Increasing person-centred care in paediatrics.

BACKGROUND: Paediatric patients (PPs) often feel that they are not involved in care and treatment decisions. Although training clinicians may help, there is a lack of evaluated training programmes specifically for work with PPs. The aim of this article is to evaluate 'Me first', a training programme aimed at improving clinicians' attitudes and communication skills when working with PPs. METHODS: A total of 69 clinicians attended 'Me first' training and completed questionnaires across three time points: (1) prior to attending the training; (2) at the end of the training; and (3) 4-6 weeks later. This included 14 medical staff, 29 nursing staff and 26 allied health staff. Attitude was measured using the Leeds Attitudes to Concordance II (LATCon II) scale, and communication skills were measured using the Effective Listening and Interactive Communication Scale (ELICS). RESULTS: Overall, clinicians reported that their attitude and communication skills improved after attending 'Me first'. This was maintained 4-6 weeks later. Subgroup analysis showed that allied health staff did not maintain the improved attitude at the follow-up conducted 4-6 weeks later. Subgroup analysis showed that allied health staff did not maintain the improved attitude at the follow-up conducted 4-6 weeks later CONCLUSIONS: Findings suggest that 'Me first' may be helpful in improving clinician attitudes and communication skills with PPs. Further research should examine whether PPs report higher levels of communication and decision making with clinicians who have attended training.

The Me first communication model.

This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.

Diminished production of anti-inflammatory mediators during neutrophil apoptosis and macrophage phagocytosis in chronic granulomatous disease (CGD).

Genetic defects in the phagocyte nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase enzyme system result in chronic granulomatous disease (CGD). In addition to recurrent, life-threatening infections, patients with CGD frequently present with sterile inflammatory complications, suggesting that NADPH-oxidase deficiency predisposes to these responses in the absence of persistent microbial infection. The mechanisms involved in the aberrant, inflammatory process are unknown. In this study, we have shown that neutrophils isolated from CGD patients, which are more resistant to spontaneous apoptosis in vitro, also produce significantly less of the anti-inflammatory mediator cyclopentenone prostaglandin D(2) (PGD(2)). In addition, during phagocytosis of opsonized and nonopsonized apoptotic targets, CGD macrophages are severely compromised in their ability to produce PGD(2) and transforming growth factor-beta (TGF-beta). We suggest that delayed apoptosis of inflammatory cells, such as neutrophils and deficient production of the anti-inflammatory mediators PGD(2) and TGF-beta during macrophage clearance of apoptotic debris and invading pathogens, contributes to persistence of inflammation in CGD.