1756 Paediatric rapid reviews – do they enable timely patient review and appropriate escalation in a tertiary paediatric hospital?

Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four–15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin ( n = 3), atracurium ( n = 1) and rocuronium ( n = 1). Three patients (25.0%) had non–IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.

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Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

BMJ Open Quality ◽

10.1136/bmjoq-2020-001120 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001120

Author(s):

Brendan Joseph McMullan ◽

Michelle Mahony ◽

Lolita Java ◽

Mona Mostaghim ◽

Michael Plaister ◽

...

Keyword(s):

Length Of Stay ◽

Antibiotic Use ◽

Hospital Length ◽

Audit And Feedback ◽

Hospital Length Of Stay ◽

Oral Antibiotic ◽

Intravenous Therapy ◽

Paediatric Hospital ◽

Inpatient Settings ◽

Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

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The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03966-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julius Sama Dohbit ◽

Namanou Ines Emma Woks ◽

Carlin Héméry Koudjine ◽

Willy Tafen ◽

Pascal Foumane ◽

...

Keyword(s):

Quality Of Care ◽

Neonatal Death ◽

Lessons Learned ◽

Adoption Rate ◽

Paediatric Hospital ◽

Neonatal Asphyxia ◽

Safe Childbirth Checklist ◽

Low Middle Income Countries ◽

Safe Childbirth

Abstract Background Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

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Automation in Systematic, Scoping and Rapid Reviews by an NLP Toolkit: A Case Study in Enhanced Living Environments

Lecture Notes in Computer Science - Enhanced Living Environments ◽

10.1007/978-3-030-10752-9_1 ◽

2019 ◽

pp. 1-18 ◽

Cited By ~ 5

Author(s):

Eftim Zdravevski ◽

Petre Lameski ◽

Vladimir Trajkovik ◽

Ivan Chorbev ◽

Rossitza Goleva ◽

...

Keyword(s):

Rapid Reviews ◽

Living Environments

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Guided Self-help Teletherapy for Behavioural Difficulties in Children with Epilepsy

Journal of Clinical Psychology in Medical Settings ◽

10.1007/s10880-021-09768-2 ◽

2021 ◽

Author(s):

Sophie Bennett ◽

Isobel Heyman ◽

Sophia Varadkar ◽

Anna Coughtrey ◽

Fahreen Walji ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Unmet Need ◽

Hospital Setting ◽

Physical And Mental Health ◽

Paediatric Hospital ◽

Complex Needs ◽

Self Help ◽

Behavioural Difficulties

AbstractBehavioural difficulties impact greatly upon quality of life for children with chronic illness and their families but are often not identified or adequately treated, possibly due to the separation of physical and mental health services. This case study describes the content and outcomes of guided self-help teletherapy for behavioural difficulties in a child with epilepsy and complex needs using an evidence-based behavioural parenting protocol delivered within a paediatric hospital setting. Behavioural difficulties and progress towards the family’s self-identified goals were monitored at each session. Validated measures of mental health and quality of life in children were completed before and after intervention and satisfaction was measured at the end of treatment. Measures demonstrated clear progress towards the family’s goals and reduction in weekly ratings of behavioural difficulties. This case demonstrates that a guided self-help teletherapy approach delivered from within the paediatric setting may be one way of meeting unmet need.

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