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Darling J.C.,Academic Unit of Paediatrics | Bardgett R.J.M.,Bradford Teaching Hospitals NHS Foundation Trust
Medical Teacher | Year: 2013

Background: Many medical schools have moved to large end-of-year Objective Structured Clinical Examinations (OSCEs) in which it is difficult to involve children as patients. It is nevertheless important to assess student competencies in clinical examination of children. Methods: We set up a partnership with a local primary school, where children aged 8-11 years have assisted with our OSCE annually from 2007 to 2012. Approximately 30 children attend each exam, and are distributed between 14 simultaneous stations, each part of a 20-station circuit. Approximately 280 candidates complete the same paediatric station (e.g. cardiovascular examination) in one morning. Evaluation: A total of 160 children took part in the exams over this period, and of 129 (80.6%) who filled a questionnaire: 99.2% agreed that they 'had enjoyed taking part in the exam'; 100% 'thought it was a good experience'; and 96.1% 'thought that it was well organised'. Parent and teacher feedback has been overwhelmingly positive. Conclusion: We conclude that it is feasible to involve school children in a large-scale OSCE. A school-medical school partnership is mutually beneficial, improving assessment of important paediatric clinical skills, while providing a positive experience for children who participate. © 2013 Informa UK Ltd. Source

Ladhani S.,Academic Unit of Paediatrics | Heath P.T.,Vaccine Institute | Aibara R.J.,Central Middlesex Hospital | Ramsay M.E.,Public Health England | And 6 more authors.
Vaccine | Year: 2010

This study describes the long-term complications in children with Haemophilus influenzae serotype b (Hib) vaccine failure and to determine their risk of other serious infections. The families of 323 children with invasive Hib disease after appropriate vaccination (i.e. vaccine failure) were contacted to complete a questionnaire relating to their health and 260 (80.5%) completed the questionnaire. Of the 124 children with meningitis, 18.5% reported serious long-term sequelae and a further 12.1% of parents attributed other problems to Hib meningitis. Overall, 14% (32/231 cases) of otherwise healthy children and 59% (17/29 cases) of children with an underlying condition developed at least one other serious infection requiring hospital admission. In a Poisson regression model, the risk of another serious infection was independently associated with the presence of an underlying medical condition (incidence risk ratio (IRR) 7.6, 95% CI 4.8-12.1; p < 0.0001), both parents having had a serious infection (IRR 4.1, 95% CI 1.6-10.3; p = 0.003), requirement of more than two antibiotic courses per year (IRR 2.3, 95% CI 1.4-3.6; p = 0.001) and the presence of a long-term complication after Hib infection (IRR 1.8, 95% CI 1.1-3.1; p = 0.03). Thus, rates of long-term sequelae in children with vaccine failure who developed Hib meningitis are similar to those in unvaccinated children in the pre-vaccine era. One in seven otherwise healthy children (14%) with Hib vaccine failure will go on to suffer another serious infection requiring hospital admission in childhood, which is higher than would be expected for the UK paediatric population. © 2009 Elsevier Ltd. All rights reserved. Source

Khor C.C.,Genome Institute of Singapore | Khor C.C.,National University of Singapore | Davila S.,National University of Singapore | Davila S.,Genome Institute of Singapore | And 117 more authors.
Nature Genetics | Year: 2011

Kawasaki disease is a systemic vasculitis of unknown etiology, with clinical observations suggesting a substantial genetic contribution to disease susceptibility. We conducted a genome-wide association study and replication analysis in 2,173 individuals with Kawasaki disease and 9,383 controls from five independent sample collections. Two loci exceeded the formal threshold for genome-wide significance. The first locus is a functional polymorphism in the IgG receptor gene FCGR2A (encoding an H131R substitution) (rs1801274; P = 7.35 × 10 -11, odds ratio (OR) = 1.32), with the A allele (coding for histadine) conferring elevated disease risk. The second locus is at 19q13, (P = 2.51 × 10 -9, OR = 1.42 for the rs2233152 SNP near MIA and RAB4B; P = 1.68 × 10 -12, OR = 1.52 for rs28493229 in ITPKC), which confirms previous findings. The involvement of the FCGR2A locus may have implications for understanding immune activation in Kawasaki disease pathogenesis and the mechanism of response to intravenous immunoglobulin, the only proven therapy for this disease. © 2011 Nature America, Inc. All rights reserved. Source

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