Paediatrics

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison

JOURNAL OF ADVANCED NURSING, Issue 2 2009
Hanan Tork
Abstract Title.,Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison. Aim., This paper is a report of a study to examine the psychometric properties of the Care Dependency Scale for Paediatrics in Germany and Egypt and to compare the care dependency of school-age children in both countries. Background., Cross-cultural differences in care dependency of older adults have been documented in the literature, but little is known about the differences and similarities with regard to children's care dependency in different cultures. Method., A convenience sample of 258 school-aged children from Germany and Egypt participated in the study in 2005. The reliability of the Care Dependency Scale for Paediatrics was assessed in terms of internal consistency and interrater reliability. Factor analysis (principal component analysis) was employed to verify the construct validity. A Visual Analogue Scale was used to investigate the criterion-related validity. Findings., Good internal consistency was detected both for the Arabic and German versions. Factor analysis revealed one factor for both versions. A Pearson's correlation between the Care Dependency Scale for Paediatrics and Visual Analogue Scale was statistically significant for both versions indicating criterion-related validity. Statistically significant differences between the participants were detected regarding the mean sum score on the Care Dependency Scale for Paediatrics. Conclusion., The Care Dependency Scale for Paediatrics is a reliable and valid tool for assessing the care dependency of children and is recommended for assessing the care dependency of children from different ethnic origins. Differences in care dependency between German and Egyptian children were detected, which might be due to cultural differences. [source]


Care dependency of children in Egypt

JOURNAL OF CLINICAL NURSING, Issue 3 2008
Hanan Tork RN
Aims., This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non-disabled Egyptian children. Background., A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. Method., The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non-disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school-age children (50·8% of whom were disabled and 49·2% were non-disabled). Results., Reliability was examined in terms of internal consistency using Cronbach's alpha (0·91). Inter-rater reliability revealed moderate to very good Kappa statistics between 0·57,0·89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non-disabled children. Conclusion., The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. Relevance to clinical practice., The findings raise concerns regarding the extent to which disabled and also non-disabled school-age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs. [source]


Abstracts of the Paediatrics and Child Health Division, RACP Annual Scientific Meeting, May 2004

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9-10 2004
Article first published online: 14 SEP 200
First page of article [source]


Abstracts of the Paediatrics and Child Health Division, RACP Annual Scientific Meeting, May 2002

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2002
Article first published online: 17 OCT 200
First page of article [source]


Scleroderma ,en coup de sabre' and progressive facial hemiatrophy.

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2002
Is it possible to differentiate them?
Abstract The aim was to be able to evaluate the diagnosis of two diseases by a consensus of clinical opinion used in the Department of Dermatology of the National Institute of Paediatrics in Mexico City. To differentiate between scleroderma ,en coup de sabre' (SCS) and progressive facial hemiatrophy (PFH), colour slides of 13 patients diagnosed as SCS and nine as PFH were examined by two dermatologists and microscopic slides by two pathologists. In both cases, the slides were randomly presented and no clinical information was given. The clinical and histopathological findings were statistically compared with two-tailed tests and , = 0.05. , coefficients were obtained to evaluate the concordance between dermatologists, pathologists, and in terms of the consensus diagnosis. The usefulness of photographic assessment is limited by the inability to palpate the consistency of lesions. The most important clinical feature that differentiated both conditions was cutaneous sclerosis present in eight of 13 patients with SCS and in none of the PFH patients (P < 0.005). Other clinical features more frequently found in SCS were cutaneous hyperpigmentation and alopecia. The more frequent clinical features in PFH were total hemifacial involvement and ocular changes. Statistically significant histopathological features were: connective tissue fibrosis present in all cases with SCS and two of nine patients with PFH (P < 0.0002); adnexal atrophy present in 11 of 13 patients with SCS, and in three of nine with PFH (P < 0.02), and mononuclear cell infiltrates in all patients with SCS cf. six with PFH (P < 0.05). Our results suggest that in most cases it is possible to differentiate SCS from PFH based on clinicopathological findings. [source]


