Logan Manikam

A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children

BackgroundSouth Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent.MethodsData Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013.Inclusion Criteria – Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0–18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals.Data Extraction – Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion.Results15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were:1. Lack of asthma knowledge in families and healthcare professionals.2. Under-use of preventer medications.3. Non-acceptance/denial of asthma.4. Over-reliance on Emergency Department management.5. Communication problems.6. Non-adherence to medication.7. Use of complementary therapies.Little facilitators regarding asthma management were identified.ConclusionsSeveral key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs, health service utilisation pattern explanations and the impact of prejudice and stigmatisation. Other explanations such as language barriers are not strictly ethnic specific but instead reflect a minority position.Further research is required to identify why barriers exist, the mechanisms by which they impact on asthma management and how they can be overcome. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those that are related to being a minority will enable the application of generic system-wide interventions where ethnicity is not the issue and ethnically-tailored interventions where needed.

Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review

Specific allergen immunotherapy (SIT) is an effective allergy treatment, but it is unclear whether SIT is effective for atopic eczema (AE). We undertook a systematic review to assess SIT efficacy and safety for treating AE.

Epidemiology of community acquired pneumonia

Abstract Despite efforts in prevention worldwide including recent advances in vaccine therapy, childhood community acquired pneumonia (CAP) remains a major cause of morbidity and mortality both in the developed and the developing world. Traditionally, qualifying the aetiology of CAP proved to be fraught with challenges particularly due to low yields from blood and sputum specimens. In recent years however, new advances in techniques such as enzyme-linked immunosorbent assay and polymerase chain reaction have dramatically improved detection rates of both bacteria and viruses. In addition to qualifying the true burden of disease by known organisms such as Streptococcus pneumoniae it has led to the identification of organisms such as human bocavirus which have not previously been associated with CAP. This article aims to provide a brief update to the clinician on the current epidemiology of CAP in this post-vaccination era. It is based on a combination of recommendations from existing clinical practice guidelines, recent systematic reviews and the current literature.

Management of sexually transmitted infections in pubertal children

Sexually transmitted infections (STI) comprise a variety of infections transmissible through sexual contact. Mutually consenting sexual relationships have become commonplace in adolescence and sexual abuse or exploitation awareness has risen, resulting in increased presentations of children with sexual health concerns. Difficulties persist in diagnosing and managing STIs in children. With increased emphasis on paediatricians involvement in transitional care, competence in sexual history taking and clinical presentation recognition remains essential. Additionally, an awareness of strengths and limitations of diagnostic modalities needs to be present. Furthermore, specific additional issues in this age group such as independent consent for diagnosis and treatment, fear of pregnancy and privacy and confidentiality concerns should be addressed carefully. Failure to address these issues may lead to disengagement with health services resulting in potentially adverse short- and long-term health and social consequences in young persons. This review aims to provide an overview of an approach to diagnosing and managing a pubertal child with an STI and the consideration of the unique issues surrounding childrens care.

Definition and monitoring of neonatal hypoglycaemia: a nationwide survey of NHS England Neonatal Units.

Neonatal hypoglycaemia is common; however, there is an ongoing controversy regarding its operational definition, with recent guidance from the Paediatric Endocrine Society (PES) recommending using significantly higher blood glucose thresholds and longer periods of monitoring than existing guidance.1 A 2014 survey of Australasian neonatal units identified that the most common clinical threshold for the treatment of hypoglycaemia was 2.6 mmol/L, and some units used potentially unreliable nearside blood glucose monitoring devices.2 The most recent published survey of British neonatologists showed wide variation in definitions of neonatal hypoglycaemia from <1 to <4 mmol/L.3 We surveyed neonatal units in England to assess current working practice on the definition and monitoring of neonatal hypoglycaemia. All …

Transient pseudohypoaldosteronism masquerading as congenital adrenal hyperplasia

We report a six-week-old boy with genitourinary structural abnormalities who presented with profound hyponatraemia and hyperkalaemia due to transient type 1 pseudohypoaldosteronism (PHA) precipitated by a urinary tract infection (UTI), which responded rapidly to intravenous saline and antibiotics. In infants with structural abnormalities of the urinary tract, we wish to highlight the importance of recognizing type 1 PHA and its association with a UTI since prompt and appropriate treatment rapidly corrects the associated metabolic abnormalities. Conversely, the identification of type 1 PHA in an infant should precipitate a search for a UTI and structural abnormalities of the urinary tract.

