Since the beginning of the 21st century, the world has seen a changing trend in computing power thanks to advancements in technology. One peculiar platform in the field of usability is the tablet. Due to its recent introduction, it has had a relatively short life span with few established methodologies. The tablet is gaining market share at a tremendous speed and thus there has been a big demand of the appropriate evaluation methods. This comprehensive study intention is to; through a literature survey and transformation of collected material identify what usability requisites there are when developing a user interface for a tablet application. Existing user interface guidelines from various companies involving the development of tablet software are examined and paired up with usability principles in the creation of the usability checklist. The usability checklist practical effectiveness is tested on various tablet applications and the results are compared to the results of a usability user test  valuation. The majority of the usability problems found by the user test evaluation are codiscovered, in addition, there were a greater number of undiscovered usability problems that was identified with the checklist evaluation.

Up to 80% of serious medical errors occur due to miscommunication from one provider to another (The Joint Commission, 2012). In order to ensure ongoing safe patient care, it is imperative that anesthesia providers communicate effectively and consistently when transferring patient responsibility to other providers, especially to post-anesthesia care unit (PACU) nurses. Multiple patient transfers occur each day and patients are commonly transferred between multiple providers during the same hospital stay. These opportunities are extremely vulnerable to communication errors. Structured patient handoff checklists or tools increase the consistency of information transferred from anesthesia providers to other providers. The Joint Commission recommended in 2012 that all anesthesia providers utilize a standardized patient handoff checklist to increase and improve the quality of data transferred from anesthesia provider to the PACU nurse. Certified Registered Nurse Anesthetists (CRNA) at a local surgical unit provide the bulk of patient handoffs in this postoperative unit, and currently, there is no mandated use of a standardized handoff checklist. As a result, the CRNAs provide a verbal patient handoff that is unscripted. Verbal patient handoffs differ among providers due to individual provider preference. Without using a standardized handoff checklist, there is a risk of increasing communication errors which increase medical errors and negative patient outcomes. Salzwedel (et al., 2013), in a study when utilizing a handoff checklist, concluded that critical patient data conveyed during patient handoffs increased by 32.4% to 48.7% (Salzwedel et al., 2013). Tscholl et al. (2015) and McElroy et al. (2015) through surveys, determined that data transferred between anesthesia providers was more structured. Handoff checklists increased PACU nurse satisfaction regarding the overall handoff experience (McElroy et al., 2015). No studies, to date, were found that understand the perceptions and thoughts of CRNAs regarding the utilization of patient handoff checklists or tools in clinical practice. This Doctor of Nursing Practice (DNP) project assesses the perceptions and thoughts of utilizing standardized handoff checklists among CRNAs. The hope of this study is to better understand CRNA perceptions in order to identify potential barriers or knowledge gaps regarding the benefit of utilizing a standardized patient handoff checklists. Data from this project may be used to structure future quality improvement projects aimed at decreasing communication errors and improve patient outcomes. The results of this project show the majority of CRNAs (89.5%) surveyed for this project were already familiar with handoff checklists. However, only 26.3% of those same participants agreed they currently use a standardized patient handoff checklist. Of the surveyed participants, only 36.8% were interested in utilizing a standardized patient handoff tool even though nearly 50% agreed that using a handoff checklist would increase the consistency of information transferred from anesthesia provider to nurses. This correlates with the 73.7% of participants who already believe they currently transfer pertinent patient information successfully without utilizing a standardized handoff checklist or tool. Despite studies reporting improved patient outcomes, decreased medical errors, and the Joint Commission’s recommendations to use standardized handoff checklists or tools, the majority of anesthesia providers at this facility do not choose to use handoff checklists. By surveying anesthesia providers' thoughts and perceptions, the researcher attempted to answer why anesthesia providers are not utilizing handoff checklists in their daily routines.

