TY - JOUR
T1 - Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application
AU - Frasier, Lori D.
AU - Thraen, Ioana
AU - Kaplan, Rich
AU - Goede, Patricia
N1 - Funding Information:
TeleCAM, a secure web based system, was used to collect and test cases used for peer reviewed diagnostic assessment in this study as part of a Phase 2 Small Business Innovative Research Grant funding by the NIH, and NICHD. TeleCAM is a telehealth information system that provides a standards-based technological infrastructure for the collection, storage, and display of digital images via a secured web technology ( Lazadikou, 2010 ). This application has previously demonstrated excellent usability among remote centers engaged in medical child abuse assessments ( Thraen, Frasier, Cochella, Yaffe, & Goede, 2008 ). IRB approval was obtained July 14, 2009. Two expert reviewers originated and submitted 60 cases (30 each) from a practice pool collected over 20 years. Both expert reviewers (LF and RK) are board certified in pediatrics and child abuse pediatrics with over 20 years experience each in evaluating child abuse, and participating in peer review processes. Sixty cases were selected for convenience and selected with excellent photodocumentation and/or clinical history. The dichotomous outcomes of “negative” or “positive” in regards to child sexual abuse were varied by ordered sets of information. Sets contained minimal (historical, or interview information only, no images or laboratory information), moderate (reported historical or interview information combined with digital images of physical findings) or comprehensive information (reported historical, or interview information, digital images of physical findings, and additional medical findings such as laboratory, pathology, and radiological findings). All cases were de-identified to meet HIPAA standards and are used for teaching purposes only.
Funding Information:
This research has been supported by NIH , NICHD Grant HD 052329 to Ms. Goede is the PI, and owner of VisualShare.
PY - 2012/2
Y1 - 2012/2
N2 - Objectives: The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Methods: Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables. Results: The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings. Conclusion: These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.
AB - Objectives: The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Methods: Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables. Results: The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings. Conclusion: These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.
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U2 - 10.1016/j.chiabu.2011.06.006
DO - 10.1016/j.chiabu.2011.06.006
M3 - Article
C2 - 22405479
AN - SCOPUS:84858404628
SN - 0145-2134
VL - 36
SP - 149
EP - 155
JO - Child Abuse and Neglect
JF - Child Abuse and Neglect
IS - 2
ER -