The development and implementation of a training package for dietitians on cow’s milk protein allergy in infants and children based on UK RCPCH competencies for food allergies – a pilot study

Background

Many food allergy guidelines have been published worldwide over recent years. The United Kingdom National Institute of Health and Clinical Excellence guidelines and The Royal College of Paediatrics and Child Health food allergy care pathways require dietitians to assist with the diagnosis and management of food allergies, which highlighted the need for further education of dietitians to meet these competencies. The aim of this study was to design a competence based one day education course for dietitians on the diagnosis and management of cow’s milk protein allergy in infants and children.

Methods

A one day training course was developed. Dietitians’ knowledge was assessed via multiple choice questions before and on the day of the course and retention of knowledge was assessed one month after the course. Pre course reading was given once the first assessment was completed.

Results

Thirty seven dietitians attended the course and 32 completed all three assessments. A significant improvement in assessment scores was seen between the pre course and on the day assessments of 7.2% (p < 0.001) and between pre course and post course assessments of 8.9% (p < 0.001). In delegates who rated their perceived level of knowledge as high, a significant increase was seen between pre course and on the day and between pre course and post course (both p < 0.001). Actual increase in knowledge was seen alongside a significant increase in high rating of perceived level of confidence between pre course and on the day and between pre course and post course (both p < 0.001).

Conclusions

Educating dietitians using the format of one day teaching with pre and post course assessment has improved both knowledge and competencies in the diagnosis and management of cow’s milk protein allergy. Further courses in other areas of food allergy could be developed using this approach within the UK and worldwide.     

A comparative analysis of ENP’s and SHO’s in the application of the Ottawa ankle rules

This study investigates the comparative effectiveness of Senior House Officers (SHOs) and Emergency Nurse Practitioners (ENPs) in the application of the Ottawa ankle rules, in a large inner city Emergency Department in the United Kingdom (UK). Sixty patients with ankle injuries were randomly included in this study which took place in the minor injuries unit of the ED over a 12 month period.Data were obtained retrospectively from the patients records relating to six individual aspects of the Ottawa ankle rules. Sixty patients were selected and divided equally between the ENPs and SHOs.The results show a variation between the ENPs and SHOs in application of individual criteria of the Ottawa ankle rules. ENPs more commonly documented bony tenderness to lateral and/or medial malleoli than the SHOs. However, the SHOs documentation of their diagnostic testing was superior with the ENPs failing to document what X-rays 17 patients received. The study demonstrates a statistically significant difference between the two groups of health practitioners. In all but one of the five subquestions of the Ottawa ankle rules there was a statistical significance of 0.053 or less. This clearly shows a difference in the documentation of the Ottawa ankle rules by the health practitioners questioning whether appropriate care is given.Both groups were poor at documenting negative findings and neither consistently documented their application of the Ottawa ankle rules either in part or its entirety.     

Prognostic factors in patients with aggressive non-Hodgkin’s lymphoma without complete response to first-line therapy