Class of 2006 Abstract / Objectives: To evaluate the public’s awareness regarding the professional role pharmacists have in a community pharmacy setting. Methods: The study design was a small-scale, cross-sectional survey conducted in two community pharmacy sites. Subjects included patients picking up prescription medications requiring pharmacist consultation. Volunteer participation and completion of the PQ, constituted eligible enrollment into the study. The pharmacy questionnaire (PQ) consisted of 11 statements. Subjects were to read and signify along an ordinal scale whether they strongly disagreed to strongly agree with each statement. A total of 134 surveys were completed and returned for analysis from the two pharmacy sites. Analysis of the PQ looked at responses within and between group demographics, such as gender, age, frequency and reason for visitation to pharmacy. The impact of the independent variables on patient responses to the questionnaire and the differences in patient responses between the two collection periods was analyzed using independent t-tests or a one-way ANOVA. Results: The average response scores were positive for all Statements, ranging from ‘Somewhat Agree’ to ‘Agree.’ The two lowest rated statements were concerning the refusal to fill an unsafe prescription, and checking for prescription 3x for accuracy. The three highest rated Statements were ensuring patient understanding of proper medication use, answering questions about side effects, and pharmacist knowledge and expertise. Women answering questions more positively than men, particularly with ensuring patient understanding of proper medication use (p <0.01) and answering questions about side effects (p <0.05). The pharmacists’ knowledge and expertise was significantly higher rated in women than in men (p <0.01) and older women answered more positively than younger women (p <0.05). The statement about Refusing to fill an unsafe prescriptions had subjects 26 to 35 years old answering more negatively when compared to the 46 to 55 and >65 year old groups (p <0.05). As age increased, subjects responded more positively to the pharmacist verifying dosages, and men disagreed to a greater degree than women (p <0.01). Increases in the frequency of pharmacy visits had a visual trend of more positive responses, but only the verification of dosages was nearly significant (p <0.05). By whom the questionnaire was completed by (self or non-self) had no bearing on the response. Conclusions: Regardless of age, gender, or setting, patients tended to be reasonably familiar with the role community pharmacists take part in as a member of the health care profession.

Uma parte dos estudos sobre pragmática se debruça sobre o uso das habilidades comunicativas, que se referem à capacidade do indivíduo em participar de uma díade, tendo como objetivo o intercâmbio comunicativo. As habilidades comunicativas permitem o uso da linguagem para diferentes objetivos e funções, de pistas contextuais para determinar o que se diz e a interação entre pessoas para iniciar, manter ou terminar conversações. Na literatura nacional, ainda não há um protocolo de avaliação de habilidades pragmáticas validado e os materiais disponíveis exigem um tempo de análise extenso. Com este foco, o trabalho aqui apresentado teve como objetivo a elaboração de um checklist para caracterizar o perfil pragmático de crianças, a fim de proporcionar uma redução no tempo de análise para pesquisadores e clínicos. Foram selecionadas 30 crianças de 3 a 8 anos divididas em dois grupos, pareados por idade e gênero, sendo um grupo de 15 crianças com alteração de linguagem (G1) e um grupo de 15 crianças com desenvolvimento típico de linguagem (G2). Crianças do G2 foram avaliadas com um teste de triagem por um fonoaudiólogo. As crianças com alteração de linguagem foram selecionadas a partir da lista de espera na Clínica de Fonoaudiologia da Faculdade de Odontologia de Bauru (FOB-USP), não tendo recebido qualquer intervenção fonoaudiológica. O projeto foi submetido ao Comitê de Ética da FOB-USP e aprovado sob o protocolo no 025148/2012. Para o checklist, foi realizada a adaptação do Protocolo de Habilidades Comunicativas Verbais. Para verificar a melhor maneira de realizar a marcação e a permeabilidade da análise proposta, foi realizado um estudo piloto em que três fonoaudiólogas analisaram separadamente as gravações de duas crianças em interação com um adulto. As sugestões foram estudadas e as alterações pertinentes foram realizadas antes da análise de dados. Na coleta de dados, foram realizados registros em DVD de 30 minutos de interação espontânea entre a criança e seu responsável. Para garantir a confiabilidade dos dados, a avaliação foi realizada com dois observadores independentes