Abstract BACKGROUND Optic nerve sheath meningiomas (ONSM) are rare, comprising 1-2% of paediatric CNS meningiomas. Despite slow growth, ONSM often lead to vision loss in the affected eye. Diagnosis is challenging due to the tumour’s proximity to the optic nerve, complicating biopsy or complete removal. METHODS We searched our Neuro-Oncology MDT database for patients treated for ONSM between Jan 2018 and Dec 2023. We retrospectively reviewed clinical presentation and diagnostic workup that led to the diagnosis of ONSM. RESULTS 6 children aged 3-15years (mean 9 years) were identified over 5 years. 3 children were treated at GOSH, 2 at UCLH and 1 at BCH. 3/6 patients were male. 2/6 underwent a biopsy. Presenting symptoms included headache, acute visual loss and eye pain. 2/6 patients presented with bilateral vision deterioration. The average time between onset of symptoms and presentation was 8 months (range 3–15 months). Identified causes of delayed diagnosis included delayed presentation related to COVID-19 pandemic (2 patients) and impaired quality of imaging due to dental braces (1 patient). Whilst awaiting diagnosis, 2 patients lost vision completely in their affected eye. Diagnostic workup included: optic disc examination (6 patients), lumbar puncture (2 patients), angiotensin-converting enzyme (sACE) (2 patients), MRI brain and spine (6 patients), CT scan (6 patients), PET-DOTATE scan (3 patients), NF2 genetic testing (4 patients). Two patients completed PBT therapy while 1 is undergoing radiotherapy. One patient underwent an enucleation, while the rest are under surveillance. CONCLUSIONS Paediatric ONSM diagnosis remains challenging despite advanced imaging. Our review highlights the added value of CT and PET-DOTATATE when a biopsy is high-risk. CT reveals calcification in 20-50% ONSM while the role of PET-DOTATATE is related to the expression of somatostatin receptor 2 in meningiomas. Despite optimal treatment, vision loss maybe unavoidable. Early multidisciplinary consultations are advised for enhanced outcomes.
Explica la metodologia para realizar el proceso de seleccion de personal basado en el modelo de competencias laborales. L investigacion de tipo descriptiva se realizo en el Colegio Salesiano Don Bosco Guatemala. Para recopilar informacion se consulto bibliografica actualizada que detalla el metodo de competencias laborales. Para efectos de implementacion se tomo como base la bibliografia de M.A. Larry Segura, autor guatemalteco, la cual cuenta con formatos y aplicaciones estandarizadas para nuestro medio. La inmersion en el tema condujo a valorar la formacion por competencias laborales, como una alternativa a desarrollar, y que permitira guiar a mejores resultados al, en el proceso de reclutamiento y seleccion de personal, tomando dicha institucion como referencia para la elaboracion del proyecto de investigacion Se propuso el modelo para que el departamento de recursos humanos de la institucion lo implementara, guiandose paso a paso para realizar el proceso de dotacion de personal para los distintos puestos de trabajo. Para esta institucion, contar con las personas que cumpliera con las competencias especificas y que contribuyera al cumplimiento de los objetivos. Las competencias son caracteristicas estables que tienen una relacion causal con el rendimiento y desempeno laboral, esto quiere decir que provocan y facilitan el exito en una actividad porque combinan los conocimientos, las habilidades, destrezas y actitudes. Para la institucion fue muy valioso conocer el modelo para implementar una metodologia nueva y de actualidad en el proceso de seleccion de personal asi como contar con personal capacitado para sus puestos de trabajo, basados en el sistema de competencias laborales, porque al contar con personal competente, la institucion sera mas productiva, tal como se le propuso al Colegio Salesiano Don Bosco de la Ciudad de Guatemala
Academic Foundation Programme (AFP) trainees face challenges in making the most of the research opportunities available to them. Improved support for trainees throughout the AFP may result in improved outcomes and increase retention of clinical academic trainees. Peer support may address some of the challenges faced by AFP trainees at this early stage of their careers. A Plan-Do-Study-Act (PDSA) approach was used to design and implement a peer support programme for AFP trainees in paediatrics. Feedback from recent AFP graduates was used to identify challenges and possible solutions, which were then incorporated into the programme. Trainee views informed the format of the support offered, especially the role of trainee coordinator and importance of regular meetings. The PDSA approach facilitated constant re-evaluation of the programme, which continued to evolve over several years. Peer support is highly valued by AFP trainees, who use the network to obtain information, as well as concrete assistance, and emotional support from their peers. Such networks are not self-perpetuating, and a significant commitment is required from fellow trainees to ensure the success of the network.