Dietary prevention of allergic diseases in infants and small children

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 1 2008
Amendment to previous published articles in Pediatric Allergy, Clinical Immunology, European Academy of Allergology, Immunology 200, by an expert group set up by the Section on Pediatrics
Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP-EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer-reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer-reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high-risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4,6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months. [source]


Emergencies in Paediatrics and Neonatology

ANZ JOURNAL OF SURGERY, Issue 10 2009
Spencer W. Beasley MS FRACS
No abstract is available for this article. [source]


100 Cases in Paediatrics

ACTA PAEDIATRICA, Issue 6 2010
Jonas F. Ludvigsson
No abstract is available for this article. [source]


Training in Paediatrics , The Essential Curriculum

ACTA PAEDIATRICA, Issue 4 2010
Trond Markestad
No abstract is available for this article. [source]


The paediatrician , past, present and future , a conversation with Nils Rosén von Rosenstein

ACTA PAEDIATRICA, Issue 9 2009
Ingemar Kjellmer
Abstract An imagined conversation takes place with the author of the first textbook of Paediatrics, Nils Rosén von Rosenstein. Enormous progress in the prevention and treatment of diseases of children is demonstrated. But a different spectrum of diseases has replaced the old one. And in spite of unprecedented material well-being a substantial minority of our children cannot make full use of their capabilities. Conclusion:, We must resume the full responsibility for our children and act as their advocates in society. [source]


Resuscitation at the limits of viability , an Irish perspective

ACTA PAEDIATRICA, Issue 9 2009
RA Khan
Abstract Background:, Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. Objective:, To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. Design/Methods:, An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. Results:, The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22,25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. Conclusion:, Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability. [source]


European Academy of Paediatrics Research in Ambulatory Setting network (EAPRASnet): a multi-national general paediatric research network for better child health

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2010
S. Del Torso
Abstract Background In 2008, the European Academy of Paediatrics launched a paediatric-based research network , EAPRASnet (European Academy of Paediatrics Research in Ambulatory Setting network). The network has recruited primary care and general paediatricians from European and Mediterranean countries. Methods Every paediatrician joining the network has been asked to complete a recruitment survey. The aims of the survey were to characterize paediatrician's demographics, practice arrangements and patient's demographics, to define main incentives for research, and to learn what paediatricians view as unsolved issues that need to be studied. Results A total of 156 paediatricians from 19 countries were recruited with 144 completing the questionnaire (92%). Majority of respondents (89%) were general paediatricians for more than half of their time. Practice arrangement of 47% of paediatricians was solo practice, with 40% in group practice. Electronic medical records were being used by 72% of respondents. Over 70% of the paediatricians had more than 1000 patients under their clinical care, and patients younger than 6 years old contributed nearly half of the patient population. Areas of most interest for research were: quality of care indicators, communication with parents, obesity, attention deficit hyperactivity disorder and effective well child care. Main incentives for participation in a research project were interest in the topic (81%) and effort to improve quality of care (71%). Lack of time was the leading reported obstacle for research activity (72%). EAPRASnet is growing, and the network's structure, operation and funding are described. Methods for joining the network and the process of study development are presented. Conclusion A core group of EAP general paediatricians are committed to research in their practices. The information gathered will serve for future planning of research projects in the EAPRASnet to harmonize and optimize the care given to children in the primary care setting in Europe. [source]


Meetings Organised on the Occasion of Excellence in Paediatrics

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2010
Article first published online: 2 DEC 200
First page of article [source]


Early childhood factors influencing health-related quality of life in adolescents at 13 years

