The objective was to investigate the prevalence of Pseudomonas aeruginosa (PA) in patients with complex neurodisability and current treatment practice in our centre in order to inform future guidelines. A retrospective case note review was undertaken at a tertiary children’s hospital. One hundred sixty-two patients (mean age 11.7 years) with a primary diagnosis of neuromuscular disease (NMD) or severe cerebral palsy (CP) and a respiratory sample sent for analysis during the study period were studied. Associations between PA in respiratory samples and diagnosis, long-term ventilation, presence of a gastrostomy or a tracheostomy, antibiotic choice, clinical deterioration and adverse events were analysed. Twenty-five (15%) had one or more PA isolate in respiratory samples. There was a significant association between PA in respiratory samples and tracheostomy (p<0.05). In 52% samples, multiple pathogens co-existed. There was no significant association between choice of antibiotic and clinical outcome but when antibiotics were changed to specific PA antibiotics during the course of the illness, all resulted in clinical improvement. Twenty-six episodes involving 8 patients with recurrent admissions involved PA organisms that were resistant to one or more antibiotics.Conclusions: A larger prospective study may establish clearer criteria for guideline development. Techniques such as point-of-care testing to identify virulent strains of PA may improve patient outcomes and prevent the development of antibiotic resistance in the future. What is Known:•Children with complex neurodisability are at increased risk of respiratory morbidity and of infection with gram-negative organisms such as Pseudomonas aeruginosa.•There are currently no guidelines to inform treatment choices in this group of vulnerable children. What is New:•15% children in this study population had Pseudomonas aeruginosa in respiratory samples during a 12-month period, the majority of whom did not require critical care treatment. Thirteen of these children had a tracheostomy in situ and 12 did not. •In those that deteriorated clinically or developed antibiotic resistant organisms, earlier detection and targeted treatment of Pseudomonas aeruginosa may have prevented deterioration.
BackgroundA lack of vitamin D can lead to skeletal deformities and disturbances in growth.1 The Scientific Advisory Committee on Nutrition (SACN) published a report in July 2016 making new recommendations for vitamin D supplementation. Subsequently, our local guidelines were updated on the supplementation of vitamin D in the paediatric population, pregnant women, and breastfeeding mothers.AimIt is currently unknown whether these guidelines are being adhered to and as such, this audit was designed to assess the vitamin D supplementation status of these populations.ObjectivesEstablish current level of understanding around the routine use of vitamin supplements; Consider what advice is currently provided and who provides this advice; Determine the current use of vitamin D supplementation in children as well as the levels of vitamin D supplementation in breastfeeding mothers and pregnant women; Assess whether these groups are consuming appropriate quantities of vitamin D supplementation and identify reasons why they may not be.MethodsData collection was undertaken by pharmacists across two hospitals. Standards were based on the new guidelines published by SACN and local guidelines and were agreed by the clinical lead paediatric pharmacist. Data capture tools were designed in alignment with the standards and piloted. Modifications were made, exclusion criteria established and a total of 164 forms were distributed. All data collected was inputted to a database and analysed accordingly. Ethical approval was not required.ResultsOf the 164 questionnaires distributed, 93 were returned (57% response rate). Less than 30% of the parents surveyed stated they had received advice on childhood vitamin supplementation (n=16 of total n=54) and only 24.5% of children (n=25 of total n=102) were receiving a form of vitamin supplementation. A significantly higher percentage of pregnant/breastfeeding mothers 77% (n=30 of total n=39) stated they had received advice regarding vitamin supplementation. In these cases, midwives and health visitors most commonly provided the advice. Despite this, only 54% (n=21) confirmed that they were taking vitamin supplements.ConclusionWith such low rates of vitamin supplementation, the overall outcome shows poor adherence to current guidance. The results suggest a great need to improve public understanding and education of the risks associated with lack of vitamin D. Standardising practice, enhancing services and the advice provided to patients are ways to encourage compliance to guidelines and ultimately improve the health of those populations who are at risk.ReferenceScientific Advisory Committee on Nutrition (SACN). Vitamin D and health. London: TSO; 2016.
Discussion A novel remote monitoring system implemented within NHS Lothian did not significantly increase patient CPAP compliance. Excess leak from the mask was significantly reduced however, suggesting that compliance may be affected in a study inclusive of a greater number of patients and over a greater period of time. Therefore, more highly powered studies are required to determine if remote monitoring in the treatment of OSAHS patients can help to improve patient compliance.
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