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Mashup Score: 0When is a ‘decision’ an important decision in a decision tool - 13 hour(s) ago
Apart from a global reduction in attendances during the COVID-19 pandemic,1 emergency departments continue to see growth in the presentations of children and young people (CYP).2 However, there has not been a similar increase in admissions leading to the so-called ‘needle in the haystack’ phenomenon which describes the difficulty clinicians face in selecting CYP for investigation or intervention when the incidence of modifiable disease is so low. CYP who present overtly unwell are always going to receive resuscitation regardless of the underlying cause of illness as restoration of adequate oxygenation, replenishment of circulating volume or support of cerebral function is a priority. These numbers, however, are small, likely no more than 1–2% of total attendances. A larger group of patients (perhaps 40% but with large regional and national variation) have a clinical appearance to healthcare professionals suggesting investigations are not necessary as they are deemed so low risk of seri
Source: adc.bmj.comCategories: General Medicine News, Hem/OncsTweet
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Mashup Score: 1
Cystic fibrosis (CF) is a well-characterised genetic disease caused by reduced function or absence of cystic fibrosis transmembrane regulator (CFTR) protein. In the 1930s–1950s, the gastrointestinal (GI) manifestations were the most life-threatening—the term ‘cystic fibrosis’ was a description first used by Dorothy Andersen related to the characteristic postmortem histology of the pancreas, and death before school age was common, with severe malnutrition due to pancreatic exocrine insufficiency a major contributor. The introduction of pancreatic enzyme replacement therapy resulted in the focus of clinical management moving to the lungs. The landscape of CF care is now once again dramatically changing with the introduction of CFTR modulator drugs.1 These medications act directly to improve the function of the mutant protein and in older children and adults have been shown to significantly improve lung function, body mass index and quality of life, reduce pulmonary exacerbation by up to
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 1Paediatric inpatient services for adolescents in England - 2 day(s) ago
There is growing scrutiny regarding the quality of inpatient care for adolescents in England, and whether services can meet their unique medical and psychosocial needs.1 Adolescents represent a substantial proportion of paediatric health service users and have a rising chronic disease burden. Adolescents with chronic conditions have high unplanned admission rates and longer hospital stays than younger groups. Despite broad agreement that inpatient services should cater specifically to adolescents’ needs, there are sparse data available detailing what is actually happening on the ground. We surveyed the paediatric clinical leads of all 155 National Health Service (NHS) England hospitals with acute inpatient paediatric services to understand the current provision for adolescents. The 115 (74%) respondents reported substantial variation in current practice. Half of paediatric inpatient services routinely admit only patients <16 years to paediatric wards, with admission policies for those
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 4Multifocal tuberculosis: a phenotype of Mendelian susceptibility to mycobacterial disease - 2 day(s) ago
A just over 1-year-old girl presented with a history of multifocal tuberculosis. The patient was born at full-term in Madagascar. She was not BCG vaccinated. At 8 months old, she had measles complicated by pneumonia, with a persistent cough treated with prolonged high-dose oral corticosteroids. At 12 months old, pulmonary, cutaneous and otitic tuberculosis was diagnosed in Madagascar. Testing was positive for non-drug-resistant Mycobacterium tuberculosis in sputum (PCR) and otorrhoea (PCR, culture). Quadruple anti-tuberculosis antibiotherapy was initiated, but adherence to treatment was poor. On evaluation at our centre 2 months after initiation of treatment, we noted progression of the multifocal tuberculosis …
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 2Improving knowledge of rare disorders since 1993: the Australian Paediatric Surveillance Unit - 3 day(s) ago
The Australian Paediatric Surveillance Unit (APSU), established in 1993 to address the paucity of national data on rare childhood disorders, has become an invaluable research resource. It facilitates prospective, active surveillance for a variety of rare disorders, with monthly reporting by ~1500 paediatricians, who are invited to notify incident cases and provide demographic and clinical data. APSU is highly collaborative (used by >400 individuals/organisations), patient-informed and productive (>300 publications). In 30 years, 72 studies have been initiated on rare infections, and genetic, psychological and neurological disorders, and injuries. Return rates of monthly report cards were >90% for 30 years and paediatricians have provided data for >90% of notified cases. Although there are limitations, including case underascertainment in remote regions, APSU often provides the only available national data. APSU has assisted the government in reporting to the WHO, developing national st
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 2Clinical application of paediatric serum troponin T testing - 7 day(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 …
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 6Parasitic infections: what do paediatricians need to know? - 14 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: 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
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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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
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 51Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study - 19 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
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
When is a ‘decision’ an important decision in a decision tool? https://t.co/bNZR40dVYz via @Damian_Roland