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Mashup Score: 1Clinical application of paediatric serum troponin T testing - 4 hour(s) ago
Cardiac ischaemia is rare in children, and acute presentations of chest pain are multifactorial. Serum troponin testing may be used to aid diagnosis of suspected cardiac ischaemia in both children and adults; however, the literature suggests there is limited value in serum troponin testing in paediatric patients presenting with chest pain.1 2 We conducted a single-centre review of all troponin T (TnT) laboratory requests from paediatric patients up to their 16th birthday from 19 September 2017 to 21 September 2022. 354 samples were included in the final analysis. Table 1 describes the yield of elevated serum troponin results based on common presenting complaints and the subsequent incidence of a cardiac diagnosis. A serum TnT>10 ng/L was considered elevated based on the …
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Mashup Score: 6Parasitic infections: what do paediatricians need to know? - 7 day(s) ago
Parasitic infections and the medications used to treat them may be unfamiliar to many paediatricians. Parasitic infections, however, are not uncommonly seen in children in the UK. We summarise infections which are commonly seen, currently recommended treatment and practical guidance on formulations, adverse effects and treatment choice.
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Mashup Score: 16
Objective To estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and clinical characteristics of these patients, and which personnel facilitated the restraint. Design Audit and anonymous case series Setting Paediatric wards in England. Patients Children and young people receiving this intervention in a 1-year period. Outcome measures An online survey was sent to all paediatric wards in England, with the option of submitting anonymous case studies. Results 136/143 (95.1%) acute paediatric units responded. 144 young people received this intervention across 55 (38.5%) paediatric units. The predominant diagnosis was anorexia nervosa (64.5%), age range 9–18 years (M=14.2, SD=2.1). The duration of NGT feeding under restraint ranged from 1 to 425 days, (M = 60.2, SD=80.4). Numerous personnel facilitated the restraints, including mental health nurses, paediat
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Mashup Score: 27
In the United Kingdom (UK), preschool wheeze is usually defined as occurring in children aged one to five years old. Prevalence studies report a third of children experience at least one wheeze episode before the age of three, rising to half of all children by the age of six.1 These acute episodes represent a considerable healthcare burden, causing significant morbidity for affected children, parental stress and reduced productivity; with annual UK healthcare costs in-excess-of £53 million.2 3 The multifactorial nature of acute preschool wheeze (APSW) episodes are such that, in reality, this is an umbrella term; encompassing several phenotypes rather than a singular entity.1 In 2008, the European Respiratory Society Task Force recommended clinical phenotype categorisation as episodic viral wheeze (EVW) or multiple trigger wheeze (MTW).4 EVW is more common; typically associated with viral respiratory infections and minimal interval symptoms,4 whereas children with MTW are more commonly
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Mashup Score: 51Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study - 12 day(s) ago
Objective To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT). Design One-year quality improvement study using a before–after design. Setting Free-standing tertiary care paediatric hospital. Patients Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit. Interventions Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT. Main outcome measures Removal of inappropriate beta-lactam allergy labels. Results 80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8–12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy
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Mashup Score: 46Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study - 14 day(s) ago
Objective To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT). Design One-year quality improvement study using a before–after design. Setting Free-standing tertiary care paediatric hospital. Patients Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit. Interventions Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT. Main outcome measures Removal of inappropriate beta-lactam allergy labels. Results 80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8–12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy
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Mashup Score: 3Parasitic infections: what do paediatricians need to know? - 17 day(s) ago
Parasitic infections and the medications used to treat them may be unfamiliar to many paediatricians. Parasitic infections, however, are not uncommonly seen in children in the UK. We summarise infections which are commonly seen, currently recommended treatment and practical guidance on formulations, adverse effects and treatment choice.
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 23D printing: a useful tool for safe clinical practice in children with complex vasculature - 18 day(s) ago
Background 3D printing has been used in different medical contexts, although it is underutilised in paediatrics. We present the first use of 3D printing in the management of three paediatric patients with complex renovascular disease. Methods Patient-specific 3D models were produced from conventional 2D imaging and manufactured using 3D polyjet printing technology. All three patients had different underlying pathologies, but all underwent multiple endovascular interventions (renal artery balloon angioplasty) prior to 3D printing and subsequent vascular surgery. The models were verified by an expert radiologist and then presented to the multidisciplinary team to aid with surgical planning. Results Following evaluation of the 3D-printed models, all patients underwent successful uni/bilateral renal auto-transplants and aortic bypass surgery. The 3D models allowed more detailed preoperative discussions and more focused planning of surgical approach, therefore enhancing safer surgical plann
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Mashup Score: 8Multiple magnet ingestion causing volvulus - 18 day(s) ago
A 22-month-old boy presented to the emergency department with a 2-day history of constipation and a 1-day history of non-bilious vomiting. Examination showed a soft, distended abdomen with sluggish bowel sounds. Abdominal X-ray (figure 1) showed distended small bowel loops, lack of bowel gas distally and five foreign bodies in the right iliac fossa, likely magnetic beads from a sibling’s new toy, although the ingestion was not witnessed. Figure 1 Abdominal X-ray showing dilated loops of bowel …
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Mashup Score: 15
Objective Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing. Design Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers. Setting Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI). Main outcome measures Describe practice and variation in discharge advice, treatment recommendations and safety netting provision. Results Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) ‘nearly always’ assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
How useful is serum troponin T testing by itself in children? Low yield for collapses, palpitations or GI symptoms Risk of false-negative results Single centre retrospective review 🇬🇧 @gcmckeeman https://t.co/zI4rAJrhVZ https://t.co/gy3yKTop69