Prevention and treatment of meningococcal disease.

Meningococcal disease is a leading cause of death in children and young people. Part 1 of this two-part series discussed its epidemiology, pathophysiology, signs and symptoms (Dowson, 2014). Part 2 reviews the diagnosis, management and prevention of this disease.

Meningococcal disease in children and teenagers.

Meningococcal disease is a leading cause of death in children and young people. It causes two major disease processes, meningococcal septicaemia and meningococcal meningitis, and often results in long-term health complications. It remains a difficult disease to recognise and treat. This article, part one in a two-part series, discusses the epidemiology of meningococcal disease and explains its pathophysiology as well as signs and symptoms. Part 2, to be published on 19 March, will review diagnosis, management and prevention.

How in situ simulation affects paediatric nurses' clinical confidence.

Considering the emphasis on safety in health care, new methods for training qualified nurses are being considered. The use of simulation technologies to provide regular and repeated training for qualified nurses in the management of paediatric emergencies has yet to be investigated. This paper presents the results of a study designed to determine if and how a period of regular simulation training in the management of paediatric emergencies improves qualified nurses' clinical confidence. A mixed methods design was employed using a group of qualified paediatric nurses (n=20) who were matched into two groups. The intervention group (n=10) received three simulation-based training sessions and the control group (n=10) had no training. Each nurse completed a pre- and post-clinical confidence questionnaire and were interviewed. Results demonstrated a statistically significant improvement in confidence following simulation training, which was explained by the provision of insight and preparation for real life. Further research should aim to replicate these findings using larger sample sizes and direct assessments of nurses' clinical performance.

The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity.

AIM: To develop and test the feasibility, reliability, and validity of a practical toolkit for the assessment and feedback of skills required to manage paediatric emergencies in critical care settings. METHODS: The Imperial Paediatric Emergency Training Toolkit (IPETT) was developed based on current evidence-base and expert input. IPETT assesses both technical and non-technical skills. The technical component covers skills in the areas of clinical assessment, airway and breathing, cardiovascular, and drugs. The non-technical component is based on the validated NOTECHS tool and covers communication and interaction, cooperation and team skills, leadership and managerial skills, and decision-making. The reliability (internal consistency), content validity (inter-correlations between different skills) and concurrent validity (correlations between global technical and non-technical scores) of IPETT were prospectively evaluated in 45 simulated paediatric crises carried out in a PICU with anaesthetic and paediatric trainees (N=52). Non-parametric analyses were carried out. Significance was set at P<0.05. RESULTS: Cronbach alpha reliability coefficients were overall acceptable for the technical (alpha range=0.638-0.810) and good for the non-technical (alpha range=0.701-0.899) component of IPETT. The median inter-skill correlation was rho=0.564 and rho=0.549 for the technical and non-technical components, respectively. These indicate good content validity, as the skills were inter-related but not redundant. We also demonstrate a correlation between the global technical and non-technical scores (rho=0.471) - all Ps<0.05 during the assessments. CONCLUSION: IPETT offers a psychometrically viable and feasible to use tool in the context of paediatric emergencies training. This study shows that assessment of technical and non-technical skills in combination may offer a more clinically relevant model for training in paediatric emergencies. Further validation should aim to demonstrate skill retention over time and skill transfer from simulation-based training to real emergencies.