que deveriam preencher cada checklist, anotando se essas habilidades eram observadas (se sim, adequada ou inadequadamente) ou não observadas na amostra. Todos os registros foram considerados confiáveis e puderam ser analisados estatisticamente. Por meio da análise estatística verificou-se que os resultados foram significativos nas categorias de habilidades dialógicas e narrativo-discursivas, indicando que o checklist foi permeável ao encontrar mudanças nas habilidades pragmáticas das crianças do G1, em comparação com as crianças do G2. Mesmo nas habilidades não significantes, foram observadas diferenças entre os perfis. Este trabalho trouxe a contribuição de criar um material de fácil manuseio e aplicabilidade, capaz de verificar quantitativamente o uso das habilidades comunicativas verbais por crianças. O checklist foi sensível em verificar a assimetria entre os diferentes grupos. Sugere-se, como continuidade do estudo, a aplicação do checklist em diferentes populações. / Some studies on pragmatics focus on the use of communication skills, which refer to the individual\'s ability to participate in a dyad, aiming communicative exchange. Communication skills enable the use of language for different purposes and functions, from contextual cues to determine what is said, to interaction among people to start, maintain or end conversations. In the literature there is still no national evaluation protocol of pragmatic skills validated and the materials available require long analysis. Focusing on this, the work presented here had aimed the preparation of a checklist to characterize the pragmatic profile of children in order to provide a reduction in analysis time for researchers and clinicians. Were selected two groups of 15 children 3-8 years old, matched by age and gender, with a group of children with language disorders (G1) and a group of children with typical language development (G2). G2 children were evaluated with a screening test by a speech hearing pathologist. Children with language disorders were selected from the waiting list of the Clinic of Speech Pathology, Faculty of Dentistry of Bauru (FOB-USP), having received no phonoaudiological intervention. The project was submitted to the Ethics Committee of the FOB-USP and approved under protocol No. 025148/2012. For the checklist, was performed the adaptation of the Verbal Communication Skills Protocol. To determine the best way to perform marking and the permeability of proposed analysis, was conducted a pilot study in which three speech hearing therapists analyzed separately the recordings of two children in interaction with an adult. The suggestions were examined and relevant amendments were made before the data analysis. During the data collection the researchers recorded 30-minute DVD of spontaneous interaction between the child and the guardian. To ensure the data reliability, the evaluation was performed with two independent observers who should fill each checklist by checking whether these skills were observed (if yes, adequately or inadequately) or not observed in the sample. All records were considered reliable and could be analyzed statistically. The collected data were statistically analyzed and it was found that the results were significant in the categories of dialogic and narrative-discursive skills, showing that the checklist was permeable to find changes of pragmatic skills of children in G1 compared to G2 children. Even in skills not statistically significant, differences were observed in the profile. The present study brought the contribution of create a material easy to handle and apply, capable of quantitatively determine the use of verbal communicative skills of children. The checklist was sensitive to verify the asymmetry between the different groups. As a continuation of the study it is suggested the application of the checklist in different populations.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-05T11:53:33Z No. of bitstreams: 2 Tese - Giulena Rosa Leite - 2017.pdf: 2944113 bytes, checksum: 9194b3c298e35ecddd0323e013b325c0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-05T11:53:47Z (GMT) No. of bitstreams: 2 Tese - Giulena Rosa Leite - 2017.pdf: 2944113 bytes, checksum: 9194b3c298e35ecddd0323e013b325c0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-05T11:53:47Z (GMT). No. of bitstreams: 2 Tese - Giulena Rosa Leite - 2017.pdf: 2944113 bytes, checksum: 9194b3c298e35ecddd0323e013b325c0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-31 / Aiming at evaluating the implementation of a safe surgery protocol, developed by the Brazilian National Health Surveillance Agency (ANVISA), an integrative literature review followed by an uncontrolled, quasi-experimental before-and-after intervention study was