Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques.

Background: In the course of developing a standardized pathway for alveolar cleft repair, we conducted a systematic review comparing minimally invasive trephine with conventional open technique for iliac crest bone graft harvest in a pediatric population. Methods: A systematic review was conducted of studies comparing open with minimally invasive trephine techniques in pediatric populations undergoing alveolar cleft repair. Exclusion criteria included reviews, case series, editorials, abstracts, and those with adult-only populations. Data were compiled with outcome variables selected a priori. Results: Of 422 manuscripts screened, five met criteria. These comprised 257 patients (116 open, 141 trephine). Average age was 11 years. Patients undergoing trephine harvest had reduced length of stay (1.0-5.0 days trephine vs 1.25-5.4 days open), time to unassisted ambulation (16-46 hours vs 20-67 hours open), and less postoperative narcotic use (0.31 mg/kg vs 1.64 mg/kg IV morphine). Volume of cancellous bone was reported as 2.53 mL for open versus 1.22 mL for trephine in one study, and trephine graft was supplemented with demineralized bone in 54% of cases in another study. The use of anesthetic adjuncts was inconsistent but had a significant effect on postoperative pain and ambulation. Conclusions: Compared to open techniques, the minimally invasive trephine bone graft harvest is associated with a shorter time to discharge, slightly lower infection rates, and reduced opioid use. The possible benefits of trephine harvest must however be balanced against the risk of insufficient graft harvest. Finally, the choice of perioperative analgesic adjuncts significantly impacts patient outcomes regardless of the technique employed.

Contexte: Dans le cours de l'élaboration d'une méthode standardisée de réparation des fentes palatines, nous avons réalisé une revue systématique comparant la technique par tréphine peu invasive à la technique conventionnelle ouverte pour la collecte d'os de la crête iliaque dans une population pédiatrique. Méthodes: Une revue systématique a été réalisée sur les études comparant les techniques ouvertes avec les techniques utilisant une tréphine peu invasive dans des populations pédiatriques subissant une réparation de fente palatine. Les critères d'exclusion incluaient les revues, les séries de cas, les éditoriaux, les résumés et les études ne portant que sur une population adulte. Les données ont été compilées avec des variables de résultats sélectionnées a priori. Résultats: Parmi les 422 manuscrits sélectionnés, cinq répondaient aux critères. Ils incluaient 257 patients (116 techniques ouvertes, 141 tréphines). L'âge moyen des patients était de 11 ans. Les patients pour lesquels une collecte avait été obtenue par tréphine avaient une durée de séjour plus courte (tréphine : 1,0 à 5,0 jours; contre technique ouverte : 1,25 à 5,4 jours), un délai de déambulation non aidée plus court (16 à 46 heures contre 20 à 67 heures pour la technique ouverte) et un moindre recours aux antalgiques postopératoires (0,31 mg/kg contre 1,64 mg/kg de morphine IV). Le volume d'os spongieux collecté était de 2,53 ml avec les techniques ouvertes contre 1,22 ml avec la tréphine; le greffon par tréphine a été complété par de l'os déminéralisé dans 54% des cas dans une autre étude. L'utilisation de suppléments anesthésiques n'était pas homogène, mais a eu un effet significatif sur la douleur postopératoire et la déambulation. Conclusions: Comparativement aux techniques ouvertes, la collecte peu invasive de greffon osseux par tréphine est associée à une délai de congé plus court, des taux d'infections légèrement inférieurs et à une moindre utilisation d'opioïdes. Toutefois, les avantages éventuels de la collecte par tréphine doivent être soupesés par rapport au risque de collecte insuffisante de greffon. Enfin, le choix de suppléments analgésiques périopératoires a des répercussions significatives sur l'évolution des patients, indépendamment de la technique employée.

Improved Operative Efficiency and Surgical Times in Autologous Breast Reconstruction: A 15-year Single-center Retrospective Review.

Background: Autologous breast reconstruction using a free deep inferior epigastric perforator (DIEP) flap is a complex procedure that requires a dedicated approach to achieve operative efficiency. We analyzed data for DIEP flaps at a single center over 15 years to identify factors contributing to operative efficiency. Methods: A single-center, retrospective cohort analysis was performed of consecutive patients undergoing autologous breast reconstruction using DIEP free flaps between January 1, 2005, and December 31, 2019. Data were abstracted a priori from electronic medical records. Analysis was conducted by a medical statistician. Results: Analysis of 416 unilateral and 320 bilateral cases (1056 flaps) demonstrated reduction in operative times from 2005 to 2019 (11.7-8.2 hours for bilateral and 8.4-6.2 hours for unilateral, P < 0.000). On regression analysis, factors significantly correlating with reduced operative times include the use of venous couplers (P < 0.000), and the internal mammary versus the thoracodorsal recipient vessels (P < 0.000). Individual surgeon experience correlated with reduced OR times. Post-operative length of stay decreased significantly, without an increase in 30-day readmission or emergency presentations. Flap failure occurred in two cases. Flap take-back rate was 2% (n = 23) with no change between 2005 and 2019. Conclusions: Operative times for breast reconstruction have decreased significantly at this center over 15 years. The introduction of venous couplers, use of the internal mammary system, and year of surgery significantly correlated with decreased operative times. Surgeon experience and a shift in surgical workflow for DIEP flap reconstruction likely contributed to the latter finding.