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004
Elise Maher
Early childhood factors influencing health-related quality of life in adolescents at 13 years . Wilkins, A.J., O'Callaghan, M.J., Najman, J.M., Williams, G.M. & Shuttlewood, G. ( 2004 ) Journal of Paediatrics and Child Health40 , 102 , 109 . Objective To understand the relationship of health-related quality of life (HRQOL) to early life experience. Methodology Eight thousand five hundred and fifty-six women enrolled in a prospective study at their first antenatal clinic visit. At 13 years, of 5345 women remaining, a consecutive sample of 901 mother/child pairs provided data on adolescent HRQOL using the Child Health Questionnaire-Parent Report form (CHQ-PF50) and the Dartmouth COOP Functional Assessment Charts for Adolescents. The CHQ-PF50 yielded physical (PHS) and psychosocial (PSS) summary scores. We examined the relationship between HRQOL and early childhood predictive variables. Results PHS was related to gestation, maternal health symptoms in pregnancy, maternal anxiety at 6 months, child health and hours of childcare at 5 years (P < 0.05). PSS was related to maternal age at index visit, maternal attitude to pregnancy, maternal satisfaction with caregiving and maternal depression at 6 months, and child health and behaviour problems at 5 years (internalizing and social/attentional/thought (SAT) domains) (P < 0.05). Findings from adolescent self-reports were similar. Conclusions This study has identified a number of early childhood determinants of adolescent HRQOL. These findings add to the evidence of the effects of early adversity on the developmental pathways of children and support the need for effective early intervention. [source]


Retinopathy of prematurity: postmenstrual age at threshold in a transitional economy is similar to that in developed countries

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2008
Susan Mary Carden FRANZCO
Abstract Background:, To analyse the timing of threshold disease in infants requiring treatment for retinopathy of prematurity in a transitional economy. Methods:, Design: Retrospective, observational, cohort study. Setting: National Hospital of Paediatrics, Hanoi, Vietnam. Study population: Premature infants in the Neonatal ward requiring laser treatment for threshold retinopathy of prematurity. Main outcome measures: Chronological age and postmenstrual age at treatment. Results:, From January 2002 to November 2004, 42 infants from the National Hospital of Paediatrics required laser surgery for threshold retinopathy of prematurity. The mean ± standard deviation (SD) of birth weight was 1369 ± 184 g (range 1000,1700); the mean ± SD of gestation at birth was 30 ± 1.8 weeks (range 27,34); and the mean ± SD of postmenstrual age at which treatment occurred in these infants was 36.2 ± 2.5 weeks (range 31.4,42). A further 58 infants were transferred from other hospitals for laser surgery between January 2004 and October 2004. The mean ± SD of birth weight was 1325.5 ± 237.2 g (range 800,1900); the mean ± SD of gestation at birth was 30 ± 1.7 weeks (range 28,35); and the mean ± SD of postmenstrual age at which treatment was given in these infants was 36.3 ± 2.3 weeks (range 32.71,44.3). Discussions:, Despite the relative maturity of the gestation of these infants compared with infants in developed countries who develop severe retinopathy of prematurity, the timing of treatment for threshold disease appears to be related to postmenstrual age. [source]


An appreciation of Ronnie Mac Keith (1978)

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2008
Martin Bax DM
It is 100 years since Ronnie Mac Keith's birth and 50 years since he started the Journal Developmental Medicine & Child Neurology (DMCN; initially called The Cerebral Palsy Bulletin), the first number being a reprint of William Little's original article. Scope, then The Spastics Society, had just begun to raise significant sums of money and Ronnie persuaded them not only to put some money into medical research, which they did, funding the research laboratories at Guy's, but also, uniquely, to spend some money on educating and informing doctors. This led to financial backing, happily still continuing, to the publishers of DMCN, now the Mac Keith Press. Initially, it was published under the title Spastics International Medical Publications but this was a clumsy and difficult title because of the unfortunate use of the word 'spastics'and soon after Ronnie's death, who was then senior editor, the Mac Keith Press Board were delighted that his family agreed that the Press would be named after him. In the late 1950s and early 1960s, Ronnie was collecting a team around him to develop the Journal and the books, and contacted me because he knew I had literary interests. I didn't really want to edit a medical journal but I was interested in paediatrics so in the end I got involved! I worked very closely with Ronnie, both clinically and at the Mac Keith Press, and also with the Medical Education Information Unit of the Spastics Society on the meetings he ran. When he died, I tried to pull together something of Ronnie's nature in this personal memoir below, which supplemented the more formal statements about his life and career which can be found in the relevant number of the Journal.1 One hopes that Ronnie would be pleased with what we have done and I know that he would be hoping that we would continue for another 50 years developing ideas and approaches which were essentially developed by Ronnie Mac Keith. [source]


