likely to discuss fertility, but later had discussions in the Late Effects service. Conclusions Oncofertility options are important to convey to AYAs. Communication about fertility should occur repeatedly both before, during and after treatment. Referral to specialist oncofertility services and adequate information for both genders is important pre-treatment, and can be facilitated posttreatment by a Late Effects service.
IntroductionDespite increasing prevalence, European family homelessness remains under-researched.MethodsA retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December 2020. Comparison was made with a random cohort of 1500 non-homeless paediatric attendances in 2019. Homelessness was defined using the European Typology of Homelessness and Housing Exclusion, including those with addresses of no fixed abode, government homeless accommodation and certain residential settings. The objectives were to compare presentations between homeless and non-homeless children. We were interested in determining differences regarding demographics, healthcare utilisation, clinical presentation and outcomes.ResultsOf 197 437 attendances 3138 (1.59%) were homeless. Compared with the non homeless, homeless children were less likely to be ethnically Irish (37.4% vs 74.6%, p<0.001) or have been born in Ireland (82.3% vs 96.2%, p<0.001). Irish Travellers (3% vs 0.8%), Roma (22.5% vs 2.4%) and black (21.1% vs 4.2%) ethnicities were over-represented (p<0.001) in the homeless cohort.Homeless children were younger (age <12 months: 26% vs 16%; p<0.001), less likely to be fully vaccinated (73.6% vs 81.9%, p<0.001) and have registered general practitioners (89.7% vs 95.8%, p<0.001). They were more likely to represent within 2 weeks (15.9% vs 10.5%, p<0.001), and use ambulance transportation (13.2% vs 6.7%, p<0.001). Homeless children had lower acuity presentations (triage category 4–5: 47.2% vs 40.7%, p<0.001) and fewer admissions (5.9% vs 8.4%, p<0.001) than non-homeless children.DiscussionInfants, Irish Travellers, Roma and black ethnicities were over-represented in homeless presentations. Homeless children had increased reliance on emergency services for primary healthcare needs.
were excluded. Of the remaining 552 electrocardiograms, 30 were identified by the emergency clinicians as abnormal and sent for cardiology review. 13/30 of these were considered normal by the consultant cardiologist and the patients discharged. The other 17 patients were allocated to cardiology outpatient clinic. Only 3/17 required ongoing follow-up. Of the 522 electrocardiograms deemed normal by the emergency department clinicians, cardiology disagreed in 8 (1.4%). In these cases, there was either incorrect lead placement or the checklist had been applied incorrectly. All 8 patients were seen in cardiology outpatient clinic but subsequently discharged. Use of the checklist demonstrated an excellent negative predictive value of 98.47% [CI 97.32% to 99.13%]. Following implementation, time from emergency department attendance to outpatient clinic decreased from a median of 89 to 45 days (P<0.001) and survey respondents reported increased confidence in interpreting paediatric electrocardiograms. Conclusions The use of a simple checklist and guideline allows confident and accurate detection of electrocardiogram abnormality by emergency department staff and speeds referral to cardiology clinic for patients with electrocardiogram abnormalities.
The only culture of Salmonella veneziana studied was received from Captain J. H. Hill, M.C., 2nd Medical Laboratory. It was isolated from an apparently normal Italian civilian food handler in Venice. The microorganism agreed with the biochemical and tinctorial properties of the Salmonella. Acid and gas were produced from arabinose, galactose, glucose, maltose, mannitol, rhamnose, and xylose. Dulcitol, inositol, lactose, salicin, and sucrose were not fermented. Sodium citrate and dextro-tartrate were utilized. Gelatin was not liquefied. The bacterium produced hydrogen sulfide but did not form indole.On serological examination the 0 antigens were found to be identical with those of Salmonella aberdeen. S. veneziana removed all 0 agglutinins from S. aberdeen antiserum. Its 0 antigens are, therefore, XI.Formalized broth cultures of the microorganism were examined and a-/3 phase variation was detected. Phase 1 was flocculated to titer by serum derived from Salmonella bonariensis, phase 1. In agglutinin absorption tests phase 1 of S. veneziana reduced the titer of S. bonariensis, phase 1, antiserum to less than 200. The antigen of phase 1 of S. veneziana is i.Phase 2 of the bacterium was agglutinated to titer byserums containing agglutinins for antigens e ,n .... It was also agglutinated by e, h antiserum. When tested with absorbed serums possessing factors for h, n .. ., x, Z15, Z16, Z17, and zig, respectively, it was flocculated by n . . ., x, and Z16. Absorption of Salmonella abortus-equi, phase 2, antiserum by S. veneziana, phase 2, left agglutinins for the homologous strain as well as for the second phase of Salmonella glostrup. Absorption of Salmonella napoli, phase 2, antiserum by S. veneziana, phase 2, removed all the agglutinins for the homologous strain. Like S. napoli (Bruner and Edwards: Proc. Soc. Exptl. Biol. Med., 58, 289) the 3 phase of S. veneziana appears to be deficient in its antigenic components and may be expressed as e, n, x, Z16. -. S. veneziana is described and assigned the diagnostic formula of XI: i-e, n, x.... This is the third new type recognized among cultures recently isolated in Italy. The others were S. napoli and Salmonella italiana.
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