THE ECOLOGY OF SPELLING: A LENS MODEL ANALYSIS OF SPELLING ERRORS AND STUDENT JUDGMENTS OF SPELLING DIFFICULTY

Generic and Specialist Occupational Therapy Casework in Community Mental Health Teams

The aim of this research was to conduct a cluster analysis on data from 40 community mental health occupational therapists to determine if subgroups of therapists had differing referral prioritisation policies. A Ward's cluster analysis showed four clusters to be present.

These four subgroups of occupational therapists were found to differ according to several factors: the percentage of role dedicated to specialist occupational therapy or generic work, satisfaction with the balance in these roles, the number of hours worked, the number of professionally trained team members and the presence of referral prioritisation policies. The subgroups were named the aspiring specialists, the satisfied specialists, the satisfied genericists and the chameleons (those not set in applying a consistent or specific policy).

The policies that led to mainly generic working gave greatest importance to clients who were potentially violent or at risk of suicide. The policies that led to more of an occupational therapy role gave particular importance to the reason for referral and the client's diagnosis.

The College of Occupational Therapists has recommended that the majority of casework should be focused on specialist occupational therapy interventions (Craik et al 1998): most of the participants in this study were not meeting this recommendation. Although some aspired to being more specialist, the pressures to work generically may have been affecting referral policies.

Clinical judgment analysis of the parameters used by consultant urologists in the management of prostate cancer

PURPOSE

We assessed which clinical parameters consultant urologists use to recommend treatment for early prostate cancer.

MATERIALS AND METHODS

A total of 30 consultant urologists reviewed 70 paper representations of patients with prostate cancer. Each contained 7 commonly available cues, including prostate specific antigen, Gleason grade, rectal examination, magnetic resonance imaging/laparoscopic stage, medical history, patient choice and age, in addition to 2 cues not yet routinely available, that is predicted life expectancy and 10-year survival probability, as calculated using actuarial formulas based on noncancer comorbidity. Consultants indicated how strongly they would recommend radical prostatectomy, radiotherapy with or without hormones, or active surveillance/hormones. Judgment analysis was performed using multiple regression analysis with significance considered at p<or=0.01 to identify which cues consultants had used.

RESULTS

Consultants varied in the treatments that they recommended. An average of only 3 of the possible 9 cues was used to formulate decisions. Prostate specific antigen and predicted 10-year survival probability were most commonly used for recommending all 3 treatment options. Patient choice, predicted life expectancy, rectal examination and age were all used infrequently. Consultants were inconsistent in an average of 31.4% of judgments when repeat cases were analyzed with the greatest inconsistency observed when recommending radiotherapy with or without hormones and the least inconsistency when recommending radical prostatectomy.

CONCLUSIONS

Consultants were inconsistent in their decisions regarding the management of early prostate cancer and they used only a small number of available clinical parameters. Ensuring that all relevant information is available and providing clinicians with further education and training would ensure that treatment decisions become more reliable, appropriate and targeted toward patient choice.