The gap between attitudes and processes related to 'family-friendly' practices in anaesthesia training in New Zealand: A survey of anaesthesia supervisors of training and departmental directors.

Gender inequity persists within the anaesthetic workforce, despite approaching numerical parity in Australia and New Zealand. There is evidence, from anaesthesia and the wider health workforce, that domestic gender norms regarding parental responsibilities contribute to this. The creation of 'family-friendly' workplaces may be useful in driving change, a concept reflected in the gender equity action plan developed by the Australian and New Zealand College of Anaesthetists. This study aimed to explore the extent to which a family-friendly culture exists within anaesthesia training in New Zealand, from the perspective of leaders in anaesthesia departments. An electronic survey composed of quantitative and qualitative questions was emailed to all supervisors of training, rotational supervisors and departmental directors at Australian and New Zealand College of Anaesthetists accredited training hospitals in New Zealand. Twenty-eight of the 71 eligible participants responded (response rate 39%). The majority (61%) agreed with the statement 'our department has a "family friendly" approach to anaesthesia trainees'; however, there was a discrepancy between views about how departments should be and how they actually are. Several barriers contributing to this discrepancy were identified, including workforce logistics, governance, departmental structures and attitudes. Uncertainty in responses regarding aspects of working hours, parental leave and the use of domestic sick leave reflect gaps in understanding, with scope for further enquiry and education. To redress gender bias seriously through the development of family-friendly policies and practices requires supportive governance and logistics, along with some cultural change.

A three-dimensional (3D) printed paediatric trachea for airway management training.

There is a deficit of commercially available paediatric airway models for anaesthesia airway management training, particularly for infant front-of-neck access and customised airway planning. Acknowledging this, we created a three-dimensional printed prototype for an affordable, high-fidelity training device, incorporating realistic tactile feedback, reproducibility and potential for modification for specific patient pathologies. Our model, created on a Stratasys Polyjet J750™ (Rehovot, Israel) printer, is a novel and useful educational tool in paediatric airway management, and we are pleased to share access to this resource with readers. Our work adds credence to three-dimensional printing as an accessible, reproducible and pluripotent technology in clinical anaesthesia.

Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi.

BACKGROUND: The case fatality rate of severely malnourished children during inpatient treatment is high and mortality is often associated with diarrhea. As intestinal carbohydrate absorption is impaired in severe acute malnutrition (SAM), differences in dietary formulations during nutritional rehabilitation could lead to the development of osmotic diarrhea and subsequently hypovolemia and death. We compared three dietary strategies commonly used during the transition of severely malnourished children to higher caloric feeds, i.e., F100 milk (F100), Ready-to-Use Therapeutic Food (RUTF) and RUTF supplemented with F75 milk (RUTF + F75). METHODS: In this open-label pilot randomized controlled trial, 74 Malawian children with SAM aged 6-60 months, were assigned to either F100, RUTF or RUTF + F75. Our primary endpoint was the presence of low fecal pH (pH ≤ 5.5) measured in stool collected 3 days after the transition phase diets were introduced. Secondary outcomes were duration of hospital stay, diarrhea and other clinical outcomes. Chi-square test, two-way analysis of variance and logistic regression were conducted and, when appropriate, age, sex and initial weight for height Z-scores were included as covariates. RESULTS: The proportion of children with acidic stool (pH ≤5.5) did not significantly differ between groups before discharge with 30, 33 and 23% for F100, RUTF and RUTF + F75, respectively. Mean duration of stay after transitioning was 7.0 days (SD 3.4) with no differences between the three feeding strategies. Diarrhea was present upon admission in 33% of patients and was significantly higher (48%) during the transition phase (p < 0.05). There was no significant difference in mortality (n = 6) between diets during the transition phase nor were there any differences in other secondary outcomes. CONCLUSIONS: This pilot trial does not demonstrate that a particular transition phase diet is significantly better or worse since biochemical and clinical outcomes in children with SAM did not differ. However, larger and more tightly controlled efficacy studies are needed to confirm these findings. TRIAL REGISTRATION: ISRCTN13916953 Registered: 14 January 2013.