Rural hospital generalist and emergency medicine training in Papua New Guinea

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2007
David Symmons
Abstract The present paper describes the role of the hospital generalist in rural Papua New Guinea (PNG) and the contribution of emergency medicine training to that practice. Generalist practice in Tinsley District Hospital in Western Highlands Province is described, with emphasis on emergency surgery and anaesthesia. The potential of the PNG emergency medicine training programme for preparing generalists is discussed. Tinsley Hospital served a population of 40 000 people, with 4000 admissions and 300,400 operations performed annually. Two doctors and 50 nurses and community health workers provided care with minimal resources. The doctors provided supervision and teaching for nurses, community health workers, hospital administrators and primary health carers, including on long range medical patrols. Over 16 months, doctors performed 243 emergency surgical procedures including orthopaedics, general surgery, obstetrics and gynaecology. The generalist in rural hospitals is required to perform a wide variety of medical tasks in isolated settings yet there is no active postgraduate training programme. The Master of Medicine, Emergency Medicine programme includes rotations through the major disciplines of surgery, anaesthesia, internal medicine, paediatrics, obstetrics and gynaecology. It has the potential to train doctors in PNG for a generalist role as graduates will learn the foundations of the required skills. [source]


Haemophilia care then, now and in the future

HAEMOPHILIA, Issue 2009
J. OLDENBURG
Summary., Epidemiological data show the benefits of dramatically improved haemophilia care in all life-stages. There are improved administration techniques and dosing regimens, a shift from on-demand treatment to prophylaxis, successful treatment protocols for immune tolerance induction in patients with inhibitors and enhanced approaches to overall patient management. Improvements also include the introduction of virus inactivation methods for plasma derived clotting factor concentrates and the development of recombinant factor VIII therapy, which practically eliminated the risk of infectious disease transmission. Recombinant factor concentrates are recommended as treatment of choice by several guidelines today. All these developments have resulted in increased health-related quality of life and life expectancy in haemophilia patients, who are transitioning from childhood to adulthood with healthy joints and an overall healthy status today. Because of increased life expectancy, these patients are expected to experience age-related clinical problems that were not previously observed in this population. With respect to this, the spectrum of haemophilia care will be extended to diseases of older ages with the need of including further disciplines in comprehensive haemophilia care programmes. Despite these advances, the short half-life of factor VIII, requiring re-administration every 2 or 3 days and the development of inhibitors remains a challenge. Bayer's research and development currently focuses on the optimization of recombinant coagulation factors to address these challenges. Haemophilia care has experienced significant improvements within the past decades. Novel technologies and continued clinical research have facilitated the development of treatment regimen that resulted in dramatic increases in the life expectancy and quality of life of haemophilia patients. To set the scene for the following papers dealing with haemophilia care from paediatrics to geriatrics, developments behind these improvements and some aspects of future research will be presented in this paper. [source]


Review of upper airway resistance syndrome: nursing and clinical management

JOURNAL OF CLINICAL NURSING, Issue 17 2009
Tara B Giblin
Aims., This study aims to help nurses and nurse practitioners identify and manage paediatric patients with upper airway resistance syndrome. A review of upper airway resistance syndrome is provided, including the signs and symptoms of upper airway resistance syndrome, criteria for diagnosis, recommendations for treatment and implications for nursing in paediatric primary care. Background., Nurses often encounter sleep-related problems in the paediatric primary care setting. Commonly, these problems are well known and include snoring and obstructive sleep apnoea. Upper airway resistance syndrome is a relatively new diagnosis among sleep-related breathing disorders with which nurses and nurse practitioners should be familiar. Upper airway resistance syndrome is characterised by incomplete obstruction of the airway during sleep, leading to increased respiratory efforts and frequent arousals despite normal oxygen saturations. Design., Systematic review. Method. A review of the sleep literature identified articles regarding sleep and/or sleep-related breathing disorders and paediatrics, and upper airway resistance syndrome. Articles published since 2002 were prioritised; however, all articles describing upper airway resistance syndrome since 1993 were considered. Conclusion., Timely recognition of sleep-disordered breathing is crucial to ensuring that patients receive effective and appropriate treatment. Upper airway resistance syndrome should be a part of the differential diagnosis when assessing a child with a sleep-related breathing disorder. Relevance to clinician practice., Nurses and nurse practitioners should become comfortable and skilled in performing a thorough sleep history and physical examination to help identify when a child should receive a sleep study or referral to a specialist. [source]