conducted in public health institutions that possess a surgical center, which are from 5 cities that make up the Southwest Health Region II of the State of Goiás. The review consisted of 19 scientific articles searched by the association of the keywords surgical and checklist and world health organization and implantation. The population was composed of 84 workers from the multiprofessional team before the intervention, 77 workers after the intervention and 680 patients in postoperative period. The data organization process was conducted with Microsoft ® Excel 2010 program and the data analysis was made with the Statistical Package for the Social Sciences (SPSS) program. In order to present the situational diagnosis state of the stages "before training" and "after training" of the professionals, descriptive statistics were used. Then, the comparison of after-training and before-training collected data was performed using the chi-square test to test the significance between proportions. P values <0.05 were considered statistically significant. The female proportion of Healthcare Professionals (PAS) (79.9%) was statistically higher than that of males (20.1%), (p <0.020). The average age was 39.2 (± 9), the predominant age group was 41 years and over (43.9%) and the educational level was less than or equal to twelve years of study (56.1%). Regarding their training, more than a half of them was composed of nursing technicians (77.7%) and worked in a medium-sized hospital (56.8%). Healthcare professionals with a higher academic training level were nurses (8.6%) and medical surgeons or anesthesiologists (13.7%). There was a higher proportion of health professionals who responded positively to the procedures confirmation in step II (98.7%) compared to stage I (67.7%). Likewise, all the items related to visual confirmation and demarcation of the surgical site (1.6% stage I to 97.4% stage II), pulse oximeter presence (82.3% stage I to 98.7% stage II) and verbal review with the anesthesiologists (69.4% stage I to 98.7% in stage II) presented p <0.005. Regarding stage II, “before leaving the surgery room”, the items "compress/instruments count", "surgical specimen identification", "equipment functionality revision" were already performed with great consistency, even before the protocol implementation. Regarding the stage III of the checklist "before leaving the operating room", when we compared the health professionals’ perceptions, before and after the implementation of the checklist, it was observed that the variables "occurrence of wrong procedures notifications”, “the occurrence of surgeries in the wrong patients”, “the occurrence of surgeries in wrong places”, “inadequate antibiotic prophylaxis” and “revision of the postoperative and anesthesia care plan” (p <0.005) were statistically significant (p = 0.000). Conclusion: the level of evidence VI was the one of greater predominance among the articles produced in the period investigated. We interviewed 84 health professionals who work in public surgical centers of RSS II, 90.5% of the female gender; (40.5%), with professional training of Nursing Technicians (82.1%) and schooling less than 12 years of schooling (54.8%). Moments 1 "before the anesthesia" and 2 "before the surgical incision" of the checklist, had a higher rate of adhesion by professionals. / Com o objetivo de avaliar o processo de implantação do protocolo de cirurgias seguras, da Agência Nacional de Vigilância Sanitária – Brasil, realizou-se uma revisão integrativa de literatura seguida por uma pesquisa de intervenção, quase experimental do tipo antes e depois, não controlada, em instituições públicas de saúde que possuem centro cirúrgico, de 5 municípios que compõem a Região de Saúde Sudoeste II do Estado de Goiás. A revisão constou de 19 artigos científicos buscados pela associação das palavras chave surgical and checklist and world health organization and implantation. A população foi constituída por 84 trabalhadores da equipe multiprofissional antes da intervenção, 77 trabalhadores após a intervenção, e 680 pacientes em pós-operatório. Os dados foram organizados no programa Microsoft ® Excel 2010 e analisados com auxílio do programa Statistical Package for the Social Sciences (SPSS). Para apresentar as etapas do diagnóstico situacional “antes da capacitação” dos profissionais e “após a capacitação” dos mesmos, foi utilizada a estatística descritiva. Em seguida, foi realizada a comparação dos dados coletados antes e após a capacitação, utilizando o teste de qui-quadrado para testar a significância entre as proporções. Valores de p<0,05 foram considerados estatisticamente significantes. A proporção dos PAS (Profissionais da Área da Saúde) do sexo feminino (79,9%) foi estatisticamente superior