scholarly journals Low FODMAP diet in children and adolescents with functional bowel disorder: A clinical case note review

JGH Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Stephanie C Brown ◽  
Kevin Whelan ◽  
Richard B Gearry ◽  
Andrew S Day
Keyword(s):  
Children And Adolescents ◽  
Clinical Case ◽  
Case Note ◽  
Functional Bowel Disorder ◽  
Fodmap Diet ◽  
Case Note Review ◽  
Bowel Disorder

scholarly journals Cycle of child sexual abuse: Links between being a victim and becoming a perpetrator

2001 ◽  
Vol 179 (6) ◽  
pp. 482-494 ◽  
Author(s):  
M. Glasser ◽  
I. Kolvin ◽  
D. Campbell ◽  
A. Glasser ◽  
I. Leitch ◽  
...  
Keyword(s):  
Sexual Abuse ◽  
Child Sexual Abuse ◽  
Clinical Case ◽  
Strong Predictor ◽  
Case Note ◽  
Female Victims ◽  
Female Relative ◽  
Widespread Belief ◽  
Male Subjects ◽  
Case Note Review

BackgroundThere is widespread belief in a ‘cycle’ of child sexual abuse, but little empirical evidence for this belief.AimsTo identify perpetrators of such abuse who had been victims of paedophilia and/or incest, in order to: ascertain whether subjects who had been victims become perpetrators of such abuse; compare characteristics of those who had and had not been victims; and review psychodynamic ideas thought to underlie the behaviour of perpetrators.MethodRetrospective clinical case note review of 843 subjects attending a specialist forensic psychotherapy centre.ResultsAmong 747 males the risk of being a perpetrator was positively correlated with reported sexual abuse victim experiences. The overall rate of having been a victim was 35% for perpetrators and 11 % for non-perpetrators. Of the 96 females, 43% had been victims but only one was a perpetrator. A high percentage of male subjects abused in childhood by a female relative became perpetrators. Having been a victim was a strong predictor of becoming a perpetrator, as was an index of parental loss in childhood.ConclusionsThe data support the notion of a victim-to-victimiser cycle in a minority of male perpetrators but not among the female victims studied. Sexual abuse by a female in childhood may be a risk factor for a cycle of abuse in males.

Vitamin D in corticosteroid-naïve and corticosteroid-treated Duchenne muscular dystrophy: what dose achieves optimal 25(OH) vitamin D levels?

2016 ◽  
Vol 101 (10) ◽  
pp. 957-961 ◽  
Author(s):  
Nahla Alshaikh ◽  
Andreas Brunklaus ◽  
Tracey Davis ◽  
Stephanie A Robb ◽  
Ros Quinlivan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Vitamin D Deficiency ◽  
Case Note ◽  
Retrospective Case ◽  
Toxic Level ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D ◽  
Case Note Review

AimAssessment of the efficacy of vitamin D replenishment and maintenance doses required to attain optimal levels in boys with Duchenne muscular dystrophy (DMD).Method25(OH)-vitamin D levels and concurrent vitamin D dosage were collected from retrospective case-note review of boys with DMD at the Dubowitz Neuromuscular Centre. Vitamin D levels were stratified as deficient at <25 nmol/L, insufficient at 25–49 nmol/L, adequate at 50–75 nmol/L and optimal at >75 nmol/L.Result617 vitamin D samples were available from 197 boys (range 2–18 years)—69% from individuals on corticosteroids. Vitamin D-naïve boys (154 samples) showed deficiency in 28%, insufficiency in 42%, adequate levels in 24% and optimal levels in 6%. The vitamin D-supplemented group (463 samples) was tested while on different maintenance/replenishment doses. Three-month replenishment of daily 3000 IU (23 samples) or 6000 IU (37 samples) achieved optimal levels in 52% and 84%, respectively. 182 samples taken on 400 IU revealed deficiency in 19 (10%), insufficiency in 84 (47%), adequate levels in 67 (37%) and optimal levels in 11 (6%). 97 samples taken on 800 IU showed deficiency in 2 (2%), insufficiency in 17 (17%), adequate levels in 56 (58%) and optimal levels in 22 (23%). 81 samples were on 1000 IU and 14 samples on 1500 IU, with optimal levels in 35 (43%) and 9 (64%), respectively. No toxic level was seen (highest level 230 nmol/L).ConclusionsThe prevalence of vitamin D deficiency and insufficiency in DMD is high. A 2-month replenishment regimen of 6000 IU and maintenance regimen of 1000–1500 IU/day was associated with optimal vitamin D levels. These data have important implications for optimising vitamin D dosing in DMD.