Care dependency of children in Egypt

JOURNAL OF CLINICAL NURSING, Issue 3 2008
Hanan Tork RN
Aims., This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non-disabled Egyptian children. Background., A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. Method., The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non-disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school-age children (50·8% of whom were disabled and 49·2% were non-disabled). Results., Reliability was examined in terms of internal consistency using Cronbach's alpha (0·91). Inter-rater reliability revealed moderate to very good Kappa statistics between 0·57,0·89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non-disabled children. Conclusion., The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. Relevance to clinical practice., The findings raise concerns regarding the extent to which disabled and also non-disabled school-age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs. [source]


Changes in perceived effect of practice guidelines among primary care doctors

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2007
Lee Cheng MD MSc
Abstract Rationale, aims and objectives, Evidence suggests that when doctors use systematically developed clinical practice guidelines they have the potential to improve the safety, quality and value of health care. The purpose of this study was to evaluate recent changes in the perceptions of practice guidelines among US primary care doctors. Methods, Data were collected from the Community Tracking Survey 1996,97 and 2000,01. All results were weighted and adjusted to reflect the complex survey design. Results, Over the 5 years, the proportion of primary care doctors who said that practice guidelines had at least a moderate effect on their practice of medicine increased from 45.8% to 60.7%. This increase was nearly equal among primary care doctors of family medicine, internal medicine and paediatrics. In the 2001 survey, a higher perceived effect of practice guidelines was described by female doctors (OR = 1.39, 95% CI 1.19,1.63) and doctors who were practising in a large model group (OR = 1.73; 95% CI 1.04,2.89). Doctors who graduated from medical school within 10 years of the survey were more likely to report that practice guidelines had a positive effect on their practice of medicine than doctors who graduated 10 or more years before the survey. Conclusion, The perceived effect of practice guidelines on primary care doctors increased over time. Improved dissemination of guidelines and curriculum changes may have led recent primary care graduates to view practice guidelines as more important. [source]


An undergraduate paediatric curriculum based on clinical presentations and ,key features'

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2008
Ralph Pinnock
Aim: We wanted to develop and define an undergraduate paediatric curriculum in a way that would facilitate the development of clinical reasoning. Method: We sent a series of four questionnaires to paediatricians in New Zealand to explore their perceptions of common presenting complaints for an undergraduate paediatrics curriculum. The final group of paediatricians consulted had no further suggestions to add to the twenty five presentations that had already been listed. Further consultation lead to the determination of the knowledge and skills students' require in order to assess and manage these presentations. Result: We have defined with wide consultation, a framework for an undergraduate paediatric curriculum suitable for New Zealand. Conclusions: When consulting with a range of experts it can be difficult to reach agreement. By describing the curriculum as a series of presenting complaints and using the concept of ,key features' we were able to reach agreement on the content and details of an undergraduate curriculum for paediatrics. [source]


Transitional cell carcinoma in the paediatric population: Be aware of unusual aetiologies

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2007
Caroline R Dowling
Abstract: This is a case report of a 12 year old girl who presented with a rare condition in paediatrics, transitional cell carcinoma of the bladder. It is important because it is readily treated by endoscopic means if diagnosed early. Potential aetiologies for this unusual condition are explored. [source]


Developmental assessment of children: A survey of Australian and New Zealand paediatricians

