Peer review groups: problems and solutions

OBJECTIVE

To elucidate and delineate principles for dealing with problems encountered in peer review groups.

METHOD

A workshop format was utilised in which a number of interested psychiatrists were invited to role-play specific problems which occurred in established peer review groups, and reported in recent research studies. Process notes or videotapes were used to record proceedings. Principles were delineated for the management of five specific problems via role-play and discussion.

RESULTS

Principles have been delineated for the management of the following problems reported by peer review groups: dominating group member; member with disturbing behaviour; member providing inadequate treatment; member transgressing treatment boundaries; and group members strongly disagreeing about the management of a case.

CONCLUSION

Problems encountered within peer review groups were adequately replicated during role-played enactments. The workshop format offered a means of engaging with these, allowing exploration and subsequent resolution of problems which had not proved resolvable in the real group peer review situation.

Group peer review in psychiatry: the relationship to quality improvement and quality care

OBJECTIVE

This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care.

METHOD

Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored.

RESULTS

The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review.

CONCLUSIONS

Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.

Group peer review: a questionnaire-based survey

OBJECTIVE

This paper presents the findings from a questionnaire-based survey of psychiatrists designed to elucidate the positive and negative aspects of group peer review and its perceived place in accountability procedures, and to provide information about how accountability through group peer review might be improved.

METHOD

Three hundred and eighty-eight psychiatrists were surveyed via mailout questionnaire. Demographic data, details of groups, and perceptions of beneficial and detrimental effects of group peer review were sought from group participants and non-participants. Attitudes of participants were compared with those of non-participants. Features of groups related to satisfaction in participants were examined.

RESULTS

The majority of the 170 respondents participating in groups regarded peer review as a means of maintaining and improving skills, sharing ideas and methods, receiving constructive criticism and feedback, of educational benefit and an important source of professional accountability. Non-participants, while less positive overall, responded equally that participation in peer review groups would be an effective response to accountability procedures. Potential detrimental effects and problems with the functioning of peer review groups were elucidated.

CONCLUSIONS

Group peer review contributes significantly to professional accountability and education in well-functioning groups. Further strategies for the facilitation of group functioning and for the processing of problems arising in group peer review need to be developed to optimise its contribution to the maintenance and improvement of professional standards.

Effects of lead and hyperthermia on prenatal brain growth of guinea pigs

The effects of lead at blood levels of 100 micrograms/100ml or less on the brains of young animals have not been clearly defined, and little is known of its effects and interactions with other agents on prenatal brain development. This study examined the effects of subclinical doses of lead acetate given to pregnant guinea pigs on the development of the embryo brain. At 9 A.M. on day 20 or 21 of pregnancy, guinea pigs were given 6, 12.5, or 25 mg/kg body weight of 0.5% lead acetate in distilled water by intraperitoneal injection. Some of the animals at each dose rate were also exposed to hyperthermia at 11 A.M. on the day of injection and the following day. Another group was exposed to hyperthermia without lead treatment. A saline-treated control group was used for comparison. Mean levels of lead in blood 1 hour after dosing ranged between 65 and 128 micrograms/100 ml and at 24 and 72 hours between 65 and 96 micrograms/100 ml. Brain weights of newborn guinea pigs in the 12.5- and 25-mg lead acetate group were significantly reduced compared with control values. Body weights of all groups receiving lead were not significantly different from those of controls. There was no indication of interaction between hyperthermia and lead acetate in doses of 6 or 12.5 mg/kg. At 25 mg/kg plus hyperthermia, there appeared to be a strong synergistic response, with an incidence of 88% micrencephaly compared with 5% in the group given 25 mg/kg without hyperthermia and 46% in the hyperthermia without lead group.(ABSTRACT TRUNCATED AT 250 WORDS)

Retardation of brain growth of guinea pigs by hyperthermia: effect of varying intervals between successive exposures

Guinea pigs were exposed to a temperature of 42.5-43.5 degrees C on three occasions between days 20 and 23 of pregnancy. In the first experiment, groups of mothers were exposed at intervals of 18-30 hr. Each exposure ended when the deep rectal temperature had been over 43 degrees C for 6 min and mean temperatures were 43.2-43.4 degrees C. Micrencephaly was found in 78% of heated newborn offspring, the mean brain weights of all groups being significantly less than controls. In the heated groups, the brain weights were reduced significantly as the interval between exposures decreased. Abnormalities other than micrencephaly were found in 10% of heated offspring and included exomphalos, clubfoot, and hypodactyly. In the second experiment, groups of mothers were exposed for 1 hour at intervals of 6-20 hr. The mean temperatures of heated groups were 42.6-42.9 degrees C. The mean brain weights of all groups of heated newborn were significantly reduced and micrencephaly was found in 61% of newborn. Brain weights were reduced significantly as mean maternal temperature increased. There was a significant interaction between the level of temperature elevation and the interval between exposures.(ABSTRACT TRUNCATED AT 250 WORDS)