Changes in paediatric resuscitation knowledge among doctors.

AIMS: To investigate whether paediatricians have improved their resuscitation knowledge since 1992, and whether those who have attended a paediatric resuscitation course have greater knowledge than those who have not. METHODS: Telephone survey of 94 resident paediatricians admitting emergency cases. Questions on clinical scenarios were asked and adherence to internationally agreed guidelines in answering was determined. RESULTS: There were significantly more correct answers to 9/10 questions in 1999 compared to 1992. The 1999 doctors who had attended a course scored significantly better in 3/10 questions and achieved a higher total score (5.43 versus 4.55). CONCLUSIONS: Knowledge has improved since 1992; this has been over the period in which paediatric resuscitation courses were introduced. In 1999 those who had been on a course were more knowledgeable than those who had not.

Paediatricians' knowledge of cardiac arrest guidelines.

A telephone questionnaire was undertaken on middle grade trainee paediatricians to test their knowledge of European Resuscitation Council guidelines. Fifty seven responded of whom only 15 (26%) offered a correct sequence of management for asystole and eight (14%) failed to identify adrenaline in their management. For ventricular fibrillation only 18/57 (32%) identified a correct sequence and very poor specific knowledge was identified. Paediatricians will under perform in the event of cardiac arrest in children without improved training in resuscitation.

Twenty-four cases of the EEC syndrome: clinical presentation and management.

Twenty-four cases of EEC syndrome were identified as part of a nationwide study. Ectodermal dysplasia, by study definition, was present in all cases and hair and teeth were universally affected. Nail dysplasia was present in 19 subjects (79%) and the skin was affected in 21 (87%). The presence of hypohidrosis was not noted as a predominant feature in the syndrome and its occurrence appeared to depend on the presence of all other features. Distal limb defects from simple syndactyly to tetramelic cleft hand and foot were identified, including preaxial anomalies. Orofacial clefting was identified in 14 cases (58%) and lacrimal duct anomaly in 21 (87%). Significant clinical problems encountered were chiefly cosmetic or ophthalmological, but conductive deafness and genitourinary problems in some cases required surgical intervention. Altered self-image was also noted in some cases. Multidisciplinary management is necessary with the early involvement of the clinical geneticist. Developmentally, the EEC syndrome and related disorders represent disorders of ectodermal/mesodermal interaction. Candidate regions include 7q21.3, the "ectrodactyly" locus; other candidates include developmental genes implicated in the ectodermal/mesodermal interactive process.

Cleft hand/foot: clinical and developmental aspects.

Isolated limb reduction defects occur in approximately 1 in 2000 live births within which central ray anomalies are an important subgroup. Most affected persons have mild or moderate functional impairment. Considerable psychological morbidity may also occur. While there have been major strides forwards in our understanding of vertebrate limb development, the mechanisms responsible for central ray deformities remain poorly understood. Several case reports of central clefting anomalies associated with chromosomal rearrangements or interstitial deletions of 7q21.2-q21.3 suggest that this chromosomal region is important for limb development.

A career in paediatrics? A survey of paediatric senior house officers in England and Wales.

A telephone questionnaire was targeted at 189 paediatric senior house officers (SHOs) throughout England and Wales in order to evaluate their attitudes towards paediatrics and gain insight into methods by which recruitment could be improved in future years. A total of 152 senior house officers were interviewed. The group consisted mainly of general practice trainees, but included 51 career paediatricians. The majority were female (57%) and 44% were married. Our assessment revealed a perceived high work-load, but also showed that paediatrics remains a satisfying specialty. Training while in post was perceived as unsatisfactory by 32% of those questioned. Sixty per cent reported a decline in their social life since starting their post. Paediatrics was seen as the busiest of a number of specialties. This perception persisted, and in fact increased, between SHO and consultant grade. It is foreseen that this may lead to further problems in recruitment.

A survey of basic resuscitation knowledge among resident paediatricians.

A telephone questionnaire was undertaken to evaluate the knowledge of resident paediatricians on the subject of the basic resuscitation of the acutely sick child. The questionnaire was targeted at 88 resident paediatricians in hospitals accepting paediatric emergencies in four health regions. Outcome was measured as a correct response to questions based on several emergency scenarios and on the confidence expressed of basic resuscitation knowledge. The subject of emergency management of the child with a compromised upper airway was poorly answered with 40/73 (55%) resident paediatricians suggesting an incorrect endotracheal tube size for an 8 year old child. Fluid management was also deemed unsatisfactory with only 36/73 (49%) providing adequate transfusion secondary to haemorrhagic shock. In addition only 19/73 (26%) mentioned the intraosseous route as a means of obtaining vascular access in a child in extremis. Confidence of the knowledge of basic resuscitation of children was low among resident paediatricians with only 30/73 (41%) expressing confidence and 69/73 (94%) expressing a desire for more formal training in paediatric resuscitation. Resident paediatricians are usually the key personnel in the management of very sick children. This survey demonstrates a low level of basic resuscitation knowledge among resident paediatricians of all grades that must be remedied at a local and national level.

Familial pancreatic enzyme insufficiency.

A father and son with profound reduction of exocrine pancreatic activity and little visible pancreatic tissue on ultrasound or computed tomography are described. Both have some degree of liver disease, which is more marked in the son. The disorder, apparently familial, does not correspond to any reported previously.

Attitudes of paediatricians to HIV and hepatitis B virus infection.

There is a recent upsurge of interest among health care professionals regarding the risk of accidental occupational exposure to HIV virus. We evaluated knowledge of virus carriage prevalence, needlestick injuries, venepuncture practices, and glove use among paediatricians in Wales and South West Regional Health Authorities. We also attempted to evaluate hepatitis B immunisation uptake in this group. Paediatricians have traditionally been considered a low risk group in the context of accidental occupational exposure to these viruses. We targeted a four point questionnaire at 221 paediatricians. Results suggested that despite recent increasing concern about these viruses, that is reflected in the amount of medical literature recently published, and the issuing of Department of Health guidelines on venepuncture, knowledge of prevalence of HIV and hepatitis B carriage rates, and hence assessment of risk magnitude, was surprisingly poor. Safe venepuncture practices were not widely used. In the 12 months before receiving the questionnaire 55% had suffered a needlestick injury with only 10% reporting the fact. Hepatitis B immunisation uptake was highest in the junior grades (but this does not necessarily mean those at greatest risk). There were many inconsistencies between the clinicians' perceptions of risk and their practices. As the virus attains a firm hold in the heterosexual population paediatricians by virtue of the nature of venepuncture in children will almost certainly see their risk of acquiring HIV/hepatis B viruses secondary to accidental occupational exposure increase over the next decade. Without an improvement in current knowledge of carriage prevalence in high risk areas and alteration in venepuncture practices/hepatitis B immunisation uptake some will unfortunately, though avoidably, contract these bloodborne viral infections.