em relação ao sexo masculino (20,1%), (p < 0,020). A idade média foi de 39,2 (± 9), enquanto a faixa etária predominante foi acima de 41 anos (43,9%) e escolaridade menor ou igual a doze anos de estudo (56,1%). Quanto à formação, mais da metade eram técnicos em enfermagem (77,7%) e trabalhavam em hospital de médio porte (56,8%). A participação de PAS com formação superior foi de enfermeiros (8,6%) e de médicos cirurgiões ou anestesistas (13,7%). Verificou-se uma proporção maior de PAS que responderam positivamente à confirmação dos procedimentos na etapa II (98,7%) em relação a etapa I (67,7%). Da mesma forma os itens relativos a confirmação visual e demarcação do sítio cirúrgico (1,6% etapa I para 97,4% etapa II), presença do oxímetro de pulso (82,3% etapa I para 98,7% na etapa II) e revisão verbal com o anestesista (69,4% etapa I para 98,7% na etapa II) apresentaram valor de p < 0,005. Em relação ao momento II, antes de sair da sala de cirurgias, os itens “contagem de compressa/instrumental”, “Identificação de qualquer amostra cirúrgica”, “Revisão da funcionalidade equipamentos” já eram realizados com grande consistência, mesmo antes da implantação do protocolo. Em relação ao terceiro momento do checklist “antes de sair da sala cirúrgica”, quando comparamos a percepção dos profissionais de saúde, antes e após a implantação do checklist, observa-se que as variáveis “notificações de ocorrência de procedimentos errados”, “ocorrência de cirurgia em pacientes errados”, “ocorrência de cirurgias em locais errados”, “notificação de antibioticoprofilaxia inadequada” e “revisão do plano de cuidado pós-operatório e anestésico” (p<0,005) foram estatisticamente significativas (p=0,000). Conclusão: o nível de evidência VI foi o de maior predominância entre os artigos produzidos no período investigado. Foram entrevistados 84 profissionais de saúde que atuam em centros cirúrgicos públicos da RSS II, 90,5% do gênero feminino; a maioria com idade maior que 41 anos (40,5%), com formação profissional de Técnicos de Enfermagem (82,1%) e escolaridade menor que 12 anos de estudo (54,8%). Os momentos 1 “antes da anestesia” e 2 “antes da incisão cirúrgica” do checklist, tiveram maior taxa de adesão por profissionais.

Uma parte dos estudos sobre pragmática se debruça sobre o uso das habilidades comunicativas, que se referem à capacidade do indivíduo em participar de uma díade, tendo como objetivo o intercâmbio comunicativo. As habilidades comunicativas permitem o uso da linguagem para diferentes objetivos e funções, de pistas contextuais para determinar o que se diz e a interação entre pessoas para iniciar, manter ou terminar conversações. Na literatura nacional, ainda não há um protocolo de avaliação de habilidades pragmáticas validado e os materiais disponíveis exigem um tempo de análise extenso. Com este foco, o trabalho aqui apresentado teve como objetivo a elaboração de um checklist para caracterizar o perfil pragmático de crianças, a fim de proporcionar uma redução no tempo de análise para pesquisadores e clínicos. Foram selecionadas 30 crianças de 3 a 8 anos divididas em dois grupos, pareados por idade e gênero, sendo um grupo de 15 crianças com alteração de linguagem (G1) e um grupo de 15 crianças com desenvolvimento típico de linguagem (G2). Crianças do G2 foram avaliadas com um teste de triagem por um fonoaudiólogo. As crianças com alteração de linguagem foram selecionadas a partir da lista de espera na Clínica de Fonoaudiologia da Faculdade de Odontologia de Bauru (FOB-USP), não tendo recebido qualquer intervenção fonoaudiológica. O projeto foi submetido ao Comitê de Ética da FOB-USP e aprovado sob o protocolo no 025148/2012. Para o checklist, foi realizada a adaptação do Protocolo de Habilidades Comunicativas Verbais. Para verificar a melhor maneira de realizar a marcação e a permeabilidade da análise proposta, foi realizado um estudo piloto em que três fonoaudiólogas analisaram separadamente as gravações de duas crianças em interação com um adulto. As sugestões foram estudadas e as alterações pertinentes foram realizadas antes da análise de dados. Na coleta de dados, foram realizados registros em DVD de 30 minutos de interação espontânea entre a criança e seu responsável. Para garantir a confiabilidade dos dados, a avaliação foi realizada com dois observadores independentes que deveriam preencher cada checklist, anotando se essas habilidades eram observadas (se sim, adequada ou inadequadamente) ou não observadas na amostra. Todos os registros foram considerados confiáveis e puderam ser analisados estatisticamente. Por meio da análise estatística verificou-se que os resultados foram significativos nas categorias de habilidades dialógicas e narrativo-discursivas, indicando que o checklist foi permeável ao encontrar