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Background The use of survey instruments to measure women’s experiences of their maternity care is regarded internationally as an indicator of the quality of care received. To ensure the credibility of the data arising from these instruments, the methodological quality of development must be high. This paper reports the protocol for a systematic review of self-report instruments used to measure women’s experiences of their maternity care. Methods Citation databases CINAHL, Ovid MEDLINE and EMBASE will be searched from 2002 to 2018 using keywords including women, experience, maternity care, questionnaires, surveys, and self-report. Citations will be screened by two reviewers, in two rounds, for inclusion as per predetermined inclusion and exclusion criteria. Data extraction forms will be populated with data, extracted from each study, to evaluate the methodological quality of each survey instrument and the criteria for good measurement properties using quality criteria. Data will also be extracted to categorise the items included in each survey instrument. A combination of a structured narrative synthesis and quantitate summaries in tabular format will allow for recommendations to be made on the use, adaptation and development of future survey instruments. Discussion The value of survey instruments that evaluate women’s experiences of their maternity care, as a marker of quality care, has been recognised internationally with many countries employing the use of such instruments to inform policy and practice. The development of these instruments must be methodologically sound and the instrument itself fit for the purpose and context in which it is used. This protocol describes the methods that will be used to complete a systematic review that will serve as a guide for choosing the most appropriate existing instruments to use or adapt so that they are fit for purpose, in addition to informing the development of new instruments. Systematic review registration PROSPERO CRD42018105325

Background Up to 50% of paediatric hospital admissions are for infectious diseases. The vast majority are managed by General Paediatricians and General Physicians (GPs). It is therefore vital that Paediatric and GP trainees have sufficient knowledge/exposure to these illnesses during their training. The recent outbreak of Measles in Europe emphasises the need for simulated training as many current trainees will not have managed this disease previously. ‘KIDS’ is a simulation based education programme (SBE) for paediatric trainees involved in the management of children with infectious diseases from prevention to delivery of acute care. Aim/Objectives The aim of the programme was to change the behaviours of the learners in the identification and management of Measles, Rotavirus, Meningitis and Pertussis. Secondary objectives were identify the participant’s learning needs; design a programme addressing those needs; and evaluate the programme for satisfaction/acceptability levels. Methods We employed a mixed methods study design and the programme was designed using an iterative approach with a multidisciplinary stakeholder input. Paediatric SHOs (n=8) in a large teaching hospital were recruited. Pre-programme questionnaires were distributed to identify knowledge gaps and learners’ needs. The programme was designed to address the learners’ needs through 4 complex scenarios designed by subject matter experts; meningococcal septicaemia with fluid resistant shock; measles with a secondary pneumonia; pertussis with associated apnoeas and finally rotavirus gastroenteritis and hypoglycaemia. These scenarios were delivered using hi-fidelity manikin based simulation in an on-site simulation centre. Post-training satisfaction surveys were distributed. Semi-structured interviews were conducted with participants at 4weeks to determine if the programme impacted on their behaviours when managing similar cases in clinical practice. Results Pre-programme questionnaire (n=10) used to determine the content of the scenarios. Post-programme questionnaire (n=8) identified a high satisfaction rate with the programme with 100% reporting that the programme addressed their needs and that they would like more training of this type. At delayed post-training interviews (n=8), all interviewees reported that they had benefitted from the programme and it had impacted their behaviours in clinical practice; 80% of the participants had changed the way they communicate with patients/parents, 50% reported more awareness of sick children and 50% reported adopting a more systematic approach to the unwell child. Conclusion A well-designed SBE programme targeting learning needs can result in more than a well-received educational experience. It can result in a change in behaviour, communication and approach to paediatric care in clinical practice.

Introduction The high-risk, low-volume nature of paediatric emergencies can results in a lack of physician comfort and confidence in dealing with sick children.1 Simulation training can help improve caregiver confidence and team communication and performance in paediatric emergencies. 1 Aims Weekly, multi-disciplinary simulation sessions are held in the ED in UCHG. We sought to identify the baseline experience and confidence levels of those attending and to identify areas whereby the sessions could be improved. We then re-surveyed participants after 15 simulation sessions to identify how useful they found the sessions and to identify means of further improvement. Methods Surveys were distributed to staff attending the weekly simulation sessions before and after 15 simulations sessions. Results 17 baseline and follow up surveys were returned. The initial comfort level of respondents participating in simulations were: very uncomfortable (4) ,slightly uncomfortable (4), neither comfortable nor uncomfortable (6), comfortable (3) , very comfortable (0). 10/17 respondents felt they learned more by participating in simulations and 7/17 felt that they learn more by observing. 15/17 found the scenarios ‘helpful’ or ‘very helpful’. Suggestions to improve the sessions included: more consultant involvement (5), a registrar leading the scenario (4), longer, more complicated scenarios (6), involvement of more participants (8)and receiving the topic and study materials earlier in the week (7). We sought to implement these recommendations and then performed the follow up survey. After 15 simulation sessions 8/17 participants found the sessions very helpful and 9/17 found them helpful. 6/17 ‘strongly agreed’ and 10/17 ‘agreed’ that the sessions improved their confidence in participating in simulations. 10/17 participants felt they learned more by observing the simulations. 17/17 participants found the sessions helpful and 15/17 felt they improved their confidence dealing with sick children. Feedback on improvements made to the sessions was variable and suggestions for further improvement were received. Conclusions 100% of participants felt the sessions were helpful and 88% felt they improved their confidence dealing with sick children. Low-fidelity, in-situ simulation can improve caregiver confidence but it important to be aware of the various levels of experience within your department and to seek feedback and strive for constant improvement. References Cristallo, T., Walters, M., Scanlan, J., Doten, I., Demeter, T., & Colvin, D. (2018). Multidisciplinary, In Situ Simulation Improves Experienced Caregiver Confidence With High-Risk Pediatric Emergencies. Pediatric Emergency Care, 1.

