Lived experiences of Maltese parents of young children born with biological risks for intellectual disability

Parents of children born with risks for intellectual disability (ID) report emotional upheaval and greater support needs compared to those raising a typically developing child. Exploring these parents’ needs and experiences is critical for the provision of early intervention and/or paediatric services that benefit the whole family. Consequently, this study aimed to explore the experiences and needs of Maltese parents of young children born with biological risks for ID, during the first five years of life. It adopted a cross-sectional qualitative design, using Interpretative Phenomenological Analysis (Smith et al., 2009). Four groups of parents, (N=37) depending on their children’s age (0;6, 2;0, 3;6 and 5;0 years) were interviewed using a semi-structured interview guide. Six super-ordinate themes were identified: ‘experiencing is true understanding’, ‘family functioning’, ‘info-emotional cycle’, ‘micro-system sociological framework’, ‘service-needs-resource cycle’ and ‘experiential challenges’. Socio-cultural influences have affected parents’ interpretations of their experiences and needs. Moreover, parents reported that raising an ‘at risk’ child had an impact on their daily life as a family, as a couple and on their individual lifeworld. Maltese parents felt that their needs were not given their due importance by policymakers and professionals. This warrants the incorporation of parents’ needs, together with the needs perceived for their child, in the provision of early intervention and/or paediatric services in Malta. This study also identified parents’ experiential differences as the child grow, highlighting the need for regular re-evaluation of parents’ needs. Recommendations for changes in Maltese family policy, service provision and education of professionals were proposed to reduce parents’ stresses.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Lived experiences of Maltese parents of younf children born with biological risks for intellectual disability

Parents of children born with risks for intellectual disability (ID) report emotional upheaval and greater support needs compared to those raising a typically developing child. Exploring these parents’ needs and experiences is critical for the provision of early intervention and/or paediatric services that benefit the whole family. Consequently, this study aimed to explore the experiences and needs of Maltese parents of young children born with biological risks for ID, during the first five years of life. It adopted a cross-sectional qualitative design, using Interpretative Phenomenological Analysis (Smith et al., 2009). Four groups of parents, (N=37) depending on their children’s age (0;6, 2;0, 3;6 and 5;0 years) were interviewed using a semi-structured interview guide. Six super-ordinate themes were identified: ‘experiencing is true understanding’, ‘family functioning’, ‘info-emotional cycle’, ‘micro-system sociological framework’, ‘service-needs-resource cycle’ and ‘experiential challenges’. Socio-cultural influences have affected parents’ interpretations of their experiences and needs. Moreover, parents reported that raising an ‘at risk’ child had an impact on their daily life as a family, as a couple and on their individual lifeworld. Maltese parents felt that their needs were not given their due importance by policymakers and professionals. This warrants the incorporation of parents’ needs, together with the needs perceived for their child, in the provision of early intervention and/or paediatric services in Malta. This study also identified parents’ experiential differences as the child grow, highlighting the need for regular re-evaluation of parents’ needs. Recommendations for changes in Maltese family policy, service provision and education of professionals were proposed to reduce parents’ stresses

Value of clinical, ultrasonographic and MRI signs as diagnostic differentiators of non-benign lipomatous tumours

Suspicion of malignant change within a lipoma is a common and increasing workload within the UK Sarcoma multidisciplinary team (MDT) network, and a source of considerable patient anxiety. Currently, there is no lipoma-specific data, with regard to which clinical or radiographic features predict non-benign histology, or calculate an odds-ratio specific to a lipomatous lesion being non-benign. We performed a 9-year, double-blind, unmatched cohort study, comparing post-operative histology outcomes (benign versus non-benign) versus 15 signs across three domains: Clinical (size of tumour, depth, growth noticed by patient, previous lipoma, patient felt pain), Ultrasonographic (size, depth, vascularity, heterogenous features, septae) and MRI (size, depth, vascularity, heterogenous features, septae, complete fat signal suppression). Receiver operating characteristic (ROC) analysis, odds ratios and binary logistic regression analysis was performed double-blind. When each sign is considered independently, (ROC analysis, followed by binary logistic regression) only Ultrasound depth is a significant predictor (p = 0.044) of a histologically non-benign lipoma. Ultrasonographically determined vascularity and septation were not statistically significant predictors. None of the clinical signs were statistically significant (p > 0.05). Of the MRI signs none was statistically significant (p > 0.05). However, heterogeneous MRI features fared better than MRI depth. Ultrasound signs (Pseudo R-Square = 0.105) are more predictive of the post-operation histology outcome than Clinical signs (Pseudo R-Square = 0.082) or MRI tests (Pseudo R-Square = 0.052) Ultrasound and Clinical tests combined (Pseudo R-Square = 0.147) are more predictive of the post-operation histology outcome than MRI tests (Pseudo R-Square = 0.052). This work challenges the traditional perception of “red-flag” signs when applied to lipomatous tumours. We provide accurate data upon which an informed choice can be made, and provides a robust bases for expedited risk/benefit. The importance of an experienced and cohesive MDT network is emphasised.peer-reviewe

Family education seminar for hypospadias surgery, a powerful preoperative tool -7yr outcomes

The effectiveness of educational pre-operative interventions is welldocumented. Parents of children with hypospadias have been shown to retain little of the information provided in the standard hospital outpatient setting.1 Pre-operative educational interventions have not been documented in hypospadias2 . We present experience of our multidisciplinary hypospadias family seminars over 7 years (20122018) in a regional centre. The contribution to parents satisfaction, of various domains demonstrated through formal quantitative-qualitative analysis.peer-reviewe

Cost-benefit analysis of cutaneous laser surgery in secondary burn reconstruction

Thermal disease presents a major burden to individual patient morbidity, healthcare cost as well as to over all economy. Burns also also represent a significant per-patient utlilisation of finite healthcare resources. Secondary complications in these patients, such as multiple drug resistant organisms, may have a devastating effect.peer-reviewe

Perceptions regarding correct pre-operative storage and transfer of amputated digits : a national experience

Replantation of amputated body parts is a highly specialised, cost-intensive procedure and can offer significantly increased quality of life in selected cases. To optimise chances of successful replantation, appropriate preparation and transfer to the replantation centre is critical. In the absence of custom made devices for storage of the amputated part, pre-hospital preparation is often determined by the referring practitioner, prior to contact with the referring department. This study has re-explored the perceptions of referring practitioners regarding correct pre-operative storage and transfer of amputated tissue to the Welsh Centre for Plastic Surgery, following an earlier national audit (2008).peer-reviewe

Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.peer-reviewe

Literature Included for Critical Appraisal.

<p>Literature Included for Critical Appraisal.</p