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway.

OBJECTIVE: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. DESIGN: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). PATIENTS: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. INTERVENTIONS: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. MAIN OUTCOME MEASURES: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. RESULTS: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 µg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. CONCLUSIONS: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions.

BACKGROUND: There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS: Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS: Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION: The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.

Suprazygomatic maxillary nerve block: an ultrasound and cadaveric study to identify correct sonoanatomical landmarks.

​PURPOSE: Suprazygomatic maxillary nerve blocks (SMB) are used in adult and pediatric patients to provide analgesia for midface surgery and chronic maxillofacial pain syndromes. The ultrasound-guided SMB technique ensures visualisation of the needle tip, avoidance of the maxillary artery and confirmation of local anesthetic spread. The goal of this study was to correctly identify SMB sonoanatomical landmarks to ensure the nerve block is performed safely and effectively. METHODS: Following an ultrasound-guided SMB with dye injection on 2 embalmed cadavers, pre-tragal face-lift style incision with a full thickness flap dissection was performed allowing accurate visualization of the bony landmarks being used for sonography and identification of the location of the injected dye. RESULTS: This study identifies the correct sonoanatomic landmarks as the maxilla and the coronoid process of the mandible which suggests that the block needle tip and local anesthetic injection are within the infratemporal fossa as opposed to the previously reported pterygopalatine fossa. CONCLUSION: An improved understanding of the sonoanatomy will aid clinicians who are learning, performing and teaching the ultrasound-guided suprazygomatic approach to the maxillary nerve block.

Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review.

PURPOSE: To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training. METHOD: The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles. RESULTS: Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified. CONCLUSIONS: Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.

Pediatric Hand Fracture Referring Practices: A Scoping Review.

BACKGROUND: Pediatric hand fractures are common, but few require surgery; therefore, these fractures are often perceived to be overreferred. Our objective is to systematically identify and describe pediatric hand fracture referring practices. METHOD: A scoping review was performed, searching electronic databases and grey literature up to January 2018 to identify referring practices for children (17 years and younger) with hand fractures (defined as radiographically confirmed fractures distal to the carpus) to hand surgeons. All study designs were included, and study selection and data extraction were independently performed in duplicate by 2 reviewers. Outcomes included referring rates, necessity of referral, referring criteria, and management of fractures. RESULTS: Twenty (10 cross-sectional, 7 prospective cohorts, and 3 narrative reviews) studies reporting on referring practices or management of 21,624 pediatric hand fractures were included. Proportion of pediatric hand fractures referred to hand surgeons ranged from 6.5% to 100%. Unnecessary referral, defined as those fractures within the scope of primary care management, ranged from 27% to 78.1%. Ten studies reported referring criteria, with 14 unique criteria identified. The most common referring criteria were displacement (36.4%), loss of joint congruity (36.4%), and instability (36.4%). The most common justification for these criteria was increased likelihood of requiring surgery. The most common initial management was immobilization (66%-100%). Final management was provided by orthopedic or plastic hand surgeons with 0% to 32.9% of fractures requiring surgery. CONCLUSION: Referring practices vary widely in the literature. Major gaps in the literature include objective measures and justification for referring criteria and primary care education on hand fracture referring practices.

