Ambulatory Child Health最新文献

Method This was a prospective study of a 1-year cohort of children born to mothers registered with 25% of general practices in Nottingham. A cohort of 2308 babies was followed up for 15–18 months. All referrals for five tracer physical conditions (undescended testes, congenital heart disease, squints, developmental dysplasia of the hip and congenital hearing loss) were followed up through hospital record systems and copies of child health surveillance reviews from the personal child health records.

Results One thousand, nine hundred and seventy-two (85%) of the initial cohort were followed up. Four hundred and thirteen (21%) children had been referred for one of the tracer conditions and 91% had been referred directly from child health surveillance reviews. Only 49 (12%) children needed treatment or follow-up after assessment. The sensitivity of screening was high, ranging from 72% for congenital heart disease to 100% for developmental dysplasia of the hip and hearing loss. However, false positive rates were also very high, ranging from 60% for undescended testes to 97% for developmental dysplasia of the hip and hearing loss. Thus the positive predictive value of referral for dysplasia of the hip or hearing loss was only 5%, with a negative predictive value of 100%. In contrast, the positive predictive value for undescended testes was 67%, with a false negative rate of 14%. Eighty-four per cent of those who needed treatment or follow-up after assessment had been referred from the child health surveillance programme. The largest proportion of abnormalities was identified from the 6-week review, but most referrals came from the neonatal review and the health visitor distraction test.

Conclusion The majority of children with the five tracer conditions used in this study were identified during child health surveillance examinations.

Method A randomised, single-blind, controlled trial of incorporating an exploration of barriers to changing practice into an educational strategy for GPs was conducted in 18 practices. Both groups of practices received visits during which they received the results of a previous audit on the management of hypertension in the elderly. The nine intervention practices were encouraged to explore barriers that would prevent them from implementing the pertinent research findings, in addition to an exploration of the issues and creation of a practice action plan. Control groups received the education without the element of exploring barriers to change. The outcome measures were changes in response to a questionnaire before and after the educational intervention.

Results There were statistically significant differences between the two groups after the educational visit. Those practices who were encouraged to explore barriers to change were more likely to show change in behaviour compared to the control group. All the intervention practices produced an action plan for improving the performance, whereas none of the controls did so. The intervention practices also showed more concordance in management protocols after the intervention.

Conclusion Addressing the barriers preventing practitioners from implementing research findings is effective in implementing change.

Method A randomised, single-blind, controlled trial of incorporating an exploration of barriers to changing practice into an educational strategy for GPs was conducted in 18 practices. Both groups of practices received visits during which they received the results of a previous audit on the management of hypertension in the elderly. The nine intervention practices were encouraged to explore barriers that would prevent them from implementing the pertinent research findings, in addition to an exploration of the issues and creation of a practice action plan. Control groups received the education without the element of exploring barriers to change. The outcome measures were changes in response to a questionnaire before and after the educational intervention.

Results There were statistically significant differences between the two groups after the educational visit. Those practices who were encouraged to explore barriers to change were more likely to show change in behaviour compared to the control group. All the intervention practices produced an action plan for improving the performance, whereas none of the controls did so. The intervention practices also showed more concordance in management protocols after the intervention.

Conclusion Addressing the barriers preventing practitioners from implementing research findings is effective in implementing change.

The prevalence of psychiatric disorders is increased in children and adults with intellectual disability. Brain damage or dysfunction interact with social and family factors to increase susceptibility to mental illness. Psychiatric disorders in the context of genetic syndromes are commonly overlooked, and there is substantial underdiagnosis of mental disorders because of the atypical and non-specific clinical presentations, and the frequent assumption that psychiatric symptoms are an inherent part of the underlying intellectual disability. There is a strong need for evidence-based practice in the use of drugs in this population, especially since many are unlicensed for use in children. There is an urgent need to understand and establish the pharmacokinetics, pharmacodynamics, and side-effect profiles of psychotropic medication in this population. Positive trends in pharmacotherapy include the use of atypical antipsychotics instead of the classic antipsychotics, serotonin-specific reuptake inhibitors (SSRIs) rather than tricyclic antidepressants and newer antiepileptic drugs. Another welcome trend is the use of SSRIs instead of antipsychotics in the long-term management of challenging behaviour in this population.