Parental self-efficacy and the management of childhood atopic eczema: development and testing of a new clinical outcome measure.

BACKGROUND: Effective parental management of childhood eczema requires education and support to reduce disease severity and improve the child's quality of life. Self-efficacy is a key factor influencing effective chronic disease management, yet there are no published scales to measure parental self-efficacy in managing childhood eczema. The Parental Self-Efficacy with Eczema Care Index (PASECI) was designed to measure parental self-efficacy in managing childhood eczema as a pre- and postintervention tool in the evaluation of a structured Eczema Education Programme (EEP). OBJECTIVES: To develop and test the validity, reliability and sensitivity of a new outcome measure (PASECI) designed to assess parental self-efficacy in managing their child's eczema to determine pre- vs. postintervention changes in educational intervention evaluation studies. METHODS: PASECI was developed from the literature, expert consultation and piloting of a 40-item prototype. The final 29-item scale is arranged in four subscales. Parents of children with eczema aged 0-16 years (n = 242) attending the EEP were assessed at 1 week pre-EEP and 4 weeks postintervention. Cronbach's α and factor analyses were undertaken. RESULTS: PASECI has face, content and construct validity. It is reliable, with high item internal consistency (α > 0·87 in all domains). Factor analysis revealed four viable domains. It was sensitive to change for postintervention measures using sign tests (P < 0·001). CONCLUSIONS: PASECI is a useful, valid, reliable and sensitive evaluative outcome measure of self-efficacy in parents managing childhood eczema.

A national survey of obstetric early warning systems in the United Kingdom: five years on.

The Confidential Enquiries into Maternal Deaths in the UK have recommended obstetric early warning systems for early identification of clinical deterioration to reduce maternal morbidity and mortality. This survey explored early warning systems currently used by maternity units in the UK. An electronic questionnaire was sent to all 205 lead obstetric anaesthetists under the auspices of the Obstetric Anaesthetists' Association, generating 130 (63%) responses. All respondents reported use of an obstetric early warning system, compared with 19% in a similar survey in 2007. Respondents agreed that the six most important physiological parameters to record were respiratory rate, heart rate, temperature, systolic and diastolic blood pressure and oxygen saturation. One hundred and eighteen (91%) lead anaesthetists agreed that early warning systems helped to prevent obstetric morbidity. Staffing pressures were perceived as the greatest barrier to their use, and improved audit, education and training for healthcare professionals were identified as priority areas.

A service evaluation of the Eczema Education Programme: an analysis of child, parent and service impact outcomes.

BACKGROUND: The systematic support of parents of children with eczema is essential in effective disease management. The few existing support models have a limited evidence base. This paper reports the outcome-orientated service evaluation of an original, extensive, social learning-theory based, nurse-led Eczema Education Programme (EEP). OBJECTIVES: To evaluate the EEP using specified child and parental outcomes and service impact data. METHODS: From a sample of 257 parent-child dyads attending the EEP, a pretest-post-test design evaluated its child impact using health-related quality of life measures (Infants' Dermatitis Quality of Life index, which includes a small dermatitis severity element, and Children's Dermatology Life Quality Index), severity measures (Patient Orientated Eczema Measure), a new parental measure (Parental Self-Efficacy in Eczema Care Index) and service impact data based on general practitioner (GP) attendance patterns pre- and postintervention. RESULTS: Statistically significant impacts were observed on infant quality of life (P < 0·001), child quality of life (P = 0·027), disease severity (P < 0·001) and parental self-efficacy (P < 0·001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post-EEP reduced by 62%. CONCLUSIONS: The EEP appears to be an effective model of delivering structured education to parents of children with eczema, and one generalizable to other multiethnic metropolitan populations. As a noncontrolled study, this rigorous service evaluation highlights the model's significance and the case for an evaluative multicentre randomized controlled trial of this educational intervention to inform a nurse-led programme of care.

Poor numeracy skills are associated with glycaemic control in Type 1 diabetes.

