Emily Broadis

Sign on the dotted line: parental consent

The issue of informed consent in paediatric surgery has always been contentious. Despite the fact that taking consent is one of the most frequently performed tasks of a surgeon, it is rarely audited. Indeed, there are few studies looking at the consent process in adult practice and fewer in the paediatric setting. The aim of this study was, therefore, to determine parental understanding, recall, attitudes and opinion of the consent process in a busy paediatric day surgery unit. A prospective study was conducted using a questionnaire consisting of 20 questions. These were handed out to the parents of all children undergoing one of four procedures: circumcision, prepuceplasty, orchidopexy and herniotomy over a 3-month-period. Completed questionnaires were collected and analysed. One hundred and sixty-one parents were asked to complete the questionnaire. Ninety-three were collected, a response rate of 58%, 87% believed consent was taken by the performing surgeon, 15% felt the consent process was rushed, but 91% thought the right amount of detail was given. Ninety-seven percent of parents believed that the consent form was a legal necessity and 72% believed that a child in Scotland had to be aged 16 or over to sign the consent form. Interestingly, 23% of parents were unsure if signing the consent form meant that they could not claim compensation if anything went wrong. Ninety-one percent recalled the procedure being explained in the outpatient clinic, but 22% did not remember potential complications being discussed. The amount parents recalled of potential complications varied. Seventy percent felt that a leaflet about the procedure prior to attending the unit would be helpful. In conclusion consent is an extremely important part of our practice. This study highlights some of the common parental misconceptions and limitations of the process. Parents appear satisfied and consenting for procedures is overall performed well. Some areas could be improved and more research is required in this area.

Choledochal malformations: the Scottish experience.

INTRODUCTION Excisional surgery for choledochal malformations in Scotland is currently performed in three specialist pediatric surgical centers using open or laparoscopic-assisted techniques. We reviewed the outcome of children who had excisional surgery in Scotland between 1992 and 2010. MATERIALS AND METHODS Case notes for all patients undergoing excisional surgery in any of the three specialist pediatric surgical centers in Scotland between 1992 and 2010 were retrospectively reviewed. RESULTS A total of 25 patients were identified, with a female preponderance of 4:1. Of these, three patients (12%) were diagnosed by antenatal ultrasound scan. The commonest presenting symptoms were anorexia (56%), abdominal pain (52%), and jaundice (52%). Only 20% had the classical triad of abdominal pain, jaundice, and a palpable mass. Using the Kings College Hospital classification, 14 patients had type 1 malformations, 8 had type 4 malformations, and 3 had type 2 malformations. Median age at operation was 2 years (range 35 days to 13.5 years). Two centers performed open excision while the third center used primarily a laparoscopic-assisted technique. Median follow-up was 2.1 years (range 30 days to 11.9 years). Three patients (12%) required repeat laparotomy. The wound infection rate was 8% (n=2). The recurrent cholangitis rate was 8% (n=2). There was one late death due to adhesive small bowel obstruction, 4 years after surgery. To date, no patient has developed biliary tree stones or liver failure. CONCLUSIONS Choledochal malformation excisional surgery, either open or laparoscopic assisted, can be safely performed in appropriately equipped, pediatric surgical centers in Scotland by experienced pediatric surgeons.

Paediatric burns in LMICs: an evaluation of the barriers and facilitators faced by staff involved in burns education training programmes in Blantyre, Malawi

BACKGROUND A burn prevention and education programme - the Reduction of Burn and Scald Mortality and Morbidity in Children in Malawi project - was implemented from January 2010-2013 in Queen Elizabeth Central Hospital, Malawi. This study aimed to investigate the barriers and facilitators of implementing education-training programmes. METHODS Semi-structured interviews with 14 Scottish and Malawian staff delivering and receiving teaching at training education programmes were conducted. All interviews were recorded, transcribed and analysed using thematic analysis. RESULTS Overarching barriers and facilitators were similar for both sets of staff. Scottish participants recognised that limited experience working in LMICs narrowed the challenges they anticipated. Time was a significant barrier to implementation of training courses for both sets of participants. Lack of hands on practical experience was the greatest barrier to implementing the skills learnt for Malawian staff. Sustainability was a significant facilitator to successful implementation of training programmes. Encouraging involvement of Malawian staff in the co-ordination and delivery of teaching enabled those who attend courses to teach others. CONCLUSIONS A recognition of and response to the barriers and facilitators associated with introducing paediatric burn education training programmes can contribute to the development of sustainable programme implementation in Malawi and other LMICs.

G13 Continent Catheterisable Conduit

• This procedure is used to provide a catheterisable conduit between the skin surface and bladder.

G14 V-Quadrilateral-Z (VQZ)-plasty for Stoma

• This procedure is used to create the cutaneous opening of a continent catheterisable conduit instead of a flush stoma.

G17 Posterior Urethral Valves

• The valves consist of a leaflet of tissue that originates from inferior aspect of the verumontanum in the posterior urethra (Fig. 1).

F16 Hypospadias Repair: Stage Two

The second stage of a proximal hypospadias repair. Is timed for approximately 6 months after the first stage.

F15 Two-Stage Hypospadias Repair: Stage One

A two-stage repair is done for a hypospadia with a proximal meatus or severe chordee, when a graft is required to create a new urethral plate (Fig. 1).