Which clinical errors lead to the referral of UK paediatricians to the National Clinical Assessment Service?

The aim of this study was to determine which clinical errors lead to the referral of UK paediatricians to the National Clinical Assessment Service (NCAS). Data for the 10-year period from 1 April 2001 to 31 March 2011 were analysed. Referrals are classified into clinical, behavioural and health related. Clinical referrals can be general, relating to general deficiencies in knowledge and skills, or specific and concerned with a critical incident. Specific clinical referrals were analysed. There were 259 paediatric cases in this period. There were 110 (42?%) clinical concerns in the 259 cases. In 47 of the 110 cases, these were general concerns. There were 63 cases where specific clinical concerns had led to the referral. These were: diagnosis and management of child protection cases, 19; prescribing errors, 13; diagnosis other than child protection cases, 12; treatment incidents, 7; difficulties with transfer of a patient to another unit, 6; poor resuscitation, 4; and slow response to an emergency, 2. In 16 of the cases, the patient died. Conclusion: This analysis reveals some different errors to those in other studies of paediatric litigation and complaints. Mistakes in child protection cases were the commonest reason for referral to NCAS. Prescribing errors were the second commonest cause. Difficulties in the diagnosis and treatment of a range of different conditions accounted for the next biggest group of referrals. This study helps highlight areas of paediatrics, such as child protection and prescribing, where training needs to be improved in order to improve patient safety.     

Installation of mechanical ventilation in a horse stable: effects on air quality and human and equine airways

Objectives  

To examine the effects of installing a mechanical ventilation system at a riding-school stable on indoor air quality and human and horse airways.     

Men's health in Europe

Background

In 2011 the European Commission launched the report ‘The State of Men's Health in Europe’ covering the health of 290 million men across 34 European countries. This is the first official statement on the health of men in Europe. The work was carried out by a team of writers from across Europe aided by a management advisory group, a reviewing group and a broader reference group.

Methods

Data from major international databases were used to compile a detailed analysis based on population data, lifestyle and preventable risk factors, use of health services and morbidity and mortality data based on the ICD-10, with the results focused on the “European shortlist” of 65 causes of death.

Results

Changes in male demographics are creating a reversal in the age distribution ratio, with a decreasing younger population but increasing numbers of elderly men. The data on morbidity and mortality are most striking in relation to the high levels of premature death in men across the disease spectrum with marked differences between countries.

Conclusions

The very large variations seen in the health of men across Europe demonstrates that much of men's higher risk of premature death is caused by socio-cultural factors and therefore avoidable. No country should be complacent about the health of its male population.     

From ERPs to academics

Standardized tests have been used to forecast scholastic success of school-age children, and have been related to intelligence, working memory, and inhibition using neuropsychological tests. However, ERP correlates of standardized achievement have not been reported. Thus, the relationship between academic achievement and the P3 component was assessed in a sample of 105 children during performance on a Go/NoGo task. The Wide Range Achievement Test - 3rd edition was administered to assess aptitude in reading, spelling, and arithmetic. Regression analyses indicated an independent contribution of P3 amplitude to reading and arithmetic achievement beyond the variance accounted for by IQ and school grade. No such relationship was observed for spelling. These data suggest that the P3, which reflects attentional processes involved in stimulus evaluation and inhibitory control may be a biomarker for academic achievement during childhood.     

Sequence analysis of the protein kinase gene family in human testicular germ-cell tumors of adolescents and adults

The protein kinase gene family is the most frequently mutated in human cancer. Previous work has documented activating mutations in the KIT receptor tyrosine kinase in testicular germ-cell tumors (TGCT). To investigate further the potential role of mutated protein kinases in the development of TGCT and to characterize the prevalence and patterns of point mutations in these tumors, we have sequenced the coding exons and splice junctions of the annotated protein kinase family of 518 genes in a series of seven seminomas and six nonseminomas. Our results show a remarkably low mutation frequency, with only a single somatic point mutation, a K277E mutation in the STK10 gene, being identified in a total of more than 15 megabases of sequence analyzed. Sequencing of STK10 in an additional 40 TGCTs revealed no further mutations. Comparative genomic hybridization and LOH analysis using SNP arrays demonstrated that the 13 TGCTs mutationally screened through the 518 protein kinase genes were uniformly aneuploid with consistent chromosomal gains on 12p, 8q, 7, and X and losses on 13q, 18q, 11q, and 4q. Our results do not provide evidence for a mutated protein kinase implicated in the development of TGCT other than KIT. Moreover, they demonstrate that the general prevalence of point mutations in TGCT is low, in contrast to the high frequency of copy number changes.     

Heritability and Longitudinal Stability of Schizotypal Traits During Adolescence

The study investigated the genetic and environmental etiology of schizotypal personality traits in a non-selected sample of adolescent twins, measured on two occasions between the ages of 11 and 16 years old. The 22-item Schizotypal Personality Questionnaire- Child version (SPQ-C) was found to be factorially similar to the adult version of this instrument, with three underlying factors (Cognitive-Perceptual, Interpersonal-Affective, and Disorganization). Each factor was heritable at age 11–13 years (h ² = 42–53%) and 14–16 years old (h ² = 38–57%). Additive genetic and unique environmental influences for these three dimensions of schizotypal personality acted in part through a single common latent factor, with additional genetic effects specific to both Interpersonal-Affective and Disorganization subscales at each occasion. The longitudinal correlation between the latent schizotypy factor was r = 0.58, and genetic influences explained most of the stability in this latent factor over time (81%). These longitudinal data demonstrate significant genetic variance in schizotypal traits, with moderate stability between early to middle adolescence. In addition to common influences between the two assessments, there were new genetic and non-shared environmental effects that played a role at the later assessment, indicating significant change in schizotypal traits and their etiologies throughout adolescence.     

Kasabach-Merritt syndrome

Eight infants with hemangiomata associated with severe consumption coagulopathy are reviewed; three died. The presentations and method of management are discussed. The varied response to different modalities of therapy initiated this report and led to a search of the world literature in an attempt to identify the pattern of response, if any, to particular therapy. From our own experience with two cases and from the review of the literature, it appears that radiotherapy alone or in combination with steroids gives a superior overall treatment in terms of reducing the death rate.