Learning to TODDLE: inspiring the paediatricians of tomorrow.

With numbers of children and young people waiting for treatment rising to record-high levels in the UK, the need for paediatricians is emphasised. In order to accommodate these demands, it is essential that more medical students are encouraged to pursue paediatric careers. By providing vital career support to aspiring paediatricians at an undergraduate level, recruitment into paediatrics can be amplified. An important way in which medical students gain early exposure to paediatrics is through local paediatric organisations like university societies, who can nurture interest towards the specialty and provide links to exploring and building upon paediatric career development. By empowering student initiatives to create opportunities for students to pursue paediatrics, we can build and support the next generation of paediatricians from the ground up. This was demonstrated by the Edinburgh University Paediatrics Society's free virtual career building series TODDLE: 'The building blOcks to Developing your paeDiatric portfoLio and carEer'. Feedback from the TODDLE series evidently showed an appetite for paediatric career support at an undergraduate level internationally, with attendees commenting on the usefulness, novelty and accessibility of the series. TODDLE emphasised the importance of providing paediatric career advice to medical students and showed the feasibility and practicality of student-led initiatives in providing this support as well as other paediatric exposures. Through collaborative work and the sharing of resources, any organisation at a student level can offer opportunities for engagement in paediatrics on a national and international basis.

Learning from Excellence: the 'Yaytix' programme.

BACKGROUND AND AIMS: Learning from error can have a negative impact on the staff involved in the error ('second victim phenomenon'1). We created a project, based on the principles of the Learning from Excellence project,2 to learn from excellence and correct the imbalance of negative to positive feedback in the context of hospital practice. METHODS AND RESULTS: Using a questionnaire, we surveyed staff on existing feedback mechanisms and morale. We then introduced a system where staff recorded and commented on examples of excellence in practice. Recipients and their supervisors received copies of these reports and the feedback was analysed and discussed with senior staff (consultant, senior charge nurse, managers). We re-audited the staff two months after starting this project and noted improvements in staff morale and in positive reporting. CONCLUSIONS: This project has improved the process of giving and learning from positive feedback and had a significant impact on staff morale. We can also demonstrate an example of improved clinical practice (from feedback received) and will now attempt to measure clinical outcomes with a new prospective study. Finally, we hope to set up a regional programme of reporting excellence in South-East Scotland.

"Compression Necrosis" - A Cause of Concern for Early Implant Failure? Case Report and Review of Literature.

Purpose: Compression necrosis refers to bone tissue damage that can occur when excessive pressure or force is applied to surrounding bone during implant placement. This pressure can compromise blood supply to the bone, leading to necrosis. Compression necrosis is a concern, because it can affect the stability and long-term success of dental implant. Patients and Methods: This case report highlights a case of early bone loss and implant failure possibly due to compression necrosis. Clinical data, photographs, radiographs, blood examination report and histology were presented to document the early failure of an implant placed in the mandibular left posterior region of a 33-year-old female patient. Results: Radiograph taken six weeks after implant placement showed severe angular defect. Therefore, the implant was surgically removed. Histological examination of the area showed bony trabeculae with an absence of osteoblastic riming, suggestive of necrotic bone. Conclusion: Using excessive torque values when placing implants in dense bones can increase the risk of implant failure due to bone over compression. Dental professionals must follow the manufacturer's instructions and employ quality surgical techniques during implant placement into dense cortical bone to minimise risks.

Implementation of a Novel Seizure Assessment Tool for Unified Seizure Evaluation Improves Nurse Response.

ABSTRACT: BACKGROUND: Ictal and postictal testing is an essential aspect of clinical care when diagnosing and treating seizures. The epilepsy monitoring unit (EMU) has standard operating procedures for nursing care during and after seizure events, but there is limited interrater reliability. Streamlining ictal and postictal testing processes may enhance care consistency for patients in the EMU unit. The purpose of this study was to create an ictal and postictal seizure assessment tool that would increase the consistency of nursing assessment for EMU patients. METHODS: This prospective study had 4 phases: baseline assessment, instrument development, staff education, and field testing. During baseline assessment, an advanced practice provider and an epilepsy fellow graded nurse ictal and postictal assessment via survey questions. After instrument development, education, and implementation, the same survey was administered to determine if nursing consistency in assessing seizure events improved. The tool used in this study was created by a team of clinical experts to ensure consistency in the assessment of seizure patients. RESULTS: A total of 58 first seizure events were collected over a 6-month intervention period; 27 in the pretest and 31 in the posttest. Paired t test analyses revealed significant improvement in the clinical testing domains of verbal language function (P < .005), motor function (P < .0005), and item assessment order (P < .005) postintervention. There was nonsignificant improvement in the domains of responsiveness (feeling [P = .597], using a code word [P = .093]) and visual language function (P = .602). CONCLUSION: The data captured in this study support the need for this instrument. There is strong need to increase consistency in assessing seizure events and to promote continued collaboration among clinical teams to enhance care to EMU patients. Validation of this instrument will further improve team collaboration by allowing nurses to contribute to their fullest extent.