mudanças nas habilidades pragmáticas das crianças do G1, em comparação com as crianças do G2. Mesmo nas habilidades não significantes, foram observadas diferenças entre os perfis. Este trabalho trouxe a contribuição de criar um material de fácil manuseio e aplicabilidade, capaz de verificar quantitativamente o uso das habilidades comunicativas verbais por crianças. O checklist foi sensível em verificar a assimetria entre os diferentes grupos. Sugere-se, como continuidade do estudo, a aplicação do checklist em diferentes populações. / Some studies on pragmatics focus on the use of communication skills, which refer to the individual\'s ability to participate in a dyad, aiming communicative exchange. Communication skills enable the use of language for different purposes and functions, from contextual cues to determine what is said, to interaction among people to start, maintain or end conversations. In the literature there is still no national evaluation protocol of pragmatic skills validated and the materials available require long analysis. Focusing on this, the work presented here had aimed the preparation of a checklist to characterize the pragmatic profile of children in order to provide a reduction in analysis time for researchers and clinicians. Were selected two groups of 15 children 3-8 years old, matched by age and gender, with a group of children with language disorders (G1) and a group of children with typical language development (G2). G2 children were evaluated with a screening test by a speech hearing pathologist. Children with language disorders were selected from the waiting list of the Clinic of Speech Pathology, Faculty of Dentistry of Bauru (FOB-USP), having received no phonoaudiological intervention. The project was submitted to the Ethics Committee of the FOB-USP and approved under protocol No. 025148/2012. For the checklist, was performed the adaptation of the Verbal Communication Skills Protocol. To determine the best way to perform marking and the permeability of proposed analysis, was conducted a pilot study in which three speech hearing therapists analyzed separately the recordings of two children in interaction with an adult. The suggestions were examined and relevant amendments were made before the data analysis. During the data collection the researchers recorded 30-minute DVD of spontaneous interaction between the child and the guardian. To ensure the data reliability, the evaluation was performed with two independent observers who should fill each checklist by checking whether these skills were observed (if yes, adequately or inadequately) or not observed in the sample. All records were considered reliable and could be analyzed statistically. The collected data were statistically analyzed and it was found that the results were significant in the categories of dialogic and narrative-discursive skills, showing that the checklist was permeable to find changes of pragmatic skills of children in G1 compared to G2 children. Even in skills not statistically significant, differences were observed in the profile. The present study brought the contribution of create a material easy to handle and apply, capable of quantitatively determine the use of verbal communicative skills of children. The checklist was sensitive to verify the asymmetry between the different groups. As a continuation of the study it is suggested the application of the checklist in different populations.

Published Article / Children with Learning Problems (LP) differ from other children and are mostly identified in the primary grades. Factors which may influence the development of sensory products to stimulate children with LP are design factors such as illustrations, colour, themes and supporting factors which include therapeutic practices and cultural sensitivity. The previous mentioned factors may be beneficial for text enhancement and reading comprehension within books for children with Learning Disabilities (LD). It is envisaged that if design factors as well as sensory stimulants are integrated into play therapy mediums such as the Sensory Product (SP), it will be able to stimulate a child with LP through different therapeutic practices. Special needs teachers aid children with LP through intervention strategies once they are identified. Intervention strategies involve the use of instruments such as scripted and prescribed programmes (Fuchs & Fuchs, 2006), reading aloud by teachers to children (Fisher, Flood, Lapp & Frey, 2004) and one-on-one instruction as part of the three-tiered Reading to Intervention Model (RIM) (Scanlon & Sweeney, 2008). SP have the potential to assist teachers and children with LP but only if those products are appropriate for the children's developmental level (Oravec, 2000).

