Leeds, United Kingdom
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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.


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.


PubMed | Academic Unit of Paediatrics
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2010

The development of invasive Haemophilus influenzae serotype b (Hib) disease after prior immunization with the Hib conjugate vaccine (ie, Hib vaccine failure) is extremely rare, suggesting that affected children may have an underlying genetic susceptibility in their immune response. The objective of this study was to investigate single-nucleotide polymorphisms (SNPs) known to affect function in biologically plausible genes in relation to the risk of Hib vaccine failure and its clinical manifestations.The families of UK children with Hib vaccine failure diagnosed during the period October 1992 through December 2005 were identified through enhanced national surveillance and approached for the study at a median interval of 4 years after invasive disease. The Wellcome Trust Case Control Consortium data sets were used as controls. Nineteen functional SNPs in 14 immune response genes were investigated in 172 white children.The recessive homozygous genotype for a SNP in the TIRAP (also known as MAL) gene (rs1893352) that is in strong linkage disequilibrium (r2=0.93) with the known functional Ser180Leu polymorphism in white persons was strongly associated with nonmeningitis cases of Hib vaccine failure (odds ratio, 5.6; 95% confidence interval, 2.7-11.5; P=1.2 x 10(-7)). In addition, the recessive homozygous genotype for another SNP (rs1554286) in strong linkage disequilibrium with both the C-819T (r2=0.87) and C-592A (r2=0.75) promoter polymorphisms in the interleukin-10 gene was associated with epiglottitis only (odds ratio, 5.8; 95% confidence interval, 2.4-14.2; P=1.1 x 10(-5)).Our findings strongly suggest that the development of invasive Hib disease after prior immunization is in part genetically determined and may direct the immune response to specific clinical manifestations.


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.

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