AIMS: To assess the numeracy and literacy skills of individuals with Type 1 diabetes and determine if there is a relationship with achieved glycaemic control independent of their duration of diabetes, diabetes education, demographic and socio-economic factors. METHODS: One hundred and twelve patients completed the study (mean current age 43.8 ± 12.5 years, 47% male, mean duration of diabetes 22.0 ± 13.2 years) out of 650 randomly selected patients from the Bournemouth Diabetes and Endocrine Centre's diabetes register. The Skills for Life Initial Assessments were used to measure numeracy and literacy. These indicate skills levels up to level 2, equivalent to the national General Certificate of Secondary Education grades A*-C. HbA(1c) was also measured. Pearson's correlation was used to measure the correlation of numeracy and literacy scores with HbA(1c.) To compare mean HbA(1c) between those with or without level 2 skills, t-tests were used, and multiple linear regression was used to investigate whether any differences were independent of duration of diabetes, diabetes education, demographic and socio-economic factors. RESULTS: Literacy was not associated with achieved HbA(1c). In contrast, participants with numeracy skills at level 2 or above achieved an HbA(1c) lower than those with numeracy skills below level 2 (P = 0.027). Although higher socio-economic status was associated with lower mean HbA(1c) , the relationship between numeracy and HbA(1c) appeared to be independent of socio-economic factors. CONCLUSIONS: Low numeracy skills were adversely associated with diabetes control. Assessment of numeracy skills may be relevant to the structure of diabetes education programmes.

Factors associated with the anonymous reporting of lifetime domestic violence in a genitourinary medicine clinic: a patient self-reported questionnaire study.

Domestic violence (DV) occurs frequently within the UK, with one in four women and one in six men experiencing DV during their life. DV is the leading cause of morbidity for women aged 19-44 years and is associated with sexual health problems. However, few data exist on the prevalence of DV in UK genitourinary (GU) medicine settings. An anonymous questionnaire was self-completed by patients (n = 476/500) attending Bournemouth GU medicine clinic during July 2009 to explore associations between lifetime DV and sociodemographic, sexual and behavioural factors. Overall, 21% (98/472) reported that they had ever been abused by a partner (12% [27/229] of men and 29% [71/243] of women). Logistic regression highlighted that being female, having children/dependants and use of illicit drugs were the most important factors associated with lifetime DV. Regular staff training on DV is recommended to increase awareness and signposting to relevant services.

Comparison of techniques for identification of peripheral vestibular nystagmus.

OBJECTIVE: To determine the best clinical method for identifying peripheral vestibular nystagmus, by comparing eye movement examination with optic fixation, and with fixation removed using Frenzel's glasses, infra-red video-Frenzel's goggles or an ophthalmoscope, with results of electronystagmography. METHOD: One hundred patients referred for electronystagmography from the audiovestibular medicine clinic at Queen Alexandra Hospital, Portsmouth, were examined immediately before undergoing electronystagmography. RESULTS: Video-Frenzel's goggles were highly effective at detecting peripheral vestibular nystagmus, with a sensitivity of 85 per cent (95 per cent confidence interval, 62.1-96.8 per cent) and a specificity of 65 per cent (53.5-75.3 per cent), compared with electronystagmography. Ophthalmoscopy had comparable sensitivity to Frenzel's glasses (used in the dark), i.e. 26.3 per cent (9.1-51.2 per cent) compared with 31.6 per cent (12.6-56.6 per cent), respectively. Frenzel's glasses as normally used in ENT clinics (i.e. in dim lighting) were ineffective, with a sensitivity of just 10 per cent (1.2-31.7 per cent). CONCLUSION: Video-Frenzel's goggles should be used in all clinics with substantial numbers of balance-impaired patients. Traditional Frenzel's glasses have no place in clinical practice unless formal black-out facilities are available.

Guillotine versus dissection tonsillectomy: randomised, controlled trial.

OBJECTIVE: This trial aimed to compare the guillotine technique of tonsillectomy with 'cold steel' dissection, the current 'gold standard'. DESIGN: A single centre, randomised, controlled trial. METHODS: One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared. RESULTS: Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage. CONCLUSION: This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.