This study’s aim was to explore face, content, concurrent validity and psychometric properties of the Swedish Child Dissociative Checklist (CDC) as well as and to provide guidelines towards validation. The CDC is used in Sweden when dissociation is highly probable, and validation could motivate wider use. Qualitative data was gathered from psychologists-in-training (N = 4) clinical psychologists (N = 5) and parents (N = 23) through a focus group, interviews and questionnaires, respectively. Quantitative data using the CDC and items from the Child Behaviour Checklist (CBCL) was obtained from parents. Results suggest good face, content and convergent validity. Factor analysis provides suggestions for future investigations into quantitative validation. Guidelines when validating is revising certain items, investigating the possibility of developing two versions of the CDC, utilizing an adequate sample size as well as assessment with a clinical group. / Studiens syfte var att undersöka face, innehålls- och konvergent validitet samt psykometriska egenskaper hos den svenska versionen av Child Dissociative Checklist (CDC), samt utforma riktlinjer för validering. I Sverige har CDC använts vid hög närvaro av dissociativa symptom, och validering kan motivera bredare användning. Kvalitativ data samlades in från psykologstudenter (N = 4), kliniska psykologer (N = 5) och föräldrar (N = 23) genom fokusgrupp, intervjuer respektive frågeformulär. Kvantitativa data erhölls från föräldrar med CDC och items från Child Behaviour Checklist (CBCL). Resultaten tyder på god face, innehålls- och konvergent validitet. Faktoranalys bidrar med förslag på framtida tillvägagångssätt för kvantitativ validering. Riktlinjer vid validering är revidering av vissa items, utforskning av möjligheten att utveckla två versioner av CDC, tillgång till ett stort sample samt jämförelse med en klinisk grupp.

Background: Surgical checklists are in use as means to reduce errors for safer surgery. Checklists are infrequently applied during procedures and have been limited to lists of procedural steps as aid memoires. Aims: We aimed to formulate a performance based checklist and to study its effect on the surgical task performance of novice surgeons when applied during both, routine knot tying and simulated emergency laparoscopic tasks. We also aimed to study the effect of the performance based intra-procedural checklist in clinical environments during elective laparoscopic procedures as a way of error reduction mechanism and improvement of patient safety. Methods: The study was conducted in two settings, lab-based and clinical-based environments. The lab-based study was conducted during both routine and emergency tasks. Lab-based study- routine task: Twenty novices were randomised into two equal groups, those receiving paper feedback (control group), and those receiving paper feedback and the checklist that was applied at 20 seconds intervals (checklist group). The task involved performing laparoscopic double knots which were repeated over 5 separate stages. Human reliability assessment technique was used for error analysis on unedited video recordings of the tasks. Endpoints included number of errors, error probability (number of errors/number of knots), error types and number of completed knots. Non-parametric statistics were used for data analysis. Lab-based- emergency task: Thirty consented laparoscopic novices were exposed unexpectedly to a bleeding vessel in a laparoscopic virtual reality simulator as an emergency surgical scenario. The task consisted of using laparoscopic clips to achieve haemostasis. Subjects were randomly allocated into 2 equal groups; those using the checklist (checklist group) and those without (control group). The checklist was applied by the trainees in the checklist group at 20 seconds intervals. The surgical performance was computed on eight predetermined technical factors. Clinical-based study: Surgical trainees in the general surgery at Tayside NHS were included in this study and required the attendance of a trainer during the procedure as per routine practice. Record year of trainees and previous experience on laparoscopic cholecystectomy were noted. Two elective laparoscopic cholecystectomies for each trainee were video-recorded without the use of the checklist, directly followed by 2 further operations after the introduction of the checklist. The unedited videos were analysed for error detection using human reliability analysis technique. Total number of errors per time during each