Procedural Pain Management During Tenotomy for Congenital Talipes Equinovarus.

The majority of infants with congenital talipes equinovarus (CTEV) require tenotomy of the tendoachilles. The pain response of this procedure in the awake infant has not been previously reported. In this observational study, multimodal pain management strategies, including oral sucrose, oral paracetamol, topical anesthetic, local anesthetic, a pacifier (dummy), and swaddling, were used. Physiological responses and pain were recorded. Pain was rated out of 10 at regular intervals, using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Ninety-one infants (65 men, mean age = 53 days, range = 19-217 days) were observed. At baseline, median FLACC, heart rate (HR), and oxygen saturation (Spo2) were 1, 159, and 97% respectively. Peak median FLACC and HR were 9 and 200, respectively, and lowest median Spo2 was 92%. The median (interquartile range) time for FLACC to return to 3 or less was 2 (2-5) minutes. Achilles tenotomy for CTEV in the awake infant is associated with high pain levels despite provision of multimodal pain relief measures.

A narrative-informed evaluation of tree of life for parents of children with physical health conditions.

BACKGROUND: Parents of children with chronic health conditions can face many challenges. The Tree of Life narrative therapy group intervention aims to connect parents with their skills and resources before collectively exploring the 'storms' (challenges) they face. A narrative-informed evaluation aimed to story the parents' experiences of attending the group. METHODS: Seven parents attended a Tree of Life group intervention and then participated in a narrative-informed group interview to generate stories regarding their experience of the group. The interview was recorded with consent and later transcribed. RESULTS: A thematic analysis was undertaken and highlighted that the group offered parents a 'safe place to stand' to talk about difficulties; a different perspective on their situation; connection with the skills of other parents; new ideas to introduce more independence to their child; and togetherness within the 'storms' (challenges). CONCLUSIONS: The narrative-informed evaluation offered opportunities to further thicken parents' preferred identity stories whilst also contributing to the evidence base of narrative-informed group interventions for parents.

The parent and child experience of childhood vitiligo: An interpretative phenomenological analysis.

Vitiligo is a chronic and visible skin condition involving depigmentation with half of those with the condition developing it before the age of 20. This study sought to gain an experiential understanding of the impact of vitiligo on children and their parents. Interpretative phenomenological analysis was used, and semi-structured interviews were conducted with four child-parent dyads (eight participants). Analysis of the participants' accounts revealed four overarching themes (Continuing Burden, The Significance of Visible Difference, Uncertainty and Unpredictability, and Coping), with 12 subthemes. There were some subtle differences between the parents and children. Both parents and child participants described the condition as posing a continuing burden with most participants reporting experiencing unwanted attention and being concerned about future relationship impact. Some parents described experiencing a sense of resignation to the condition, whereas all the children described a greater sense of acceptance. Nevertheless, acceptance seemed fragile, and parents were concerned that their children needed assistance in developing self-confidence. The findings represent the first in-depth analysis of childhood vitiligo.

Neurocognitive, academic and functional outcomes in survivors of infant ependymoma (UKCCSG CNS 9204).

PURPOSE: This is the first UK multi-centre case-controlled study with follow-up in excess of 10 years to report the neurocognitive, academic and psychological outcomes of individuals diagnosed with a brain tumour in early childhood. Children enrolled into the UKCCSG CNS 9204 trial, diagnosed with intracranial ependymoma when aged ≤ 36 months old, who received a primary chemotherapy strategy to defer or avoid radiotherapy, were recruited. METHODS: Outcomes of those who relapsed and subsequently received radiotherapy (n = 13) were compared to those enrolled who did not relapse (n = 16), age-matched controls-diagnosed with solid non-central nervous system (SN-CNS; n = 15) tumours or low-grade posterior fossa pilocytic astrocytoma (PFPA; n = 15), and normative data. Analyses compared nine neurocognitive outcomes as primary measures with quality of survival as secondary measures. RESULTS: Relapsed ependymoma participants performed significantly worse than their non-relapsed counterparts on measures of Full Scale IQ, Perceptual Reasoning, Word Reading and Numerical Operations. The relapsed ependymoma group performed significantly worse than SN-CNS controls on all primary measures, whereas non-relapsing participants only differed significantly from SN-CNS controls on measures of Processing Speed and General Memory. Relapsed ependymoma participants fared worse than all groups on measures of quality of survival. CONCLUSIONS: The relapsed irradiated ependymoma group demonstrated the most significantly impaired neurocognitive outcomes at long-term follow-up. Non-relapsing participants demonstrated better outcomes than those who relapsed. Results tentatively suggest avoiding radiotherapy helped preserve neurocognitive and learning outcomes of individuals diagnosed with ependymoma when aged ≤ 36 months old. Prospective neurocognitive surveillance is required. Recommendations for clinical and research practice are provided.

Hart-Devlin revisited: law, morality and consent in parenthood.

The debate about law and morality is not new but changing social structures and advances in science, medicine and technology have impacted the decisions courts have to make. Within the fast-changing societies of the 21st century, is judicial decision-making cognisant of these advances and how do the judiciary currently reconcile difficult emergent issues concerning law, science and morality? The dilemma of decision-making regarding frozen embryos, the gametes of deceased donors and the issue of consent is analysed by reference to recent case law and the problem of decision-making in relation to the newly possible.

Contact at the borderline: psychoanalytic psychotherapy with EB patients.

Against expectation, the experience of setting up a psychotherapy service for adult epidermolysis bullosa (EB) patients at St Thomas' Hospital in London has been that take up is slow and wary. Prior indications from the wider team were that need is high. This may reflect differences in the experience of need on the part of patients and staff. Published research on the psychosocial aspects ofEB is minimal. This article proposes a type of genetic trauma particular to this patient group. It then examines some clinical psychodynamics with regard to the capacity of some severely affected patients to experience and acknowledge feelings such as love and need. Some aspects of the psychological significance of the skin as an organ of the body will be discussed, with particular reference to what happens when it goes wrong.

Severe (psychopathic) personality disorder: a review.

The development of the concept, causes and management of severe (psychopathic) personality disorder is reviewed against the current background of government concern about the activities of a small group of individuals alleged to be showing the disorder to a dangerous degree. The authors acknowledge the problems involved in 'labelling' the disorder. The term psychopathic has a somewhat chequered history. It did not enter U.K. legislation until the Mental Health Act 1959. To this extent, it is a legal term and does not equate to any exact degree with the clinical descriptions currently in use. However, the term 'psychopathic disorder' will be used as a kind of shorthand for variants in everyday use. It is important to note that in this contribution we are only considering those 'psychopaths' who have come to the attention of the criminal justice and mental health systems. There are also 'psychopaths' who, for a variety of reasons, have not come to official attention and a recent contribution by Board and Fritzon (2005) highlights some interesting common characteristics in business managers and a sample of forensic patients detained in high security establishments.