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International audience; Background: Training clinicians on the use of hospital-based patient monitoring systems (PMS) is vital to mitigate the risk of use errors and of frustration using these devices, especially when used in ICU settings. PMS training is typically delivered through face-to-face training sessions in the hospital. However, it is not always feasible to deliver training in this format to all clinical staff given some constraints (e.g., availability of staff and trainers to attend in-person training sessions and the costs associated with face-to-face training). Objective: The literature indicates that E-learning has the potential to mitigate barriers associated with time restrictions for trainers and trainees and evidence shows it to be more flexible, and convenient for learners in healthcare settings. This study aimed to develop and carry out a preliminary evaluation via a case study of an e -learning training platform designed for a novel neonatal sepsis risk monitor system (Digi-NewB).Methods: A multi-modal qualitative research case study approach was used, including the analysis of three qualitative data sources: (i) audio/video recordings of simulation sessions in which participants were asked to operate the system as intended (e.g., update the clinical observations and monitor the sepsis risk), (ii) interviews with the simulation participants and an attending key opinion leader (KOL), who observed all simulation ses-sions, and (iii) post-simulation survey.Results: After receiving ethical approval for the study, nine neonatal intensive care unit (NICU) nurses completed the online training and participated in the simulation and follow-up interview sessions. The KOL was also interviewed, and seven out of the nine NICU nurses answered the post-simulation survey. The video/audio analysis of the simulations revealed that participants were able to use and interpret the Digi-NewB interface. Interviews with simulation participants and the KOL, and feedback extracted from the survey, revealed that participants were overall satisfied with the training platform and perceived it as an efficient and effective method to deliver medical device training.Conclusions: This study developed an online training platform to train clinicians in the use of a critical care medical device and carried out a preliminary evaluation of the platform via a case study. The e-learning platform was designed to supplement and enhance other training approaches. Further research is required to evaluate the effectiveness of this approach.

Background The process of developing a survey instrument to evaluate women’s experiences of their maternity care is complex given that maternity care encapsulates various contexts, services, professions and professionals across the antenatal, intranatal and postnatal periods. Aim To identify and prioritise items for inclusion in the National Maternity Experience Survey, a survey instrument to evaluate women’s experiences of their maternity care in the Republic of Ireland. Methods This study used an adapted two-phase exploratory sequential mixed methods design. Phase one identified items for possible inclusion and developed an exhaustive item pool through a systematic review, focus groups and one to one interviews, and a gap analysis. Phase two prioritised the items for inclusion in the final item bank through a Delphi study and consensus review. Findings Following iterative consultation with key stakeholder groups, a bank of 95 items have been prioritised and grouped within eight distinct care sections; care during your pregnancy, care during your labour and birth, care in hospital after the birth of your baby, specialised care for your baby, feeding your baby, care at home after the birth of your baby, overall care and you and your household. Conclusion Robust and rigorous methods have been used to develop a bank of 95 suitable items for inclusion in the National Maternity Experience Survey.

Background Recognition of the measurement of women's experiences of their maternity care as a critical component of care quality evaluation has led to a proliferation of instruments to measure this concept. However, the suboptimal methodological and psychometric quality of these instruments, or the lack of reporting of same, hinders the credibility and efficient use of the arising results, which often serve as an indicator for the direction of limited resources within maternity services. Aim To review systematically and critically appraise self-report survey instruments measuring women's experiences of their maternity care. Methods A systematic review was conducted using comprehensive searches of the CINAHL, OVID MEDLINE and EMBASE citation databases. Inclusion and exclusion criteria were applied, and a stepped approach employed to facilitate evaluation of the methodological and psychometric quality of included instruments. Findings 4905 records were obtained from database searches. Additional records were obtained via reference checking and by expert suggestion. Following stepped screening, 40 papers related to 20 instruments are included in this review. Findings indicate that evidence of the methodological and psychometric quality have not been reported for many included instruments. Conclusions Published evidence of the methodological and psychometric quality of self-report survey instruments to evaluate women's experiences of their maternity care is lacking. The conduct and reporting of future development processes of such instruments can be improved. Systematic review PROSPERO registration: 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.