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ObjectiveIndia has been struggling with infant malnutrition for decades. There is a need to identify suitable platforms for community engagement to promote locally feasible, resource efficient Infant and Young Child Feeding (IYCF) interventions. This study aims to explore if and how schools could represent a site for community engagement in rural India, acting as innovation hubs to foster positive change in partnership with the Angawadi centres.DesignFive-phase formative study; A parallel mixed methods approach structured by a socioecological framework was used for data collection at individual, household and community levels. This paper focuses on the qualitative findings.SettingThis study was undertaken in nine villages within two blocks, ‘Ghatol’ and ‘Kushalgarh’, in the Banswara district of Rajasthan, India.Participants17 schools were identified. Interviews were conducted with local opinion leaders and representatives in the education sector, including principals, schoolteachers, block and district education officers. Across the nine study villages, information was gathered from 67 mothers, 58 paternal grandmothers using Focus Discussion Groups (FDGs) and 49 key respondents in Key Informant Interviews.ResultsSchools were considered an important community resource. Challenges included limited parental participation and student absenteeism; however, several drivers and opportunities were identified, which may render schools a suitable intervention delivery site. Enrolment rates were high, with schools and associated staff encouraging parental involvement and student attendance. Existing initiatives, including the mid-day meal, play opportunities and education on health and hygiene, further highlight the potential reliability of schools as a platform for community mobilisation.ConclusionsSchools have been shown to be functional platforms frequently visited and trusted by community members. With teachers and children as change agents, schools could represent a suitable setting for community mobilisation in future wider scale intervention studies. Expanding the supportive environment around schools will be essential to reinforce healthy IYCF practices in the long term.

Aims To systematically review the effectiveness of preventive and therapeutic interventions for RTIs in children and adults with DS. Methods PubMed, Embase.com, CINAHL, the Cochrane Library and trial registries were searched for published and ongoing studies of respiratory tract diseases, cardiovascular diseases and obstructive sleep apnoea to provide a broad overview of the existing evidence base. These databases were searched for controlled trials, cohort studies and controlled before-after (CBA) studies and trial registries were searched for ongoing studies. Initially, all before mentioned study types were included to provide a broad overview of the existing evidence base. However, those with a critical risk of bias were excluded using the Cochrane risk of bias tool. Results A total of 13,575 records were identified from which five studies fulfilled the eligibility criteria and three fulfilled our criteria for data extraction. These three studies assessed the effectiveness of drugs for preventing RTIs in children with DS. One randomised controlled trial (RCT) of moderate risk of bias compared zinc therapy with placebo. Outcome data were only reported for 50 (78%) children who presented with “extreme” symptoms; no benefit of zinc therapy was found. One non-RCT with serious risk of bias included 26 children and compared pidotimod (a synthetic dipeptide with immunomodulatory properties) with no treatment; pidotimod was associated with fewer upper RTI recurrences compared with no treatment (1.43 vs. 3.82). A prospective cohort study with moderate risk of bias compared 532 palivizumab treated children under the age of 2 with 233 untreated children and found that children treated with palivizumab had fewer RSV-related hospitalisation (23 untreated, 8 treated) but the same number of overall RTI-related hospitalisations (73 untreated, 74 treated) in the first two years of life. Conclusions The evidence base for the management of RTIs in people with DS is incomplete. Methodological rigorous studies are warranted to guide clinicians in how best to prevent and treat RTIs in people with DS.

Down’s Syndrome (DS) is one of UK’s commonest genetic conditions with a stable incidence of 1 in 1000 live births. Despite this, there is a paucity of research on the most cost-effective management options. A systematic review was undertaken to map original UK and ROI research and identify gaps. In a follow-on study, we will undertake a prioritisation exercise involving experts, stakeholders and carers to prioritise future research investment. A systematic review of Medline, Embase, Cinahl-Ovid and Cochrane Library was undertaken utilising terms related to DS, UK and ROI. Exclusion criteria: (a) Studies were categorised by participant demographics, study type, research and clinical themes, funding amount and type. Grey literature searches (Google Scholar), research networks (eg. Trisomy 21 Research Society, Down’s Syndrome Medical Interest Group), charities (eg. Down Syndrome Association) are ongoing and will be reported at the conference. 2331 published articles were retrieved from electronic database searches. We excluded 2174 studies after screening titles/abstracts of which 80% were prenatal studies. After reviewing full text of the remaining 157 articles, a further 26 were excluded. This left 131 studies (Figure 1). A large number of articles (58; 44%) focused on disease epidemiology (eg. incidence, prevalence) with little studies undertaken (8; 6%) to improve their management. Data extraction is ongoing with further findings reported at the conference. With incidence remaining static and DS continuing to be a high-burden condition in the UK, DS should be an area of high priority for funders, policymakers and researchers. Once completed, this review will provide an insight into funding trends and research gaps in this vulnerable population. This will facilitate subsequent identification and prioritisation of research investments and priorities.

