Lifetime cardiovascular management of patients with previous Kawasaki disease

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.

Multiple mini-interviews: opinions of candidates and interviewers

OBJECTIVES

To assess candidates' and interviewers' perceptions of the use of a multiple mini-interview (MMI) for selection of senior house officers (SHOs) to a UK regional paediatric training programme.

METHODS

Both candidates and interviewers completed anonymous questionnaires (comprising 16 and 25 questions, respectively). Demographic data were recorded for both groups. Data were analysed by frequencies; using Mann-Whitney and Kruskall-Wallis tests for comparisons; and Cronbach's alpha for internal consistency within the data.

RESULTS

Both candidates and interviewers were positive about the fairness of the MMI (mean scores of 4.0 and 4.4, respectively). The majority of candidates (83%) had not been to this type of interview before. Gender, age and previous experience of MMIs did not account for differences in candidate responses (P > 0.05). A total of 86% of candidates were international medical graduates who preferred the format more than UK graduates did (P = 0.01). Interviewers were mainly experienced consultants who agreed that the multi-station format was better than the traditional interview (mean score 4.8) and represented a reliable process (mean score 4.4). Interviewers were concerned about the range of competencies covered and the subsequent performance of candidates in post (mean scores 3.6 and 3.2, respectively).

CONCLUSIONS

Both candidates and interviewers agreed that the MMI format was reliable, fair and asked appropriate, easy-to-understand questions. In high-stakes interviews such as for specialty training in Modernising Medical Careers programmes, it is vital that all concerned have confidence in the selection process.

A comparison of teaching methods: interactive lecture versus game playing

BACKGROUND

We compared an interactive lecture with a game based on charades as a means of teaching child development to fifth year medical students.

METHODS

Students were randomised to either intervention and the data analyst was blinded to which method of teaching the students had received. Performance of the students was assessed after the teaching with a multiple choice questionnaire. Long term performance was assessed by comparing the students' OSCE scores in the child development station.

RESULTS

The students that received an interactive lecture performed significantly better in the MCQ than those who were taught using the game.

CONCLUSIONS

Neither group had any difference in long term performance in this subject following the interventions.

Reliability of a regional junior doctor recruitment process

INTRODUCTION

Recruitment to Paediatric Senior House Officer (SHO) posts has traditionally been undertaken by each individual hospital trust. This study looks at a regional recruitment process.

METHODS

Shortlisting was carried out in a single day marking application forms according to set criteria. A 3 station interview was used.

RESULTS

Reliability for both shortlisting and interviews was high (G co-efficients > or = 0.8).

DISCUSSION

This regional recruitment process for SHOs showed high reliability and is a model applicable to all specialties.

Liver disease in children with cystic fibrosis

Identification, evaluation and treatment of liver disease are increasingly important challenges in children with cystic fibrosis (CF). Liver disease usually presents at puberty and is receiving more attention with improved life expectancy. The abnormal CF transmembrane regulator protein in the apical surface of the biliary epithelium causes the disease. Hyperviscous bile accumulates in the biliary tree causing cholangiocyte and hepatocyte injury, stimulating focal fibrosis. Fibrosis is thought to lead on to cirrhosis over a period of years, a process which is usually asymptomatic. Steatosis and biliary tree anomalies including cholecystitis also occur. Clinical signs of liver disease appear late, by which time cirrhosis may be established. Early diagnosis would allow interventions to be evaluated but there is no gold standard for screening. Currently, regular clinical assessment, measurement of liver enzymes, ultrasound and liver biopsy are all used to evaluate liver disease in CF. Bile acid therapy reverses many markers of the disease but there is no good evidence that progression to cirrhosis can be prevented. A few children with cirrhosis decompensate (demonstrated by falling plasma albumin or coagulopathy) but they do well with liver transplantation. Children with portal hypertension as the sole manifestation of CF liver disease can be effectively managed with a programme of variceal obliteration or porto-systemic shunts.