Paediatric Services

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    "Will anybody listen?" parents' views on childhood asthma care: a qualitative study.
    (Royal College of General Practitioners., 2024-05-28) Warren, Kate
    Background: Asthma is the most common chronic disease in children, resulting in considerable morbidity and health care utilisation, especially in geographical areas with high deprivation. Parents play a pivotal role in children's asthma management. Aim: To explore the views of parents whose children have asthma, regarding barriers and facilitators to receiving adequate asthma care. Design & setting: A qualitative study conducted in an urban, multi-ethnic setting with high socioeconomic deprivation and paediatric asthma related hospital admissions. Method: The study used a pragmatic approach underpinned by a perspective of critical realism. Parents of children with asthma were recruited through purposive and convenience sampling and data collected through semi-structured interviews. Transcripts were analysed using thematic analysis, facilitated by NVivo software. Results: 10 parents participated in nine interviews. Six themes were identified relating to: (1) the establishment of a new life dynamic following a diagnosis of asthma; (2) the turbulent and drawn-out process of asthma diagnosis; (3) the roles and expectations of the partnership established between parents and healthcare services; (4) the importance of schools in asthma management; (5) sources and access to relevant information; and (6) the importance of social support networks. Parents frequently felt unsupported and misunderstood, particularly during the diagnostic process. Conclusion: Unmet parental educational and emotional needs, particularly around the time of diagnosis were identified as a key barrier to adequate asthma management. Deeper understanding of gaps in support can instruct asthma care delivery and inform co-produced interventions, thus improving asthma outcomes in children.
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    L-2-hydroxyglutaric aciduria: a report of clinical, radiological, and genetic characteristics of two siblings from Egypt.
    (Taylor & Francis online, 2024-04-01) Mahmoud, Ahmed Ali Mahmoud
    L-2-hydroxyglutaric aciduria (L-2-HGA) is a rare autosomal recessive disease characterized by elevated levels of hydroxyglutaric acid in the body fluids and brain with abnormal white matter. We present two siblings with psychomotor retardation and quadriparesis. Their brain imaging showed diffuse bilateral symmetrical involvement of the cerebral cortex, white matter, basal ganglia and cerebellum. The whole exome sequence studies revealed a homozygous likely pathogenic variant on chromosome 14q22.1 (NM_024884.2: c.178G > A; pGly60Arg) in the gene encoding for L-2-hydroxyglutarate dehydrogenase (L2HGDH) (OMIM #236792). Therefore, using the L2HGDH gene study is beneficial for L2HGA diagnosis.
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    Quality-of-life outcomes after bone-anchored hearing device surgery in children with single-sided sensorineural deafness.
    (Wolters Kluwer., 2013-01-01) Banga, Rupan; Child, Anne; Doshi, Jayesh; Lawrence, Rebecca; McDermott, Ann-Louise; Proops, David; Reid, Andrew
    Abstract Objective To report our experience in a series of children with single-sided sensorineural deafness where a bone-anchored hearing device (BAHD) was used for auditory rehabilitation. Study Design Retrospective case review. Setting Tertiary referral centre. Patients Eight children (4 boys and 4 girls) who had BAHD surgery for single-sided sensorineural deafness between 2007 and 2010. Intervention(s) Bone-anchored hearing device was used for auditory rehabilitation. Main Outcome Measure(s) Glasgow Children’s Benefit Inventory (GCBI), Single-sided Deafness (SSD) Questionnaire and change in health benefit scores (visual analogue scale). Results All but one of the children showed a positive GCBI score; the child that reported a negative score was because of low self confidence and self-esteem issues secondary to bullying at school. The results of the SSD questionnaire were generally positive with a mean satisfaction score of the BAHD as 9/10. All the children had an improvement in heath benefit. Conclusion Our findings add further evidence to support patient perceived benefit of a BAHD in single sided sensorineural deafness in the paediatric population.
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    Predicting the severity of acute appendicitis in children using neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).
    (Cureus., 2022-08-31) Mcleish, Bethan; Singhal, Shika
    Introduction The ability to predict risk of perforation in acute appendicitis (AA) could direct timely management and reduce morbidity. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are surrogate severity markers in infections. This study investigates the use of PLR and NLR as a marker for distinguishing uncomplicated (UA) and complicated appendicitis (CA) in children. Materials and methods This retrospective single-center study collected data between January 1, 2014, and December 31, 2020. Children between five and 17 years of age with histologically confirmed appendicitis were included. Cut-off values for NLR and PLR were determined by employing the receiver operating characteristic (ROC) curve with sensitivity and specificity in addition to regression analysis. Results A total of 701 patients were included with a median age of 13 years. Out of which 52% of the cohort was female. The difference between the NLR and PLR ratios between UA and CA was significant (p=0.05, Kruskal-Wallis). For UA, the area under the ROC curve (AUC) and cut-off for NLR and PLR were 0.741, 3.80 with 95% CI of 0.701-0.781 and 0.660, 149.25 with 95% CI of 0.618-0.703, respectively. In CA, using NLR and PLR, AUC and cut-off were 0.776, 8.86 with 95%CI of 0.730-0.822 and 0.694, 193.67 with 95%CI of 0.634-0.755, respectively. All were significant with p<0.001. Conclusions NLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide non-operative management in children.