scholarly journals Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

2018 ◽  
Vol 6 (7) ◽  
pp. 1-314 ◽  
Author(s):  
Paul Aylin ◽  
Alex Bottle ◽  
Susan Burnett ◽  
Elizabeth Cecil ◽  
Kathryn L Charles ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Studies ◽  
Surveillance System ◽  
Case Note ◽  
General Level ◽  
Mortality Data ◽  
Mortality Reduction ◽  
Trust Level ◽  
Case Note Review

BackgroundSince 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied.ObjectivesTo improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality.DesignMixed methods.SettingEnglish NHS acute hospital trusts.ParticipantsEleven trusts were included in the case study. The survey involved 78 alerting trusts.Main outcome measuresRelative risk of mortality and perceived efficacy of the alerting system.Data sourcesHospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey.MethodsDescriptive analysis of alerts; association with other measures of quality; associated change in mortality using an interrupted time series approach; in-depth qualitative case studies of institutional response to alerts; and a national cross-sectional evaluative survey administered to describe the organisational structure for mortality governance and perceptions of efficacy of alerts.ResultsA total of 690 mortality alerts generated between April 2007 and December 2014. CQC pursued 75% (154/206) of alerts sent between 2011 and 2013. Patient care was cited as a factor in 70% of all investigations and in 89% of sepsis alerts. Alerts were associated with indicators on bed occupancy, hospital mortality, staffing, financial status, and patient and trainee satisfaction. On average, the risk of death fell by 58% during the 9-month lag following an alert, levelling afterwards and reaching an expected risk within 18 months of the alert. Acute myocardial infarction (AMI) and sepsis alerts instigated institutional responses across all the case study sites, although most sites were undertaking some parallel activities at a more general level to address known problems in care in these and other areas. Responses included case note review and coding improvements, changes in patient pathways, changes in diagnosis of sepsis and AMI, staff training in case note write-up and coding, greater transparency in patient deterioration, and infrastructure changes. Survey data revealed that 86% of responding trusts had a dedicated trust-level lead for mortality reduction and 92% had a dedicated trust-level mortality group or committee in place. Trusts reported that mortality reduction was a high priority and that there was strong senior leadership support for mortality monitoring. The weakest areas reported concerned the accuracy of coding, the quality of specialty-level mortality data and understanding trends in specialty-level mortality data.LimitationsOwing to the correlational nature of our analysis, we could not ascribe a causal link between mortality alerts and reductions in mortality. The complexity of the institutional context and behaviour hindered our capacity to attribute locally reported changes specifically to the effects of the alerts rather than to ongoing institutional strategy.ConclusionsThe mortality alert surveillance system reflects aspects of quality care and is valued by trusts. Alerts were considered a useful focus for identifying problems and implementing interventions around mortality.Future workA further analysis of site visits and survey material, the application of evaluative framework to other interventions, a blinded case note review and the dissemination of findings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Improving pain management for children having dental extractions under general anaesthesia

2020 ◽  
Vol 102 (9) ◽  
pp. 733-736
Author(s):  
S Marshall ◽  
A Ondhia ◽  
C Mearns ◽  
T Kandiah
Keyword(s):  
Pain Management ◽  
General Anaesthesia ◽  
Case Note ◽  
Standards Of Care ◽  
Day Case ◽  
Full Compliance ◽  
Analgesic Regimen ◽  
High Standards ◽  
Audit Standards ◽  
Case Note Review

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.

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