procedure, total number of errors per number of instrument movements, total number of instrument movements per time and number of trainer intervention while per time were noted as assessment points. Results: Lab-based- routine task: 2341 errors were detected in 141 tasks, 408 subtasks and 2249 steps during the 5 stages. During the first stage, the errors were not significantly different between groups. The checklist group committed significantly fewer errors as compared to the control group during all the later 4 stages (p < 0.01). The checklist group had an enhanced learning curve as the last 4 stages showed significant fewer errors compared to the first stage (p < 0.05), while the control group showed no improvement. Error probability was significantly higher in the control group compared to the checklist group: median [IQR] 32.6 [25.89] vs 11.7 [10.72] (p < 0.01). Individual error types during each step of the laparoscopic task were identified. The checklist group performed better with fewer errors for all the error types. While, there was no significant difference in each of 'the lack of supination', 'tissue bite' and 'out of vision'; the differences in all the rest of error types were highly statistically significant (p < 0.01). Number of completed knots was not statistically different between the 2 groups. Lab-based- emergency task: The checklist group performed significantly better in 6 out of 8 technical factors when compared to the control group median [IQR]: Right instrument path length (m) 1.44 [1.22] vs 2.06 [1.70] (p= 0.029), and right instrument angular path (degree) 312.10 [269.44] vs 541.80 [455.16] (p= 0.014), left instrument path length (m) 1.20 [0.60] vs 2.08 [2.02] (p= 0.004), left instrument angular path (degree) 277.62 [132.11] vs 385.88 [428.42] (p= 0.017). The checklist group committed significantly fewer number of errors in the number of badly placed clips (p= 0.035) and number of dropped clips (p= 0.012). Although statistically not significant, total blood loss (lit) decreased in the checklist group from 0.83 [1.23] to 0.78 [0.28] (p= 0.724), and total time (sec) from 186.51 [145.69] to 125.14 [101.46] (p=0.165). Clinical-based study: Participants performed statistically better with fewer number of errors per time with the application of the checklist compared to when no checklist was used respectively: Median [IQR] total number of errors 1.51 [0.80] vs 3.84 [1.42] (p=0.002), consequential errors 0.20 [0.12] vs 0.45 [0.42] (P=0.005), inconsequential errors 1.32 [0.75] vs 3.27 [1.48] (p=0.006) and total number of errors per number of instrument movements 0.16 [0.04] vs 0.29 [0.16] (p= 0.003). With the introduction of the checklist, the number of interventions by the trainer per time decreased from 2.79 [1.85] to 0.43 [1.208] (p=0.003) and the number of instrument movements per time decreased from 11.90 [5.34] to 10.38 [5.16] (p=0.04). Conclusions: We have developed standardised checklists to be applied during elective and emergency laparoscopic tasks. The performance based self-administered intra-procedural checklist had a significant accelerating effect on the acquisition of technical skills when applied by novices during a standardised laparoscopic lab-based routine task and improved the task performance during a simulated laparoscopic emergency scenario. The checklist enhanced the performance of surgical trainees and decreased the number of interventions of the trainer during laparoscopic cholecystectomy.

In healthcare, personal protective equipment (PPE) are sometimes misused due to improper skill acquisition or skill decay before clinical practice. Training is often didactic or web-based but it is unclear whether these methods transfer to effective physical performance. There is no standard method to evaluate these competencies and scheduling or space restrictions can limit physical practice. A Delphi survey produced relevant checklist and global rating items for evaluating use of PPE. Principles from skill learning and human-computer interaction were combined with the survey results to develop an interactive computer-based simulation for procedural practice of these skills. The assessment tool differentiated between experienced and newly-trained users and demonstrated inter-rater reliability. Learners rated their satisfaction with the simulation similar to a provincial online tutorial and pilot studies with the simulation demonstrated that learners practiced for a longer period when using the simulation as compared to the provincial online tutorial.