Using a co-production prioritization exercise involving South Asian children, young people and their families to identify health priorities requiring further research and public awareness.

To facilitate South Asian (SA) families and health‐care professionals (HCPs) participation in a prioritization exercise to co‐produce child health research and public awareness agendas.

Antibiotic prescribing in patients with self-reported sore throat.

Objectives: To investigate the predictors of general practitioner (GP) consultation and antibiotic use in those developing sore throat. Methods: We conducted a prospective population-based cohort study on 4461 participants in two rounds (2010–11) from 1897 households. Results: Participants reported 2193 sore throat illnesses, giving a community sore throat incidence of 1.57/ person-year. 13% of sore throat illnesses led to a GP consultation and 56% of these consultations led to antibiotic use. Participants most likely to have sore throats included women and children (e.g. school compared with retirement age); adjusted incidence rate ratio (aIRR) of 1.33 and 1.52, respectively. Participants with sore throat were more likely to consult their GP if they were preschool compared with retirement age [adjusted OR (aOR) 3.22], had more days of sore throat (aOR 1.11), reported more severe pain (aOR 4.24) or reported fever (aOR 3.82). Antibiotics were more often used by chronically ill individuals (aOR 1.78), those reporting severe pain (aOR 4.14), those reporting fever (aOR 2.58) or children with earache (aOR 1.85). Among those who consulted, males and adults who reported feeling anxious were more likely to use antibiotics; aOR 1.87 and 5.36, respectively. Conclusions: Only 1 in 10 people who have a sore throat see a doctor and more than half of those attending get antibiotics. Further efforts to curb antibiotic use should focus on reducing initial GP consultations through public information promoting safe self-management, targeted at groups identified above as most likely to attend with sore throats.

Improving assessment of paediatric acute breathing difficulties in medical education: a cluster randomized controlled trial

Impact assessment of an adjunct to standard teaching on knowledge gain and self‐assessed confidence for students undertaking their paediatric attachment and evaluation of an acute breathing difficulties (ABDs) learning package.

Barriers to Incorporating NICE Clinical Practice Guidelines in Medical Education: The Medical Student’s Perspective

BackgroundClinical practice guidelines (CPG) developed by the National Institute for Health and Clinical Excellence (NICE) aim to address National Health Service (NHS) practice inequalities by supporting clinicians deliver best patient care to address practice inequalities. As the future NHS workforce, it is important to quantify medical students’ knowledge of and attitude towards evidence based medicine (EBM) and NICE CPGs to identify barriers influencing evidence based medicine and CPG implementation.MethodsWe administered an online survey to medical students in England and Wales to study attitudes and knowledge of EBM and CPGs. We performed Mann-Whitney and Kruskal-Wallis tests to compare different groups’ continuous variable means.ResultsWe received 323 responses across seven medical schools. A scale reliability alpha of 0.71 reflected satisfactory questionnaire internal consistency. Students were unsure regarding development processes such as 3 year implementation timeframes (74%) and role of academic medical colleges, drug companies and lay public. Students understood the scientific evidence application in decision-making processes (83%) and that clinicians should practice EBM (87%). 77% and 51% of students believe CPG’s influence drug availability and decrease practice autonomy respectively. Two thirds of students felt guidelines reduced patient choice.ConclusionThe majority of medical students understood the importance and role of evidence based medicine and NICE guidelines. However, poor knowledge on processes of guideline development and negative views on aspects of NICE CPGs may be construed as barriers that may affect implementation in future evidence-based practice. Research is warranted to develop an educational framework for future educational strategy implementation.