Paediatric asthma education: Implementation of video-based education for families.

AIM: To understand the impact of an asthma education video resource introduced to the short stay unit (SSU) of a tertiary paediatric hospital on: (i) parental understanding of and confidence in managing their child's asthma; (ii) the impact of this resource on nurse-led education practices; and (iii) readmission rates. METHODS: A mixed methods study was conducted in the SSU over an 18-month period using quantitative survey data from parents and nursing staff and qualitative data from nursing staff focus groups. RESULTS: Of 117 parents surveyed, 94% reported an increase in their understanding of asthma. Following the introduction of the resource, there were fewer nurse-led education sessions delivered (1.91 vs. 1.54, P = 0.04) and a trend towards reduction in time spent delivering this education (27.24 vs. 24.98 min, P = 0.47). Nursing staff confidence in the family's understanding of asthma education was similar pre- and post-implementation (4.22 vs. 4.30, P = 0.97). Readmission rates dropped by 25% (readmissions within 1 month) and by 33.3% (readmission within a week) in the post-intervention cohort. CONCLUSIONS: Our asthma education video resource was demonstrated to be an acceptable and effective way of delivering asthma education to families. It created efficiency and consistency for nursing education and practice in our SSU. This resource was viewed by nursing staff as a useful adjunct to their education, enabling consistent messaging and helping structure education delivery. It has been incorporated into hospital systems and national resources which we hope will translate to a reduction in burden of asthma across the community.

Toxicity of first-line drugs for treatment of tuberculosis in children: review.

OBJECTIVE: To determine the frequency and manifestations of adverse events associated with recommended first-line anti-TB drugs in children. METHOD: Literature review. RESULTS: Overall, children tolerate anti-TB drugs very well when using currently recommended dosages. Serious adverse events are rare and even mild symptoms such as nausea or vomiting are uncommon. There are occasional case reports of severe hepatotoxicity. CONCLUSIONS: Surveillance and reporting of adverse events will need to be improved when recommended dosages of the main first-line anti-TB therapy for children are increased. Co-morbidities such as HIV infection and severe malnutrition may affect the incidence and complicate the management of possible adverse events to anti-TB therapy.

Simulated parents: developing paediatric trainees' skills in giving bad news.

AIM: In curriculum documents for medicine in undergraduate, post-graduate and continuing professional development, there is now a focus on communication skills. The challenges are to place communication skills in the crowded curriculum and then to construct and sustain a programme that uses an evidence-based approach to the teaching and learning of communication skills. For 6 years, we have conducted a programme that involves simulated parents supporting junior medical staff to refine their skills in communication, particularly in giving parents bad news. The aim of our study was to obtain a better understanding of the trainees' experiences of the programme. METHODS: Nine junior residents individually worked through two scenarios and received feedback from the simulated parent. They gave bad news to a simulated parent/actor who then gave feedback. A recording of the simulation was provided for discussion with a designated colleague at an arranged time. The tapes were then separately appraised by two independent raters - another actor and a paediatrician. Brief written reports and conducted semi-structured interviews provided more insights into the trainees' experience of the simulation. Other participating medical/medical education staff were interviewed about the simulation programme. RESULTS: Five themes emerged from the qualitative data: timeliness, emotional safety, the complexity of communication, practical usefulness and the challenge of effecting change. In addition, the ratings of the videos helped to clarify those 'parent-centred' communication skills that trainees may neglect in difficult conversations: 'ask about support', 'encourage the parent to ask questions' and 'repeat key messages'. CONCLUSION: The evaluation highlighted the value of an early-career experiential programme to highlight the importance of communication skills in post-graduate paediatrics practice.

High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate.

OBJECTIVES: Vitamin D deficiency (VDD) is common in immigrant children with increased skin pigmentation living in higher latitudes. We assessed the pattern of and risk factors for VDD in immigrant East African children living in Melbourne (latitude 37 degrees 49' South). STUDY DESIGN: A prospective survey of 232 East African children attending a clinic in Melbourne. Data were collected by questionnaire, medical assessment and laboratory tests. RESULTS: Low 25-hydroxyvitamin D (25-OHD) levels (<50 nmol/l) occurred in 87% of children, and VDD (25-OHD <25 nmol/l) in 44%. Risk factors included age <5 years, female gender, increased time in Australia, decreased daylight exposure and winter/spring season. Anaemia (20%), vitamin A deficiency (20%) and iron deficiency (19%) were also identified. CONCLUSIONS: Asymptomatic VDD is common in East African immigrant children residing at a temperate latitude. Risk factors for VDD limit endogenous vitamin D production. Screening of immigrant children with increased skin pigmentation for VDD, anaemia, iron and vitamin A deficiency is appropriate. VDD in adolescent females identifies an increased risk of future infants with VDD.

Pertussis. Presentation, investigation and management.

BACKGROUND: Pertussis (whooping cough) is a highly infectious, preventable disease, which causes significant morbidity and mortality. OBJECTIVE: This article discusses the presentations, investigations and management of cases and their contacts. DISCUSSION: Maternal antibody does not confer protection to the infant so babies are particularly at risk of infection and complications until they have completed the primary course of vaccinations at 2, 4 and 6 months of age. Diagnosis is primarily clinical, but can be confirmed with immunofluorescence on nasopharyngeal aspirate or nasal swab. Recent changes to the Australian Standard Vaccination Schedule include the removal of the 18 month dose of DTPa and the addition of an adult formulation booster vaccination at 15-17 years of age.

Slapped cheek disease. How it affects children and pregnant women.

BACKGROUND: Slapped cheek disease, otherwise known as erythema infectiosum (EI) or 'fifth disease', is a common cause of fever and rash in children. OBJECTIVE: The clinical features in children, and the implications for pregnant contacts will be discussed in this article. DISCUSSION: Erythema infectiosum is usually a mild self limiting illness in children. Patients are unlikely to be infectious after the rash and other symptoms are present, and children do not need to be excluded from school or childcare. Infection in pregnant women under 20 weeks gestation can lead to miscarriage or hydrops, but in 50% of cases the fetus is unaffected. Pregnant women who are IgM positive require appropriate specialist referral and serial ultrasounds.

Hand, foot and mouth disease.

BACKGROUND: Hand, foot and mouth disease is a common viral illness of infants and children. OBJECTIVE: This article aims to describe the cause, presentation, management and infectivity of this virus. DISCUSSION: Hand, foot and mouth disease is characterised by fever and vesicles in the mouth and on distal extremities. It is usually caused by coxsackie A virus and less commonly by coxsackie B and enterovirus 71. Hand, foot and mouth disease usually affects children under 10 years of age. Enteroviruses may also cause more serious disease such as meningoencephalitis and myocarditis. Treatment is symptomatic. Children are particularly infectious until the blisters have disappeared. Exclusion from school or childcare is not practical as the virus may be present in the faeces for several weeks.

Head lice.

BACKGROUND: Head lice infestation is a very common problem in children and causes a high level of anxiety among parents and childcare workers. OBJECTIVE: In this article we attempt to clarify issues of diagnosis and treatment of head lice and offer recommendations for dealing with head lice. DISCUSSION: Head lice are a nuisance, but they do not transmit infectious diseases. Control includes detection with wet comb technique. Treatment is usually with a topical pediculicide, but regular mechanical removal with conditioner and a comb is an alternative. Treatment failure can be the result of inadequate application of the treating product, pediculicide resistance, or failure to re-treat at 7-10 days. Reinfestation (and therefore apparent treatment failure) is common.