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2005
Sean Beggs
Objectives: To determine the current practice for developmental assessment of children by Australian and New Zealand paediatricians. To determine factors associated with higher levels of self-reported confidence and expertise in developmental paediatrics and factors associated with better practice. Methods: A cross-sectional postal survey of Australian and New Zealand paediatricians conducted in 2003, enquiring about their training in developmental paediatrics and their practice for evaluating development. Results: Of 811 questionnaires sent, 590 (73%) were returned. Ninety-one respondents indicated that they did not see children with developmental issues leaving 499 surveys for analysis. The overwhelming majority of paediatricians felt that more training was required in developmental paediatrics (88%) and that there was a need to be taught a formal developmental assessment tool (83%). Higher self-ratings of confidence and expertise in developmental paediatrics were associated with a period of formal developmental training (OR (95% CI) 2.7 (1.6,4.4), 3.4 (2.0,5.8), respectively), and being taught a formal developmental assessment tool (OR (95% CI) 2.0 (1.2,3.2), 2.2 (1.3,3.7), respectively). Predictors of paediatricians performing a formal developmental assessment included formal developmental training (OR (95% CI) 2.0 (1.1,3.8)) being taught an assessment tool (OR (95% CI) 2.8 (1.5,5.2)) and mandatory training (OR (95% CI) 2.4 (1.4,4.1)). Conclusions: Developmental paediatrics is a significant and important part of paediatric practice. This survey suggests, however, that paediatric training and continuing education should have not reflected this practice. The overall method and content of developmental training including whether formal assessment tools should be taught needs to be reviewed and revised. [source]


Emergency department attendances associated with drug-related problems in paediatrics

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2003
KL Easton-Carter
Objectives: To determine the frequency and characteristics of paediatric emergency department attendances associated with drug-related problems (DRP) at three Victorian hospitals. Methods: All paediatric medical patients attending the emergency department of the Royal Children's Hospital, Geelong Hospital or Box Hill Hospital were considered for inclusion. The investigator and attending medical practitioners screened eligible patients. A multidisciplinary panel reviewed collated data. Causality, preventability and clinical significance classifications were established by the panel. Results: Combining data from the three hospitals, over 18 weeks of data collection, a total of 8601 patients met the eligibility criteria. Of these, 280 (3.3%, 95% CI 2.9,3.7%) were determined to have emergency department attendances associated with DRP. Of the 187 cases assessed for preventability, 51.3% were judged to be preventable. Conclusions: Emergency department attendances are associated with DRP in paediatrics. Given that the need to prevent DRP in adults is recognized, it is now time to act to reduce the consequences of DRP in paediatrics. [source]


Changing patterns of coeliac serology requests

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
K. E. EVANS
Summary Background, Accurate serological tests have revolutionized the diagnosis of coeliac disease. Aim, To quantify the volume of coeliac serology requests at a district hospital over a decade, identify their origin, assess positivity rates and subsequent duodenal biopsy and histological confirmation rates. Methods, Details of patients in whom coeliac serology was requested from 1997 to 2006 were obtained from laboratory databases. The origins of request were categorized into gastroenterology, general practice, paediatrics and other specialities. Duplicate requests were excluded. Results, A total of 9976 serological tests were requested. Testing increased from 302 in 1997, to 1826 in 2006. In all, 66% of requests were in females. Tests in children accounted for 14,25% of each year's total. General practitioner requests increased from 3.3% in 1997 to 52% in 2006. The proportion of positive serological results fell from 5.7% in 1997 to 2.6% in 2006. Duodenal biopsies were performed in approximately 85% of seropositive patients in earlier years and approximately 75% of seropositive patients in later years. Most nonbiopsied seropositive patients had serology requested by general practitioners. Biopsies confirmed coeliac disease in 91% of seropositive patients. Conclusion, Increasingly, coeliac serological testing is requested by general practitioners. Twice as many females are tested. Increasing test numbers but diminishing positivity rates suggest testing is requested at lower symptom thresholds. Positive serological results are often not confirmed histologically. [source]


Using job analysis to identify core and specific competencies: implications for selection and recruitment