Aims To undertake a prioritisation exercise involving healthcare professionals (HCPs) and South Asian (SA) families to develop child health research and public awareness agendas’ Methods A two-stage process was adopted. A HCP scoping survey was undertaken to generate topics important for SA child health (1) research (2) public awareness and (3) outcome indicators. Ranked lists were discussed in four focus groups of SA adolescents and families. A Punjabi and Urdu speaking community facilitator moderated groups with a British Sign Language interpreter assisting in the deaf group. Concordant and discordant themes between HCPs and SAs were identified. Results 27 HCPs participated in the survey. Table 1 summarises their priorities 35 individuals (Age range: 16–74 and UK stay length: 3–57 years) participated. Groups varied by settings (Inner vs. Outer city), religion, descent and disability. Engagement was highest on public awareness and lowest on outcome indicators. Lack of awareness of research undertaken by funders (NIHR, Wellcome Trust, MRC) were cited. Table 2 summarises their priorities. Conclusion Community engagement yielded research and public awareness priorities which differed with HCPs. In line with NHS England and NIHR national strategies, collaboration with communities whose views are not traditionally considered is essential to determine service and research agendas important to families, professionals and providers.

A 74 year old man presented to the ear, nose, and throat department with breathlessness on exertion, intermittent voice hoarseness, and a sensation of catarrh in his throat. After a laryngoscopy with biopsy was performed, he was diagnosed as having a low grade chondrosarcoma of the larynx. Before surgical debulking of the lesion was carried out he underwent computed tomography of the chest, abdomen, and pelvis. This confirmed the presence of a subglottic mass in the larynx but also showed a mixed lytic and sclerotic expansile lesion (5.8 cm (longitudinal)×1.6 cm (axial)×4.5 cm) in the left iliac blade of the pelvis. The pelvic lesion was well corticated, with internal ossified septae and calcification. Expansion of the left iliac wing was noted, with no breach in the cortex. He had no symptoms other than those that he presented with, which resolved after surgical debulking of the chondrosarcoma. He denied any pain and was independently mobile with a normal gait. He had never smoked and drank less than 7 units of alcohol a week. He had no comorbidities and was not taking any drugs. All blood results and a chest radiograph were normal. A plain radiograph of the pelvis was taken to help characterise the pelvic lesion. This showed a solitary well corticated lesion in the left iliac bone. There was evidence of ossification within the lesion but an absence of periostitis (figure⇓). Calcification of the lesion, endosteal scalloping, and expansion of …

Cobbold and colleagues state that γ-glutamyltransferase should be measured in all patients with raised serum alanine aminotransferase because if raised it would indicate alcohol related liver disease.1 Because of its ubiquitous distribution within the …

Aims (1) To evaluate the use of an online multimedia learning package incorporating an evidence-based guideline on acute breathing difficulties (ABD) as an adjunct to standard clinical teaching. (2) To assess its impact on knowledge gain and self-assessed confidence prior to starting a paediatric clinical attachment. Methods A randomised cohort of 108 fifth-year medical students in six teaching blocks undertaking their paediatric clinical attachments were evaluated during February 2008–July 2009. Teaching blocks were randomly assigned to receive either the learning package and standard clinical teaching (n=55) or the standard clinical teaching alone (n=53). A formative 24-item knowledge assessment in multiple-choice question format incorporating video case scenarios and a seven-item questionnaire for self-appraisal of confidence in the assessment of paediatric ABD cases was administered before and after instruction. A 36-item questionnaire evaluating postinstruction student satisfaction in multimedia instruction clearness, learning methodology, presentation material quality, motivation and learning material adequacy for subsequent case management was also administered. Results All students (100%) had The learning package was also noted to be highly satisfactory to students in all sections. Conclusion The ABD learning package delineated a positive impact on cognitive gain and self-assessed confidence improvement in paediatric medical students. These results support the conclusion that a thoroughly designed tool can be invaluable in preparing students with minimal experience in paediatrics for clinical contact in addition to introducing the concept of clinical practice guidelines at undergraduate level. Further study is needed to see if similar advantages could be gained in other clinical specialities.