Exploring Plan of Care Communication With a Multidisciplinary Rounding Plan to Nursing Care Plans.

ABSTRACT: BACKGROUND: The nursing care plan (NCP) was developed approximately 100 years ago as a teaching tool for nursing students. Our neuroscience intensive care unit (NSICU) uses a multidisciplinary rounding plan (MDRP) that may provide more relevant and up-to-date information than the standard NCP. METHODS: In this prospective single-blind randomized pilot study, we examined nurses' abilities to respond to 7 clinical scenarios common to the NSICU. The NCPs and MDRPs from 70 patients were randomly assigned to 14 nurses (10 per nurse) who answered each of the 7 questions using only data from an NCP or data from an MDR. RESULTS: The MDRP mean score of 4.51 (1.50) correct answers was statistically significantly higher than the NCP mean score of 0.31 (0.71) correct answer (P < .0001). CONCLUSION: The MDRP was designed to address the modern-day communication needs of NSICU staff by leveraging technological advances. Data from this study suggest that the MDRP may have advantages over the NCP in providing contextually relevant information. Additional research is warranted to develop the MDRP as a replacement for the NCP in the NSICU setting.

Length of Stay Does Not Predict Change in Epilepsy Monitoring Unit Comfort Questionnaire Scores.

ABSTRACT: BACKGROUND: The epilepsy monitoring unit (EMU) is a clinical setting designed to help diagnose and analyze the nature behind a patient's seizures in a hospitalized unit. Patients admitted to an EMU may experience sleep deprivation, withdrawal of antiepileptic medications, and the use of a continuous electroencephalogram. The purpose of this study was to explore change in patient comfort during an EMU admission. METHODS: The Epilepsy Monitoring Unit Comfort Questionnaire (EMUCQ) was used to evaluate the initial stress level of EMU patients on their date of admission versus their fourth day on the unit. RESULTS: The average EMUCQ score from the admission date was 196.6 (26.28), whereas the mean EMUCQ score on the fourth day was 197.8 (24.79). The P value of .802 and t value of 0.25 indicated that the scores were not statistically significantly different. CONCLUSION: Although some scores indicated there was a large change between baseline and follow-up, these scores could not be readily attributed to the patient's length of stay in the unit. Future studies should examine the role of specific variables hypothesized to impact comfort in the EMU.

Delivery of the UN Convention on the Rights of the Child in an acute paediatric setting: an audit of information available and service gap analysis.

BACKGROUND: The United Nations Convention on Children's Rights stresses the importance of providing children with information relating to their health and well-being, yet reports suggest children are offered insufficient support in healthcare environments. We audited the information provided to children and families requiring planned surgical admission in comparison to those admitted acutely to medical paediatrics. Additionally, we identified examples of child-specific information resources in national and international hospitals. METHODS: Three approaches were taken to gain insight into practice locally, nationally and internationally.(1) Information resources provided to paediatric inpatients admitted to the acute receiving unit were audited in comparison to information given to children with planned admissions via process observations.(2) Qualitative feedback was gained from play specialists (n=2), families (n=30) and children (n=9; aged 3-15 years) via interviews.(3) A review, including UK, Australian and US hospitals, was conducted to assess child-specific information resources (n=36 hospitals) and to systematically compare the information available on websites (n=9 hospitals). RESULTS: At the study site, no child-specific information resources were available for acute admissions, whereas planned admissions were offered significant information face-to-face with supplemental resources. Child, parent and play specialist interviews highlighted gaps in information provision regarding hospital practicalities and processes. Twelve external child-specific resources were identified, for 4-14 year olds, explaining key care information: medical procedures, equipment and staff. These resources could positively respond to the topics cited as lacking by the interviewed patients and families at the study site. International hospital websites provided considerably more in-depth information compared with UK hospitals. CONCLUSIONS: The hospital experience of children and families can be improved by ensuring they are provided with adequate information relating to their hospital stay. It is essential that suitable high-quality resources are consistently available and that feedback from children informs the process of resource development.

