Medical professionals report lacking the confidence and assurance necessary to meet the needs of children admitted to hospital with complex needs. This has been linked to limited knowledge, inadequate communication skills and negative attitudes. Training in these areas could improve inpatient experiences for these children.
Objectives
We aimed to explore student and staff experiences of a pilot hands-on placement for pre-clinical medical students in a Special Educational Needs school. We reviewed if the project could create sustainable links between the university and community-based organisations and had the potential to improve care for children with disabilities.
Methods
23 pre-clinical intercalating BSc students spent six half days at a school for children aged five to eighteen with complex needs. Their responsibilities included teaching support, attending to personal care and supporting therapy sessions. Students completed a pre- and post-placement open-ended questionnaire about the perceived benefits and challenges of the placement. They submitted a reflective account of their experience and we conducted semi-structured interviews with three students and two school staff members, to explore emergent themes in more depth.
Results
Thematic analysis revealed three key themes: Greater confidence working with children Students felt more comfortable working with children and gained confidence in non-verbal communication tools following the placement. There was a notable decrease in stigma and both students and teachers felt the placement would improve the care of children with complex needs in the future. '... this placement definitely helped my confidence with communicating with patients who may not be verbal or have a form of learning difficulty (P2)' Increased preparedness for clinical years Students reported increased preparedness for clinical years. Many identified increased self-confidence after the placement, as well as feeling more comfortable in unfamiliar environments and empowered to take initiative and get involved. 'Since working at the school and understanding how easy it is to communicate with all of these children...it's something I can bring forward with me (P3)' Multi-disciplinary team working was contextualised, improving students' knowledge of concepts delivered in lectures. Positive impact on wellbeing Overall, students reported that the placement had a positive impact on their wellbeing. Practical roles and relationships with students and staff provided a sense of responsibility and belonging, leading students to feel more rewarded about the course. 'Actually getting involved in an organisation where you can do some good is quite important ... I definitely think it has a massively positive impact on my wellbeing (P2)' The school viewed working with university students positively. Students and staff recommended continuing the project with further iterations guided by student and staff evaluation.
Conclusions
This study has shown that a hands-on placement in a Special Educational Needs school can improve students' confidence caring for children with complex needs. The community environment allows students to undertake practical roles, providing a sense of responsibility and belonging, and helps develop transferable skills for subsequent clinical years. This may lead to improvements in care for children with disabilities by decreasing stigma and equipping future medical professionals with communication skills that are specific for those with complex needs.
Studies of the arterial switch operation for Taussig-Bing anomaly demonstrate significant rates of reintervention and mortality, particularly after initial palliation to delay complete repair. We aimed to describe the long-term outcomes of our 21-year practice of single-stage arterial switch operation for all patients with Taussig-Bing anomaly.A retrospective study was performed, and 43 patients with Taussig-Bing anomaly were identified between 1990 and 2011. Median age at arterial switch operation was 7 (range, 2-192) days, and median operative weight was 3.2 (1.4-6.2) kg. Aortic arch obstruction was present in 30 patients (70%). Hospital mortality was 7% (n=3). Follow-up was available for 37 hospital survivors at a mean of 8.1 (± 6.3) years. Late mortality was 2% (n=1). At follow-up, all patients were in New York Heart Association functional class I. Freedom from transcatheter or surgical reintervention was 73% at 1 year, 64% at 5 years, and 60% at 10 years. Eleven patients underwent 13 catheter reinterventions on the pulmonary arteries (n=8) or aortic arch (n=5). Seven patients underwent 11 reoperations, including relief of right ventricular outflow tract obstruction (n=5), pulmonary arterioplasty (n=3), recoarctation repair (n=2), and tricuspid valve repair (n=1). By multivariate analysis, a preoperative aortic valve annulus z score of ≤-2.5 was associated with reintervention (hazard ratio, 7.66 [95% confidence interval, 1.29-45.6], P=0.03).Although reintervention is common, primary correction of Taussig-Bing anomaly with arterial switch operation can be achieved in all patients with low mortality and good long-term outcomes.
