ABSTRACT
This study was undertaken to evaluate uncertainty from the Basic Specialist Trainee perspective. The survey of trainees explored 1) factors in decision making, 2) the personal impact of uncertainty, 3) the responses to both clinical errors and challenges to their decision making and 4) the potential strategies to address uncertainty. Forty-one (93%) of trainees surveyed responded. Important factors in decision making were clinical knowledge and senior colleague's opinion. Sixty percent experienced significant anxiety post call as a consequence of their uncertainty. When errors are made by colleagues, the trainee's response is acceptance (52.5%), and sympathy (32%).Trainees are strongly influenced by the opinions of senior colleagues often changing their opinions having made confident decisions. Solutions to address uncertainty include enhanced knowledge translation, and to a lesser extent, enhanced personal awareness and resilience awareness. To enhance the training experience for BST and lessen the uncertainty experienced these strategies need to be enacted within the training milieu.
Subject(s)
Anxiety/etiology , Clinical Decision-Making , Medical Errors/psychology , Pediatrics/economics , Uncertainty , Awareness , Child , Clinical Competence , Health Care Surveys , Humans , Pediatricians/psychology , Resilience, Psychological , SpecializationABSTRACT
Recent recommendations for the management of an asymptomatic term infant with one septic risk factor for Group B Streptococcal (GBS) invasive disease have advised a clinical approach. Following a previous audit in our unit which showed that high numbers of asymptomatic infants were receiving antibiotics, a new protocol was introduced which emphasised the importance of clinical examination. This study assessed the safety and efficacy of this new protocol through chart review of 1855 eligible infants. We found a statistically significant decrease (P < 0.0001) from 444 (19%) to 121 (6.5%) in the total number of term infants who underwent septic evaluations and received antibiotics. 241 asymptomatic infants with one septic risk factor were managed conservatively. No eligible infants had GBS invasive disease during the three month study period. The new protocol is a safe and effective tool for evaluating infants at risk of GBS invasive disease.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious , Sepsis , Streptococcal Infections , Streptococcus agalactiae , Antibiotic Prophylaxis/methods , Asymptomatic Infections , Clinical Audit , Clinical Protocols , Female , Humans , Infant, Newborn , Ireland , Neonatal Screening/methods , Perinatal Care/methods , Pregnancy , Retrospective Studies , Risk Factors , Sepsis/etiology , Sepsis/prevention & control , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcal Infections/physiopathology , Streptococcal Infections/transmission , Streptococcus agalactiae/drug effects , Streptococcus agalactiae/isolation & purificationABSTRACT
Sweet's syndrome is a rare skin condition associated with both drug treatment and a number of different disease processes including haematological malignancies, inflammatory conditions and HIV infection. In this case report, we present a patient with HIV, haemophilia and hepatitis C who presented to our team with significant thrombocytopaenia and Sweet's syndrome. We discuss the difficulties with diagnosis and management in the context of multiple co-morbidities and suggest that both hepatitis C and HIV may have been aetiologically involved by suppressing platelet production and also causing bone marrow-driven neutrophilic disease.