Neonatal adrenal findings: significance and diagnostic approach. Description of two cases.

Abnormal adrenal findings such as hemorrhage or calcifications in the neonate can stem from a variety of etiologies. Clinical presentation can vary significantly based on the degree of hemorrhage or the associated condition. Thorough work-up is important to rule out critical underlying conditions as well as adrenal insufficiency.

Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases.

Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care.

Limbic encephalitis associated with elevated antithyroid antibodies.

Immune-mediated limbic encephalitis affects both adults and children. Patients typically present with seizures, memory problems, and imaging changes in the medial temporal lobes. Both paraneoplastic and nonparaneoplastic forms have been described in which the antibody to the voltage-gated potassium channel-complex associated protein, leucine-rich glioma-inactivated 1, is most commonly reported. Elevated antithyroid antibodies have also been reported in a range of neurological syndromes with encephalopathy, such as limbic encephalitis, often collectively termed Hashimoto encephalopathy, a condition whereby corticosteroids responsiveness with a complete recovery is commonly observed. Here we describe 3 children presenting with limbic encephalitis with elevated thyroid antibodies that did not respond to corticosteroids alone and required more aggressive immunotherapy, mirroring the slower treatment response that is more frequently seen in other immune-mediated forms of limbic encephalitis.

Induction of apoptosis by cannabinoids in prostate and colon cancer cells is phosphatase dependent.

AIM: We hypothesized that the anticancer activity of cannabinoids was linked to induction of phosphatases. MATERIALS AND METHODS: The effects of cannabidiol (CBD) and the synthetic cannabinoid WIN-55,212 (WIN) on LNCaP (prostate) and SW480 (colon) cancer cell proliferation were determined by cell counting; apoptosis was determined by cleavage of poly(ADP)ribose polymerase (PARP) and caspase-3 (Western blots); and phosphatase mRNAs were determined by real-time PCR. The role of phosphatases and cannabinoid receptors in mediating CBD- and WIN-induced apoptosis was determined by inhibition and receptor knockdown. RESULTS: CBD and WIN inhibited LNCaP and SW480 cell growth and induced mRNA expression of several phosphatases, and the phosphatase inhibitor sodium orthovanadate significantly inhibited cannabinoid-induced PARP cleavage in both cell lines, whereas only CBD-induced apoptosis was CB1 and CB2 receptor-dependent. CONCLUSION: Cannabinoid receptor agonists induce phosphatases and phosphatase-dependent apoptosis in cancer cell lines; however, the role of the CB receptor in mediating this response is ligand-dependent.

Ecology driving genetic variation: a comparative phylogeography of jungle cat (Felis chaus) and leopard cat (Prionailurus bengalensis) in India.

BACKGROUND: Comparative phylogeography links historical population processes to current/ecological processes through congruent/incongruent patterns of genetic variation among species/lineages. Despite high biodiversity, India lacks a phylogeographic paradigm due to limited comparative studies. We compared the phylogenetic patterns of Indian populations of jungle cat (Felis chaus) and leopard cat (Prionailurus bengalensis). Given similarities in their distribution within India, evolutionary histories, body size and habits, congruent patterns of genetic variation were expected. METHODOLOGY/PRINCIPAL FINDINGS: We collected scats from various biogeographic zones in India and analyzed mtDNA from 55 jungle cats (460 bp NADH5, 141 bp cytochrome b) and 40 leopard cats (362 bp NADH5, 202 bp cytochrome b). Jungle cats revealed high genetic variation, relatively low population structure and demographic expansion around the mid-Pleistocene. In contrast, leopard cats revealed lower genetic variation and high population structure with a F(ST) of 0.86 between North and South Indian populations. Niche-model analyses using two approaches (BIOCLIM and MaxEnt) support absence of leopard cats from Central India, indicating a climate associated barrier. We hypothesize that high summer temperatures limit leopard cat distribution and that a rise in temperature in the peninsular region of India during the LGM caused the split in leopard cat population in India. CONCLUSIONS/SIGNIFICANCE: Our results indicate that ecological variables describing a species range can predict genetic patterns. Our study has also resolved the confusion over the distribution of the leopard cat in India. The reciprocally monophyletic island population in the South mandates conservation attention.