Background Rotavirus (RV) remains one of the most common causes of acute infectious gastroenteritis (GE) worldwide.1 In developed countries, mortality due to rotavirus is low, however, the morbidity and direct healthcare costs such as laboratory tests, medications, medical care and accommodation costs associated with hospitalisations are considerably high.2 There are also the indirect economic costs such as parental work days missed. Ireland introduced Rotarix® vaccine, a monovalent, live attenuated, oral vaccination against RV into the primary Childhood Immunisation Schedule for all children born on or after 1st October 2016. Aim Median cost- per- episode of laboratory confirmed RV infection requiring hospitalisation in Galway University Hospital (GUH) before and after RV vaccine introduction. Methods Data was collected retrospectively over 2 separate 1-year periods (2014 and 2017) in the Paediatric department GUH, a regional hospital in west of Ireland. All Children under 5 years admitted to hospital with laboratory confirmed RVGE were included. Information regarding the length of stay, direct costs, demographic details were collected form the medical notes. Indirect costs were collected from parents over the phone. Results There was a 57% reduction in children admitted with RVGE in 2017 (n=45) after vaccine introduction compared with RVGE admissions in 2014 (n=105) in GUH. The median age admitted was 1.5 years (range1–4) in 2014 and 1.6 years (range 0.3–4.5) in 2017. The median length of stay was unchanged; 2 nights (range 1–6) in 2014 and 2 nights (range 1–4) in 2017. The median direct cost per child per admission in 2014 was €1601 and €1705 in 2017. The total cost of RVGE admissions in GUH was reduced from €160,958 in 2014 to € 77,109 in 2017 resulting in a saving of €83,849. Conclusion There was a 57% reduction in the number of hospilisations due to RVGE in GUH in 2017- the first year after introduction of the RV vaccine in Ireland. This resulted in a direct saving of €83,849 in 2017. This provides early evidence of the public health benefit of introducing the RV vaccine into the national immunisation programme in Ireland. References Rotavirus burden and surveillance. Centers for Disease Control and Prevention. http://www.cdc.gov/rotavirus/surveillance.html Van Damme P, Giaquinto C, Huet F, Gothefors L, Maxwell M, Van der Wielen M; REVEAL Study Group. Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe, 2004–2005: the REVEAL study. J Infect Dis 2007 May 1;195Suppl 1:S4–S16.

Background Low levels of success in performing lumbar puncture have been observed among paediatric trainees. This study assessed the efficacy of simulation-based education with frequency building and precision teaching for training lumbar puncture to behavioural fluency. Methods The intervention group was assessed at baseline, at the final training trial, in the presence of distraction, and a minimum of one month after the cessation of the intervention in order to ascertain whether behavioural fluency in lumbar puncture was obtained. Subsequently, the performance of this intervention group (10 paediatric senior house officers) was compared to the performance of a comparator group of 10 more senior colleagues (paediatric registrars) who had not received the intervention. Retrospective chart audit was utilised to examine performance in the clinical setting. Results Intervention group participants required a mean of 5 trials to achieve fluency. Performance accuracy was significantly higher in the intervention group than the comparator group. Learning was retained at follow-up and persisted during distraction. Retrospective chart audit revealed no significant difference between the performance of the intervention group and a comparator group, comprised of more senior physicians, in the clinical setting, although the interpretation of these analyses are limited by a low number of lumbar punctures performed in the clinical setting. Conclusions The programme of simulation-based education with frequency building and precision teaching delivered produced behavioural fluency in lumbar puncture among paediatric trainees. Following the intervention, the performance of these participants was equivalent to, or greater than, that of senior paediatricians. This study supports the need for further research exploring the effectiveness of simulation-based education with precision teaching to train procedural skills to fluency, and the consideration of how best to explore the impact of these on patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12909-019-1553-7) contains supplementary material, which is available to authorized users.

We report the case of a 13-day-old infant with enteroviral myocarditis surviving an out-of-hospital cardiac arrest. She underwent orthotopic cardiac transplantation three months later. A year after the transplantation, she is alive and well. Enteroviral infection is common in neonates with high mortality in cases of enteroviral myocarditis. Cardiac transplantation is a treatment option for infants who fail to recover and remain dependent on inotropic support. This is the first report of an infant with out-of-hospital cardiac arrest secondary to enteroviral myocarditis surviving up to cardiac transplantation.

Relatively, few reports of deletions involving the distal long arm of chromosome 4 (4q) exist. Five further cases are described and the findings are compared with those in previous literature reports. Distal 4q deletions may be recognized by the distinctive appearance of the fifth finger, which is stiff with a hypoplastic distal phalanx and a hooked or volar nail. All cases with this characteristic fifth finger anomaly appear to have deletions involving 4q34.