MEDICAL EDUCATION, Issue 12 2008
Fiona Patterson
Objective, Modern postgraduate medical training requires both accurate and reliable selection procedures. An essential first step is to conduct detailed job analysis studies. This paper reports data on a series of job analyses to develop a competency model for three secondary care specialties (anaesthesia, obstetrics and gynaecology, and paediatrics). Methods, Three independent job analysis studies were conducted. The content validity of the resulting competency domains was tested using a questionnaire-based study with specialty trainees (specialist registrars [SpRs]) and consultants drawn from the three specialties. Job analysis was carried out in the Yorkshire and the Humber region in the UK. The validation study was administered with additional participants from the West Midlands and Trent regions in the UK. This was an exploratory study. The outcome is a set of competency domains with data on their importance at senior house officer, SpR and consultant grade in each specialty. Results, The study produced a model comprising 14 general competency domains that were common to all the three specialties. However, there were significant between-specialty differences in both definitions of domains and the ratings of importance attached to them. Conclusions, The results indicate that a wide range of attributes beyond clinical knowledge and academic achievement need to be considered in order to ensure doctors train and work within a specialty for which they have a particular aptitude. This has significant implications for developing selection criteria for specialty training. Future research should explore the content validity of these competency domains in other secondary care specialties. [source]


Well-being in residency: a time for temporary imbalance?

MEDICAL EDUCATION, Issue 3 2007
Neda Ratanawongsa
Context, Previous quantitative studies about doctor well-being have focused primarily on negative well-being, such as burnout. We conducted this study to understand residents' perspectives on well-being. Methods, We conducted 45-minute interviews with residents from 9 residencies at 2 academic hospitals in Baltimore, Maryland. From February to June 2005, we approached 49 residents through random sampling stratified by programme and gender. The semi-structured instrument elicited descriptions of well-being in residency and factors related to its promotion or reduction. Using an editing analysis style, investigators independently coded transcripts, agreeing on the coding template and its application. Results, The 26 participating residents came from internal medicine (3 programmes), psychiatry, surgery, emergency medicine, anaesthesia, obstetrics and gynaecology, and paediatrics. Six themes emerged: balance among multiple domains; professional development and temporary imbalance; professional satisfaction and accomplishment; maintaining a sense of self; stressors and coping strategies, and the role of residency programmes. Residents described well-being as a balance among multiple domains, including professional development, relationships, and physical and mental health. They viewed residency as a time for temporary imbalance, during which they invested in professional development at the expense of other domains. Some residents described feeling a ,loss of self'. Residents revealed strategies for coping with stressors and endorsed ways in which training programmes helped to enhance their well-being. Conclusions, Resident well-being was closely connected to professional development and required varying degrees of self-sacrifice with a re-balancing of personal priorities. These findings should be considered by training programmes that are interested in enhancing resident well-being. [source]


Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, Trinidad

MEDICAL EDUCATION, Issue 1 2007
Nelleen S Baboolal
Background, This study was conducted to determine factors that influence career choice among 1st-year medical students. Design And Methods, A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. Results, The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). Conclusion, The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice. [source]


Doctors' reasons for rejecting initial choices of specialties as long-term careers

MEDICAL EDUCATION, Issue 4 2003
Trevor W Lambert
Objectives, To report on rejected choices of specialty as long-term careers and reasons for rejection. Design, Postal questionnaire survey. Setting, United Kingdom. Participants, All graduates of 1996 and 1999 from UK medical schools during their first year after qualification. Main outcome measures, Any career choice which had been seriously considered and rejected and the reason for its rejection. Results, In all, 33·1% (1871) of respondents named a rejected choice and gave reasons for its rejection. Disproportionately high numbers rejected the surgical specialties, paediatrics and obstetrics and gynaecology (O&G), using the specialty distribution of positive choices as the comparator. Relatively few doctors rejected general practice (GP) after giving it serious consideration. Doctors rejecting the hospital medical and surgical specialties or paediatrics were most likely to specify reasons relating to quality of life. Three-quarters of the graduates of 1999 who rejected O&G did so because of poor career prospects. Conclusions, Quality of life issues, and concerns about working relationships, are sufficiently influential to persuade many doctors to abandon an initial choice of medical career. It is unlikely that much of the decline in entry to GP is attributable to rejection of GP by doctors who initially chose it. The decline must therefore represent an increase in the number of doctors who had never seriously considered it as a long-term career choice. [source]