Objective To investigate the impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity. Design Qualitative study based on interviews and audio/written diary data. Setting UK study within clinical academia. Participants Purposive sample of 82 clinical academics working in medicine and dentistry across all career stages ranging from academic clinical fellows and doctoral candidates to professors. Methods Qualitative semistructured interviews (n=68) and audio diary data (n=30; including 16 participants who were also interviewed) collected over an 8-month period (January–September 2020), thematically analysed. Results 20 of 30 (66.6%) audio diary contributors and 40 of 68 (58.8%) interview participants were female. Of the participants who disclosed ethnicity, 5 of 29 (17.2%) audio diary contributors and 19/66 (28.8%) interview participants identified as Black, Asian or another minority (BAME). Four major themes were identified in relation to the initial impact of COVID-19 on clinical academics: opportunities, barriers, personal characteristics and social identity, and fears and uncertainty. COVID-19 presented opportunities for new avenues of research. Barriers included access to resources to conduct research and the increasing teaching demands. One of the most prominent subthemes within ‘personal characteristics’ was that of the perceived negative impact of the pandemic on the work of female clinical academics. This was attributed to inequalities experienced in relation to childcare provision and research capacity. Participants described differential experiences based upon their gender and ethnicity, noting intersectional identities. Conclusions While there have been some positives afforded to clinical academics, particularly for new avenues of research, COVID-19 has negatively impacted workload, future career intentions and mental health. BAME academics were particularly fearful due to the differential impact on health. Our study elucidates the direct and systemic discrimination that creates barriers to women’s career trajectories in clinical academia. A flexible, strategic response that supports clinical academics in resuming their training and research is required. Interventions are needed to mitigate the potential lasting impact on capacity from the pandemic, and the potential for the loss of women from this valuable workforce.
Background/ObjectivesCentral-line associated bloodstream infections (CLABSIs) are a form of healthcare associated infection (HCAI) with devastating consequences for patients. Although the clinical outcomes of CLABSI are well-described, the impact on professionals who are involved in these events, and thus their ability to convey the severity of the condition has not been investigated.Design/MethodsSemi-structured interviews were conducted with fifteen multi-disciplinary professionals who had experience of caring for children who had developed CLABSI. Interviews were digitally recorded and transcribed verbatim. Data were analysed using the constant comparative method. ResultsAlthough CLABSI were familiar occurrences for healthcare professionals (HCPs) in this study, they were still traumatic events. They reported their experience of children with significant CLABSI becoming more unwell, more dramatically than other children. Further, memories of other children who had died as a result of CLABSI made the HCPs fearful that each subsequent child in their care would also die despite optimal treatment. They described significant emotional turmoil associated with making clinical decisions about the child’s care. Additionally, they felt that colleagues without personal experience of CLABSI were unable to appreciate the severity of the child’s condition, compared to other cases of sepsis. As a result, they often struggled to explain to their peers how unwell the child was. They believed this contributed to delays in accessing external support such as admissions to PICU or surgical removal of central lines.ConclusionsCLABSI are emotionally traumatic events for HCPs, leaving significant residual emotional impact of each case. The HCPs experience of CLABSI compared to its understanding to those who had not cared for children with CLABSI, made it difficult to adequately communicate with colleagues. This risks delays to the child’s care. A wider education on the severity and impact of CLABSI amongst allied specialties could improve awareness and may improve speed of access to potentially life-saving interventions.
Background/ObjectivesCentral-venous access devices (CVADs) are used in children with complex medical conditions to deliver life-saving treatments, such as chemotherapy and nutritional support. Infections of CVADs (central-line associated bloodstream infections; CLABSI), although rare, can result in prolonged hospital admissions, intensive care admissions and even death. As more children are facilitated to live at home, the impact of CLABSI on the emotional and mental health of the children at home and their families requires exploration.Design/MethodsSemi-structured interviews were conducted with parents of eleven children, and with twenty professionals. Interviews were digitally recorded and transcribed verbatim. Data were analysed using the constant comparative method. Data were collected as part of a larger study exploring care of invasive devices in the community.ResultsFour families had personal experience of CLABSI, and all families were aware of other children who had experienced or even died of CLABSI. CLABSIs were unpredictable and children could deteriorate rapidly. Parents who had experiences CLABSI recounted the frightening and traumatic event and described vivid memories of their child’s illness. All parents, irrespective of first-hand familiarity or not, experienced unrelenting fear that their child would develop an infection and die. Families described a state of constant vigilance where they continually monitored the child for signs of infection to ensure that they could receive treatment, further adding to their emotional workload. Hospital admissions further disrupted family life, affecting parents’ work, school, hobbies and family celebrations.ConclusionsCLABSIs are associated with significant disruption to children and families. The threat of CLABSI results in significant emotional distress for families in addition to their existing burdens. Professionals should be aware of this emotional burden when counselling families about the risk of CLABSI. Children and families with experience of CLABSI may benefit from additional psychological support.
Abstract Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children’s cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services.
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