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Mellon A.,City Hospitals Sunderland NHS Foundation Trust | Murdoch-Eaton D.,University of Sheffield
Archives of Disease in Childhood | Year: 2015

The formal roles of educational and clinical supervisor focus on education planning and goal setting against required training elements. Assessment of performance is integral to these roles that necessarily involve some elements of developmental support to trainees. Mentoring is increasingly seen as a desirable route to support doctors in training. Definitions vary, but core expectations of mentors are that they encourage personal development and offer psychosocial support to a trainee within a longitudinal relationship. A key question is whether a supervisor is the appropriate individual to act as a mentor to an individual trainee. The supervisor's role as an assessor of performance can pose challenges and potential conflicts when providing support relating to other personal needs of trainees along their career paths. It is apparent from the literature that mentoring is a multifaceted role, with different actions required of mentors and supervisors. There is evidence that mentorship can affect specialty choice, academic output and commitment to organisations. Addressing the challenges posed by an ideal of providing mentoring to all trainees is potentially as important as ensuring supervisors of competence. The potential benefits for the profession are of enhancing the development and retention of trainees of high calibre within the paediatric discipline.

Anderson C.,City Hospitals Sunderland NHS Foundation Trust
BMJ case reports | Year: 2012

The artery of Percheron is a rare anatomical variant whereby a single vessel arising from the proximal segment of one posterior cerebral artery supplies both medial thalami. This is a rare example of a single arterial supply to brain structures on both sides of the midline. Occlusion of the artery of Percheron results in bilateral medial thalamic infarction, which is manifest clinically as gaze paresis, cognitive disturbance and altered consciousness. The presentation can mimic subarachnoid haemorrhage, drug intoxication, encephalitis and other inflammatory or infective conditions. The presentation is similar to the 'top of the basilar syndrome' and early recognition should prompt further investigation for underlying stroke aetiologies and consideration can be given to thrombolysis if vascular occlusion can be confirmed.

Horridge K.A.,City Hospitals Sunderland NHS Foundation Trust | Mcgarry K.,University of Sunderland | Williams J.,University of Nottingham | Whitlingum G.,Royal Hampshire County Hospital
Developmental Medicine and Child Neurology | Year: 2016

Aims: To pilot prospective data collection by paediatricians at the point of care across England using a defined terminology set; demonstrate feasibility of data collection and utility of data outputs; and confirm that counting the number of needs per child is valid for quantifying complexity. Method: Paediatricians in 16 hospital and community settings collected and anonymized data. Participants completed a survey regarding the process. Data were analysed using R version 3.1.2. Results: Overall, 8117 needs captured from 1224 consultations were recorded. Sixteen clinicians responded positively about the process and utility of data collection. The sum of needs varied significantly (p<0.01) by level of gross motor function ascertained using the Gross Motor Function Classification System for children with cerebral palsy; epilepsy severity as defined by level of expertise required to manage it; and by severity of intellectual disability. Interpretation: Prospective data collection at the point of clinical care proved possible without disrupting clinics, even for those with the most complex needs, and took the least time when done electronically. Counting the number of needs was easy to do, and quantified complexity in a way that informed clinical care for individuals and related directly to validated scales of functioning. Data outputs could inform more appropriate design and commissioning of quality services. © 2016 Mac Keith Press.

Shelton J.A.,NHS Tayside | Brown J.J.S.,City Hospitals Sunderland NHS Foundation Trust | Young J.A.,NHS Tayside
Annals of the Royal College of Surgeons of England | Year: 2014

INTRODUCTION: Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy. METHODS: Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter. RESULTS: During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2-86 years) and a mean C-reactive protein (CRP) level of 71mg/l (range: 0-480mg/l) while the LCOA group had a mean age of 46 years (range: 11-92 years) and a mean CRP level of 162mg/l (range: 3-404mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150mg/l (p<0.05). CONCLUSIONS: A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150mg/l.

Howells R.J.,Plymouth Hospitals NHS Trust | Davies H.A.,University of Sheffield | Silverman J.D.,University of Cambridge | Mellon A.F.,City Hospitals Sunderland NHS Foundation Trust
Archives of Disease in Childhood | Year: 2010

Objective: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT). Design: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale. Setting: Eight UK paediatric units. Participants: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos. Main outcome measures: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors. Results: 188 complete consultations were analysed (median per doctor =10). 3 videos marked by any trained assessor are needed to reliably (r>0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors - "clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationship-building skills (2-tailed significance <0.001). Conclusions: The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.

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