HISTORIQUE: Les fractures de la main sont courantes en pédiatrie, mais rares sont celles qui exigent une opération. C'est pourquoi on a souvent l'impression qu'elles sont trop envoyées en consultation. Les chercheurs avaient comme objectif de déterminer et de décrire systématiquement les pratiques de consultation à cause d'une fracture de la main en pédiatrie. MÉTHODOLOGIE: En janvier 2018, dans le cadre d'une analyse exploratoire, les chercheurs ont fouillé les bases de données électroniques et la documentation parallèle pour déterminer les pratiques de consultation de chirurgiens de la main pour les enfants (de 17 ans et moins) victimes de fractures de la main (définies comme des fractures de la partie distale du carpe, confirmées par radiographie). Ils ont inclus toutes les méthodologies, et deux analystes ont chacun effectué toute l'extraction des données. Les résultats incluaient le taux, la nécessité et les critères de consultation ainsi que le traitement des fractures. RÉSULTATS: Les chercheurs ont inclus 20 études (dix transversales, sept cohortes prospectives, trois examens narratifs) sur les pratiques de consultation ou de prise en charge de 21,624 fractures de la main en pédiatrie. De 6,5 % à 100 % de ces fractures étaient envoyées en consultation à un chirurgien de la main. De 27 % à 78,1 % des consultations étaient inutiles, c'est-à-dire qu'elles pouvaient être traitées en soins primaires. Dix études faisaient état de critères de consultation, pour un total de 14 critères uniques. Ainsi, les principaux critères de consultation étaient un déplacement (36,4 %), la perte de la congruence articulaire (36,4 %) et l'instabilité (36,4 %). La principale justification de ces critères était une plus grande probabilité d'opération. L'immobilisation (66 % à 100 %) demeurait le traitement initial le plus courant. Un chirurgien orthopédique ou plastique de la main effectuait le traitement définitif, et de 0 % à 32,9 % des fractures devaient être opérées. CONCLUSION: Les publications font état de pratiques de consultation très variables. Elles comportent de grandes lacunes, soit l'objectivité des mesures, la justification des critères de consultation retenus et la formation en soins primaires sur les pratiques de consultation en cas de fracture de la main.

Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions.

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.

Randomised controlled trial of simulation-based education for mechanical cardiopulmonary resuscitation training.

INTRODUCTION: Mechanical cardiopulmonary resuscitation (M-CPR) is increasingly used in the management of cardiac arrest. There are no previously reported randomised studies investigating M-CPR training. This study of newly trained M-CPR providers hypothesised that a brief simulation-based intervention after 4 months would improve M-CPR performance at 6 months. METHODS: This study used a simulated 'in situ' cardiac arrest model. The M-CPR device used was a proprietary Lund University Cardiac Assist System 3 machine (Physio Control, Redmond, Washington, USA). Standardised baseline training was provided to all participants. Following training, baseline performance was assessed. The primary outcome measure was the time taken to initiate M-CPR and the secondary outcome was performance against a checklist of errors. Participants were then randomised to intervention group (simulation training) or control group (routine clinical use of M-CPR). After 6 months the outcome measures were reassessed. Comparative statistical tests used an intention-to-treat analysis. RESULTS: 112 participants were enrolled. The intervention group (n=60) and control group (n=52) had similar demographic characteristics. At the 6-month assessment, median time to M-CPR initiation was 27.0 s (IQR 22.0-31.0) in the intervention group and 31.0 s (IQR 25.6-46.0) in the control group (p=0.003). The intervention group demonstrated fewer errors compared with controls at 6 months (p<0.001) CONCLUSION: In this randomised study of approaches to M-CPR training, providers receiving additional simulation-based training had higher retention levels of M-CPR skills. Therefore, when resuscitation skills are newly learnt, provision follow-up training should be an important consideration.

Intra-thoracic adiposity is associated with impaired contractile function in patients with coronary artery disease: a cardiovascular magnetic resonance imaging study.

The influence of visceral adiposity on left ventricular remodeling following coronary artery disease (CAD)-related events has not been examined to date. Using magnetic resonance imaging (MRI) we explored intra-thoracic fat volume (ITFV) and strain-based markers of adverse remodeling in patients with CAD. Forty-seven patients with known CAD (25 with prior MI, 22 without prior MI) were studied. ITFV was quantified using previously validated imaging techniques. Myocardial strain was derived from cine MRI using a validated 3D feature-tracking (FT) software. Segmental LGE quantification was performed and was used to incrementally constrain strain analyses to non-infarcted (i.e. remote) segments. Remote myocardial strain was compared to the non-MI control cohort and was explored for associations with ITFV. Mean age was 57 ± 13 years with a mean BMI of 30.0 ± 6.2 kg/m2 (range 20.3-38.4 kg/m2). Patients with versus without prior MI had similar demographics and BMI (29.4 ± 4.4 vs. 30.4 ± 7.9 kg/m2, p = 0.62). Patients with prior MI had lower mean peak strain than non-MI patients (p = 0.02), consistent with remote tissue contractile dysfunction. Inverse associations were identified between ITFV and mean peak strain in both the MI group (circumferential: r = 0.43, p = 0.03; radial: - 0.41, p = 0.04; minimum principal: r = 0.41, p = 0.04; maximum principal: r = - 0.43, p = 0.03) and non-MI group (circumferential: r = 0.42, p = 0.05; minimum principal: r = 0.45, p = 0.03). In those with prior MI higher ITFV was associated with a greater reduction in remote tissue strain. ITFV is associated with contractile dysfunction in patients with CAD. This association is prominent in the post-MI setting suggesting relevant influence on remote tissue health following ischemic injury. Expanded study of intra-thoracic adiposity as a modulator of myocardial health in patients with CAD is warranted.

