special issue on concept mapping

Concept mapping was developed in the 1980s as a unique integration of qualitative (group process, brainstorming, unstructured sorting, interpretation) and quantitative (multidimensional scaling, hierarchical cluster analysis) methods designed to enable a group of people to articulate and depict graphically a coherent conceptual framework or model of any topic or issue of interest. This introduction provides the basic definition and description of the methodology for the newcomer and describes the steps typically followed in its most standard canonical form (preparation, generation, structuring, representation, interpretation and utilization). It also introduces this special issue which reviews the history of the methodology, describes its use in a variety of contexts, shows the latest ways it can be integrated with other methodologies, considers methodological advances and developments, and sketches a vision of the future of the methods evolution.

Mapping the Views of Adolescent Health Stakeholders

PURPOSE Health research that includes youth and family stakeholders increases the contextual relevance of findings, which can benefit both the researchers and stakeholders involved. The goal of this study was to identify youth and family adolescent health priorities and to explore strategies to address these concerns. METHODS Stakeholders identified important adolescent health concerns, perceptions of which were then explored using concept mapping. Concept mapping is a mixed-method participatory research approach that invites input from various stakeholders. In response to prompts, stakeholders suggested ways to address the identified health conditions. Adolescent participants then sorted the statements into groups based on content similarity and rated the statements for importance and feasibility. Multidimensional scaling and cluster analysis were then applied to create the concept maps. RESULTS Stakeholders identified sexually transmitted infections (STIs) and obesity as the health conditions they considered most important. The concept map for STIs identified 7 clusters: General sex education, support and empowerment, testing and treatment, community involvement and awareness, prevention and protection, parental involvement in sex education, and media. The obesity concept map portrayed 8 clusters: Healthy food choices, obesity education, support systems, clinical and community involvement, community support for exercise, physical activity, nutrition support, and nutrition education. Ratings were generally higher for importance than for feasibility. CONCLUSIONS The concept maps demonstrate stakeholder-driven ideas about approaches to target STIs and obesity in this context. Strategies at multiple social ecological levels were emphasized. The concept maps can be used to generate discussion regarding these topics and to identify interventions.

Training Tomorrow's Medical Education Leaders: Creating a General Pediatric Master Educator Fellowship

From the University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center, Cincinnati, OH uring the past decade, the need for proficient and inspiring clinician educators in pediatric graduate medical education has become increasingly critical with the evolving work hour changes and increasing content requirements in medical student, resident, and fellow training. General pediatrics divisions are mainly responsible for resident continuity clinics and provide a large percentage of the leadership and teaching for both residency programs andmedical student clerkships, making training in education for these individuals essential. Traditionally, training in academic pediatric fellowships intensively focuses on research methodology and outcomes, and training in education was secondary. We believe medical educator training requires an equally rigorous approach to learn to create innovative curricula while effectively evaluating their impact on physicians’ skills, behaviors, and, ultimately, associated patient health care outcomes. Additionally, there is an increasing recognition that leadership training for academic pediatricians is required to prepare physicians to respond to new roles and responsibilities, such as leading faculty development programs, quality improvement projects, and strategic planning, and promoting evidence-based medicine and health care policy changes. To address these needs, an innovative General Pediatrics Master Educator Fellowship (GPMEF) was launched at Cincinnati Children’s Hospital Medical Center in fall 2011 to formally train general pediatricians in the science of education via a unique curriculum focusing on educational scholarship and research, structured learning experiences in clinical teaching, and fostering of leadership skills. This GPMEF is uniquely designed to create a cadre of medical educators trained in educational innovation, evaluation, research methodology, and academic leadership.

See what we say: using concept mapping to visualize Latino immigrant's strategies for health interventions.

ObjectivesResearchers need specific tools to engage community members in health intervention development to ensure that efforts are contextually appropriate for immigrant populations. The purpose of the study was to generate and prioritize strategies to address obesity, stress and coping, and healthcare navigation that are contextually appropriate and applicable to the Latino immigrant community in Cincinnati, Ohio, and then use the results to develop specific interventions to improve Latino health in our area.MethodsA community-academic research team used concept mapping methodology with over 200 Latino immigrants and Latino-serving providers. A community intervention planning session was held to share the final concept maps and vote on strategies.ResultsThe concept maps and results from the intervention planning session emphasized a community lay health worker model to connect the Latino immigrant community with resources to address obesity, stress and coping, and healthcare navigation.ConclusionsConcept maps allowed for the visualization of health intervention strategies prioritized by the larger Latino immigrant community. Concept maps revealed the appropriate content for health interventions as well as the process community members preferred for intervention delivery.

And then the internet happened: Thoughts on the future of concept mapping

Over 25 years ago, in the late twentieth century, concept mapping emerged as a mixed method approach to inquiry that enables a group of people to conceptualize their thinking about a specific topic. Since then, the application of concept mapping has spread widely and an easy prediction for the future is that this trend is likely to continue; a more important and greater challenge is to think about the ways in which concept mapping may and should evolve. Discussed here are thoughts about the future of concept mapping including some predictions of likely directions and suggestions for new possibilities. Thoughts on the future are grounded in concept mapping applications that have emerged and gained ground in recent years; these include exploring wicked problems in communities and integrating concept mapping with other methods of inquiry. Thoughts on the future are also grounded in the social and cultural milieu in which we find ourselves at this time. The influence of social media and internet technologies has led to the emergence peer production and crowdsourcing as approaches to co-create information, knowledge, products and services. These tactics may create fertile ground for the further spread of concept mapping. This same collaborative milieu has produced the open software movement which in turn, offers opportunities to enhancing the methodology of concept mapping.

A Pilot Study of the Creation and Implementation of a Teaching Development Assessment Tool

BACKGROUND The importance of effective clinical teaching skills is well established in the literature. However, reliable tools with validity evidence that are able to measure the development of these skills and can effectively be used by nonphysician raters do not exist. OBJECTIVE Our initiative had 2 aims: (1) to develop a teaching development assessment tool (TDAT) that allows skill assessment along a continuum, and (2) to determine if trained nonphysicians can assess clinical teachers with this tool. METHODS We describe the development of the TDAT, including identification of 6 global teaching domains and observable teaching behaviors along a 3-level continuum (novice/beginner, competent/proficient, expert) and an iterative revision process involving local and national content experts. The TDAT was studied with attending physicians during inpatient rounds with trained physician and nonphysician observers over 6 months. RESULTS The TDAT showed emerging evidence of content, construct, and viable validity (the degree to which an assessment tool is practical, affordable, suitable, evaluable, and helpful in the real world) for the evaluation of attending physicians on inpatient rounds. Moderate to near perfect interrater reliability was seen between physician and nonphysician raters for the domains of promotion of clinical reasoning, control of the learning environment, ability to teach to multiple levels of learners, and provision of feedback. CONCLUSIONS The TDAT holds potential as a valid and reliable assessment tool for clinical teachers to track the development of each individuals teaching skills along the continuum from early development to mastery.