Background This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 – 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome. Results Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge. Conclusion This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.
Introduction British Paediatric Surveillance Unit (BPSU) promotes study of rare diseases and infections by orange card reporting system and subsequent questionnaire based surveillance. We conducted a study of surgically ligated PDA in preterm babies between September 2012 and September 2013. The questionnaire had 10 parts with a total of 43 questions to answer. 18 of these were generic questions and could have been answered by non-medical staff. The questionnaire was designed after balancing the number of questions against the completeness of the data required. The aim of this abstract is to outline some of the difficulties of such questionnaire based national surveys and possible solutions. Results 531 cases were reported and questionnaires posted to the relevant Consultants. 10% of these questionnaires were not returned and similar percentages were reported in error (see Figure 1). Abstract G134(P) Figure 1 Multiple reporting occured in 96 cases – 83 of them were duplicates, 12 were triplicates and 1 case was reported by 4 different clinicians. Incomplete data was provided in 96 cases. This was less with multiple reporting ones 11/96 (11.4%) compared to 82/199 (41%) cases which were reported once. Multiple reporting thus helped us to obtain more information about the case. But this also resulted in some discrepancies in the reporting of 12 (12.5%) cases. Conclusions In our experience, we felt that email correspondence was quicker and had a better response rate compared to paper correspondence. Division of the questionnaire into medical and non-medical parts could enable the clinician to concentrate on the relevant medical information and leaving the non-medical information to be filled in by administrative staff. The longer the time that lapsed between the case being reported to the BPSU and the questionnaire being completed by the Consultant, the more incomplete was the reported data. Improvements in data ascertainment might be possible in a neonatal project if the research team were able to access national databases such as BADGER system for named patients to improve the accuracy and quality of data. This type of surveillance has great epidemiological and clinical impact. Identifying key issues and addressing them early can ensure high quality data is collected and disseminated.
AimsComplex multitasking, multiple pressures, and frequent demands on a new consultant are daunting. We designed a course to give candidates extension beyond their clinical knowledge. We describe the inspiration, delivery, and feedback from our novel all day Consultant role simulation course aimed at ST8 paediatric traineesMethodsA full day simulation course devised for final year paediatric trainees, to support transition to Consultant working. Simulation components included:Leading a neonatal resuscitationDealing with complex ward situationsPreparing a written media statementA media interviewEmergency department resuscitationSpeaking to parents about a complaintOffice time with inbox problemsSpeaking to the Coroner and tertiary expertsAnalysing a service improvement problemA handover to the evening consultantDelivering a short presentationThe simulation events were run continuously and in parallel, demanding real time prioritisation, time management, leadership and managerial skills. Candidates were also expected to demonstrate their ability to prioritise their ‘inbox’ tasks and prepare a presentation. The day was delivered by senior trainers, simulation experts and professional actors in a bespoke simulation centre.Results and feedbackFeedback was very positive after a long, intensive day. On a 1–5 scale candidate scores were:Abstract G88(P) Table 1Candidate feedbackThe overall content was useful to me4.7The course is novel and important to senior trainees4.9I have learned a lot about how to behave as a senior healthcare professional4.2I will recommend this course4.9PrePostI feel confident to act as a first year consultant3.23.7I’m terrified of making a mistake3.62.9I’m pleased to be here today4.24.6Highest rated session was the media session scoring 4.8. Mean score for all sessions was 4.5, with no session scoring below 4.2.ConclusionOur feedback shows there is a need and desire for a course which exposes trainees to some of the aspects of being a consultant which are not otherwise addressed. The use of professional actors improved the fidelity of the course and the reliability of the simulations. We believe this course is an important addition to training.
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