Essentials•To support a self-management program, a new pediatric warfarin nomogram was developed.•The nomogram was compared with expert hematology clinician warfarin dosing.•The pediatric nomogram is suitable as doses matched most clinicians' recommendations.•The nomogram supports evidence-based warfarin dosing for families undertaking self-management.AbstractBackgroundWarfarin therapy in children is impacted by many variables. To support the implementation of a self-management program within a pediatric anticoagulation service, a pediatric-specific warfarin nomogram was needed. A literature review revealed no published pediatric nomograms; therefore, a nomogram was developed drawing upon an evidence-based "Warfarin Information for Clinicians" hospital guideline.ObjectivesThis study aimed to evaluate the suitability of a pediatric warfarin nomogram.MethodsA retrospective audit of electronic medical records compared the dosing and international normalized ratio (INR) retest decisions made by hematology clinicians to the dosing and retesting recommended by a new warfarin nomogram at a pediatric hospital. Children (aged 6 months-18 years) receiving warfarin therapy for >6 months were included. Data were collected between September 2019 and February 2020. Descriptive data analysis was performed. The study was approved by the hospital's Human Research Ethics Committee.ResultsWarfarin dosing and INR retest decisions for 39 children were included, equating to 521 INRs. The nomogram matched 81.4% of clinicians dosing decisions and 30% of INR retest decisions. Moreover, 59% of the clinician-recommended retest dates were earlier than the nomogram recommendation. In the INR 2.0-3.0 group, 84.4% of dosing decisions and 72% of retest decisions matched the nomogram.ConclusionsThese results suggest that this pediatric nomogram is a suitable tool for warfarin dosing, as recommended warfarin doses matched the majority of clinicians' decisions. Modification may be needed to nomogram recommendations for the time to retest. This nomogram can be used to support warfarin self-management and may assist clinicians and patients or families in making evidence-based dosing decisions.
Maximising opportunities and removing barriers to HIV testing can help reduce the undiagnosed HIV population. Digital STI/HIV screening services have increased in availability and can improve access and testing coverage. We identified the characteristics of individuals who tested HIV positive using a regional, integrated, self-sampling STI service. The e-notes of service users with reactive HIV screening results were reviewed. Between 8 January 2018 and 31 December 2019, 0.097% (144/148,257) users received a reactive HIV result, 30/144 (20.8%) of whom had previously diagnosed HIV infection. All of the remaining 114 users were notified of their screening result, an estimated 109/114 (95.6%) received confirmatory testing (CT) at a sexual health clinic (SHC) and the confirmatory outcome was documented in 102/114 (89.5%) of cases: 34/114 (29.8%)were HIV positive, 68/114 (59.6%) HIV were negative and the result was unknown in 12/114 (10.5%). All new diagnoses transitioned to HIV outpatient care. These individuals were median age 28 years; 94.1% (32/34) male; 88.2% (30/34) men who have sex with men and 11.8% (4/34) heterosexual; 58.8% (20/34) of white/'white other' ethnicity and 42.2% of Black, Asian and minority ethnic group; 50%(17/34) had a concurrent STI; 9% and 21% had never tested for HIV or attended a SHC before. n HIV test reactivity rate of 0.1%(95% CI) was observed. Confirmed new HIV diagnoses comprised 0.023% of all HIV tests performed. All individuals where CT confirmed a new HIV diagnosis transitioned to HIV specialist care.
Central venous catheters (CVCs) are the single most important predisposing factor for the development of pediatric venous thromboembolism (VTE). Treatment recommendations suggest anticoagulation for the duration of 6 weeks to 3 months. This project investigated clinical outcomes associated with 6 weeks compared with 3 months of enoxaparin therapy following diagnosis of a CVC-related VTE.This retrospective cohort study enrolled patients aged 18 years and below treated with enoxaparin with/without unfractionated heparin for a radiologically confirmed CVC-related VTE. Patients were identified using the pharmacy database, radiologic imaging, and medical records. Patients were divided into 2 groups based on the duration of anticoagulation (6+1 or 12±2 wk) and data were analyzed using descriptive statistics.Seventy-four patients were included. Higher rates of complete thrombosis resolution were observed in children treated for 6 weeks at treatment cessation (39.4%) and long-term follow-up (61.5%), compared with 3 months (11.8% and 9.0%, respectively).Six weeks of treatment for CVC-related VTE may provide noninferior clinical outcomes compared with 3 months of anticoagulation. An international randomized-controlled trial (Kids-DOTT) is underway to explore the optimal duration of anticoagulation for acute-provoked VTE in children. This manuscript highlights that data from such studies is urgently needed.
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