This study was conducted to retrospectively identify the prognostic factors that specifically predict survival rates of patients with aggressive non-Hodgkin’s lymphoma who did not achieve a complete response (CR) to first-line therapy. Prognostic factors in terms of survival were analyzed in 76 adult patients with non-Hodgkin’s lymphoma who had failed to achieve CR to first-line chemotherapy (CT) regimens administered at Istanbul University, Institute of Oncology, between February 1989 and October 1998. A total of 41 patients were female, and median age was 60 y (range, 18–87 y). Twenty-seven patients (35%) had primary refractory disease (stable disease + progressive disease). A partial response (PR) was demonstrated in 49 (65%). In all, 92% had been administered anthracycline on the basis of computed tomography findings. Of 27 patients with primary refractory disease, 20 died because of initial CT toxicity or disease progression. A total of 10 patients with primary refractory disease underwent second-line CT. CR was observed in only 1 of those patients. Of the 49 patients who had a PR to first-line therapy, 31 died because of disease progression. Of those patients, 14 underwent second-line CT. Four patients were observed to have a CR. Median overall survival (OS) in all patients was established at 15 mo (range, 11–19 mo), and 5-y OS was 25%. On the other hand, median OS in patients with primary refractory disease was 7.6 mo (range, 5.7–9.4 mo) and was observed to be 17.8 mo (range, 9.4–26.1 mo) in patients with a PR. The difference in survival rates between patients with primary refractory disease and those with a PR was significant (P=.005). Although median OS was 18.1 mo (range, 8.4–27.8 mo) in patients with intermediategrade histology, it was 6.1 mo (range, 1–11.7 mo) in patients with high-grade histology (P=.001). As a result of univariate analysis, significant prognostic factors associated with OS included histologic grade (intermediate/high) (P=.001), response to initial therapy (primary refractory disease/PR) (P=.005), performance status (0–2/2–4) (P=.024), and International Prognostic Index risk groups (low/low intermediate/intermediate-high/high risk) (P=.004). Multivariate analysis revealed that independent prognostic parameters associated with OS included response to initial therapy (P=.009) and histologic grade (P=.001). Although prognosis is rather poor in patients with high histologic grade and primary refractory disease, patients with a PR have a slightly better prognosis.     

Imbalance of interleukin-18 and interleukin-18 binding protein in children with Henoch-Schönlein purpura

The balance between interleukin-18 (IL-18) and its endogenous antagonist, IL-18 binding protein (IL-18BP), was evaluated in children with Henoch-Sch?nlein purpura (HSP). Plasma IL-18 and IL-18BP levels and peripheral blood mononuclear cell IL-18 mRNA expression were significantly higher in patients with active HSP (n = 30) than in healthy controls (n = 20); IL-18BP mRNA expression was similar in active HSP and controls. Plasma levels and mRNA expression of IL-18 and IL-18BP in patients in remission (n = 19) were similar to those in controls. The ratios of IL-18 / IL-18BP plasma levels and IL-18 / IL-18BP mRNA levels in active HSP were significantly higher than in patients in remission and healthy controls. Thus, adequate IL-18BP to block the proinflammatory activity of IL-18 may not be present in active HSP and regulation of the IL-18 / IL-18BP balance might provide a potential therapeutic strategy.     

Impact of family empowerment model on satisfaction and children’s length of stay in hospital

Objective

The purpose of the study was to identify the impact of family empowerment model intervention on family satisfaction and children’s length of stay in the hospital due to pneumonia.

Development of a measure to assess effective listening and interactive communication skills in the delivery of children’s rehabilitation services

Purpose: Therapists’ listening and communication skills are fundamental to the delivery of children’s rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. Method: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. Results: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. Conclusions: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills.

Implications for Rehabilitation

• Therapists’ listening and effective communication skills are essential to the successful delivery of children’s rehabilitation services, but few measures comprehensively assess these skills.

• Clinical encounters in pediatric rehabilitation involve various types of listening/communication skills: receptive listening, exploratory listening, consensus-oriented listening, and action-oriented listening.

• The ELICS is a valid and context-appropriate tool for the self-assessment of listening and communication skills in the context of pediatric rehabilitation practice.

• The ELICS allows clinicians (e.g., occupational, physical, and speech-language therapists) to assess and reflect on their listening/communication skills and may enhance the relationship-based practice of clinicians who provide therapy services to children with disabilities and their families.

     

Palliative care professional’s perceptions of barriers and challenges to accessing children’s hospice and palliative care services in South East London: A preliminary study

Objectives: Several barriers have been identified as preventing or delaying access to children’s palliative care services. The aim of this study is to further explore such barriers from palliative care professionals’ perspective from two London boroughs.

Methods: Qualitative-five children’s palliative care professionals’ perceptions were obtained from semi-structured interviews.

Results: Three themes emerged: availability and adequacy of child palliative care (e.g., unreliability of services), obstacles to accessing palliative care (e.g., logistical challenges), and cultural values and family priorities.

Conclusion: These findings contribute to the equal opportunities dialogue in this sector and the need for future research to address the challenges identified.