Pulmonary infiltrates with eosinophilia syndrome in ibuprofen overdose.

We describe the case of a 45-year-old female who developed pulmonary infiltrates and mild eosinophilia following an overdose of ibuprofen. We believe this was a case of pulmonary infiltrates with eosinophilia (PIE) syndrome and discuss the relevant literature. Although rare, PIE syndrome should be considered in those taking nonsteroidal anti-inflammatories who develop unexplained pulmonary infiltrates.

Compliance and quality in administration of a Surgical Safety Checklist in a tertiary New Zealand hospital.

AIM: Recent studies have demonstrated a reduction in perioperative complications if a surgical safety checklist is utilised. In our institution an adaptation of the WHO Surgical Safety Checklist is administered in 3 "domains": on arrival of the patient in the operating room (Sign In); before surgical incision (Time Out) and before the patients leaves the operating room (Sign Out). Since incomplete administration or staff disengagement could diminish any safety benefit we evaluated administration of this checklist. METHOD: 100 adult surgical cases were observed. Compliance with administration of the Sign In, Time Out, and Sign Out domains and their component checklist items was recorded. The timing of the checklist administration, and engagement of operating room teams were also assessed. RESULTS: The rate (per 100 cases) of the checklist domain administration was: 99 for Sign In; 94 for Time Out; and 2 for Sign Out. The mean (range) checklist item compliance was 56% (27-100%) for Sign In, 69% (33-100%) for Time Out, and 40% for Sign Out. Checklist items related to patient identity and surgical procedure were administered in 100% of Sign In administrations. Timing of the checklist administration was appropriate in over 80% of cases. Engagement by theatre teams was frequently incomplete. CONCLUSION: The Sign Out domain was almost always omitted, which may increase the risk of important omissions in postoperative care. Most other aspects of checklist administration could also be improved. This will require strong leadership from senior clinicians in all relevant teams.

Parent-perceived barriers to participation in children and adolescents with cerebral palsy.

AIM: To pilot the use of the Craig Hospital Inventory of Environmental Factors (CHIEF) questionnaire to ascertain information regarding barriers to participation experienced by a sample of New Zealand children with cerebral palsy. METHODS: The CHIEF questionnaire was administered to parents/caregivers of a consecutive sample of 32 children with cerebral palsy attending a paediatric tertiary clinic in Auckland. Twenty-three children walked independently, 5 used walking aides and four used a wheelchair. Twenty-four of the 32 parent-respondents provided contextual feedback for their responses and wider issues relating to the topic. RESULTS: The barriers to participation most commonly reported by parents were attitudes at school (72%) and in the community (56%), difficulties accessing personal equipment (59%), and the natural environment and built surroundings (56%). Contextual information from families generally supported their answers to the questionnaire but highlighted that some parents had confused the 'not applicable' and 'never' options. Discrepancy between scores on the policy-related questions and later contextual feedback suggested that the policy subscale did not fully capture family concerns about limited availability of public funding for equipment, therapy, and educational support. CONCLUSIONS: The CHIEF instrument proved easy to use in a clinic setting. However, parent-respondent feedback highlighted the difficulties in interpreting responses to some items when the instrument is used in isolation to quantify environmental barriers to participation. The results highlight the need to develop research approaches and tools that can explore barriers to participation by children with cerebral palsy taking account of socio-economic and other relevant contextual information.