Screening for anxiety and depression: reassessing the utility of the Zung scales.

BACKGROUND: While the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung's Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ). METHOD: A total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS. RESULTS: Overall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of 'Misses' and 'False Positives' to those obtained with the DASS. CONCLUSIONS: Given these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

Medication use in people with late stage Parkinson's disease and parkinsonism living at home and in institutional care in north-east England: A balance of symptoms and side-effects?

BACKGROUND: People with Parkinson's disease (PD) and parkinsonism living in care homes (residential or nursing care) in the UK represent around 10-15% of all people with PD and 3-5% of all care home residents. There are few previous data on medication use in those living in care homes with PD. In this study we aimed to compare medication use in a representative cohort of people with PD living in care homes in north-east England with those living in their own homes. METHOD: All people with late stage (Hoehn and Yahr III-V) idiopathic PD, PD dementia, or atypical parkinsonian syndromes under the care of the Northumbria Healthcare NHS Foundation Trust PD service on 1st January 2015 were identified. Demographic, disease characteristics and medication use data were collected from an audit of medical notes of all those identified. RESULTS: We identified 377 people who met the inclusion criteria, 91 (24.1%) of whom were living in a care home. Disease stage, age and age at disease onset were all significantly higher and levodopa equivalent dose significantly lower in those living in care homes, although disease duration and levodopa dose were not. Greater age, lower levodopa equivalent dose and higher disease stage were independently associated with being in a care home. CONCLUSIONS: Although people in care homes had more advanced disease, they were on a significantly lower levodopa equivalent dose. This is likely to be due to the requirement to balance symptom management with drug side-effects.

Impact and outcomes of a rural Personal Helpers and Mentors service.

OBJECTIVE: To describe impacts and outcomes associated with the Personal Helpers and Mentor's (PHaMs) service in a rural Australian town. DESIGN: A descriptive analysis of longitudinal data, uncontrolled pre-test and post-test caseworker ratings, and retrospective pre-test/post-test self-ratings and feedback comments were collected from convenience samples. SETTING: A community-based mental health recovery service. PARTICIPANTS: n=76 mental health consumers; mean age=37.78 years; 45% male; 63% Aboriginal; primary diagnoses=41% psychotic disorder and 61% mood disorder; co-morbid diagnosis=45% substance use disorder. INTERVENTIONS: Individual recovery plan (IRP), personal goal setting, caseworker mentoring and support. MAIN OUTCOME MEASURES: Gains towards goals, the Role Functioning Scale (RFS), self-ratings and feedback comments. RESULTS: The most frequently addressed goals were: attend mental health treatment services, acquire suitable accommodation and be more involved in the community. IRP completers (n=19) showed a significant improvement in caseworker-rated adaptive functioning which was adequate at case closure (t(18)=-4.38, P<0.001). Participant (n=19) ratings of the service and its key performance indicators suggested global satisfaction and gains in the management of everyday tasks, use of medications and community engagement. Good rapport was reported with the locally trained and predominantly Aboriginal (56%) staff. CONCLUSIONS: PHaMs shows promise for assisting rural people with mental illness to improve their everyday functioning, medication management and community involvement. Recruitment and capacity-building of Aboriginal staff appears to facilitate Aboriginal consumer participation.

A method of assessing the resilience of whole communities of children: An example from rural Australia.

BACKGROUND: Children living in socioeconomic disadvantage are at risk of poor mental health outcomes. In order to focus and evaluate population health programs to facilitate children's resilience, it is important to accurately assess baseline levels of functioning. With this end in mind, the aim of this study was to test the utility of 1) a voluntary random sampling method and 2) quantitative measures of adaptation (with national normative data) for assessing the resilience of children in an identified community. METHOD: This cross-sectional study utilized a sample of participants (N = 309), including parents (n = 169), teachers (n = 20) and children (n = 170; age range = 5-16 years), recruited from the schools in Tenterfield; a socioeconomically disadvantaged community in New South Wales, Australia. The Strengths and Difficulties Questionnaire (SDQ; including parent, teacher and youth versions) was used to measure psychological well-being and pro-social functioning, and NAPLAN results (individual children's and whole school's performance in literacy and numeracy) were used to measure level of academic achievement. RESULTS: The community's disadvantage was evident in the whole school NAPLAN performance but not in the sample's NAPLAN or SDQ results. The teacher SDQ ratings appeared to be more reliable than parent's ratings. The voluntary random sampling method (requiring parental consent) led to sampling bias. CONCLUSIONS: The key indicators of resilience - psychological well-being, pro-social functioning and academic achievement - can be measured in whole communities using the teacher version of the SDQ and whole school results on a national test of literacy and numeracy (e.g., Australia's NAPLAN). A voluntary random sample (dependent upon parental consent) appears to have limited value due to the likelihood of sampling bias.