MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Archives of Disease in Childhood - Education and Practice' source. Thu, 09 Feb 2012 01:09:27 +0100 http://www.medworm.com/index.php?rid=5585774&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F40%3Frss%3D1 Question In children with chronic renal failure at risk of bone disease, which interventions prevent or treat the condition? Review scope Studies were selected which compared any active intervention with any other or placebo in the treatment of children with renal failure to prevent bone disease. Review methods Cochrane Renal Group's specialised register, CCTR, MEDLINE, EMBASE, reference lists and abstracts were searched without language restriction. The quality of the studies was assessed by the Cochrane ‘risk of bias’ criteria. Fifteen studies were included. Main results The 15 studies included 369 patients, and undertook five different comparisons. Two of these (ergosterols and phosphate binders) are no longer used in clinical practice. The quality of the included studies va... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585774 Wed, 11 Jan 2012 05:00:00 +0100 5585774 http://www.medworm.com/index.php?rid=5585773&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F39%3Frss%3D1 QUESTION 1 Answer: C. Irrespective of the sIgE result, if there is a good clinical history of an IgE-mediated food allergy and there is diagnostic doubt, an OFC should be performed to confirm or disprove clinical allergy QUESTION 2 Answer: D. An sIgE can be performed as a reliable screening test for food allergy QUESTION 3 Answer: A. She has a 50% chance of being tolerant to egg (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585773 Wed, 11 Jan 2012 05:00:00 +0100 5585773 http://www.medworm.com/index.php?rid=5585772&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F38%3Frss%3D1 Study designDesign Randomised placebo-controlled trial. Allocation Allocation sequence computer-generated random number list. Blinding Physicians, parents/caregivers. Study questionSetting Southwest Finland, community based. Patients 319 children aged 6–35 months diagnosed with acute otitis media by a qualified otoscopist. Intervention 161 infants assigned to amoxicillin–clavulanate 40 mg/kg/dose (clavulanate 5.7 mg/kg) for 7 days. 158 assigned to placebo. Outcomes Primary outcome was treatment failure (no overall improvement, no improvement in otoscopic signs, perforation, severe infection requiring antibiotics, adverse reaction); secondary outcomes included time to initiation of open label antibiotics and the development of contralateral otitis media. Follow-up period Until ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585772 Wed, 11 Jan 2012 05:00:00 +0100 5585772 http://www.medworm.com/index.php?rid=5585771&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F37%3Frss%3D1 Study designDesign Prospective cohort of babies born through meconium stained amniotic fluid (MSAF) between 2003 and 2006. Setting Two teaching hospitals in The Hague, The Netherlands. Patients 394 term (>37/40) neonates were born through MSAF. The mean gestational age was 40 weeks, 56% were male, and mean birth weight was 3.5 kg. Outcomes Meconium aspiration syndrome (MAS) (respiratory distress, oxygen or mechanical ventilation requirement in the first 24 h of birth). Risk factors assessed included abnormalities of fetal heart trace, consistency of meconium, umbilical artery pH and 5 min Apgar score. Follow-up period Every baby was followed up for a minimum of 24 h before discharge if well. Main results Of 394 neonates, 19 (4.8%) developed respiratory distress compatible with MAS. Of ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585771 Wed, 11 Jan 2012 05:00:00 +0100 5585771 http://www.medworm.com/index.php?rid=5585770&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F36%3Frss%3D1 Browsing in Clinical Evidence, I noticed six updated reviews and stumbled upon a couple of head scratchers for me. One of them, literally made my head itch. Bronchiolitis review. The holy grail has not been found. I thought we had a moderately good treatment in hypertonic saline when I read a systematic review that included four randomised controlled trials (RCT) and showed that 3% saline reduced mean length of stay by a day, and also improved clinical scores, when compared to 0.9% saline. But this review notes two subsequent RCTs that are not very encouraging. The first RCT included 46 children and there was no difference in hospital admission, oxygen saturation or clinical scores between 3% saline plus epinephrine and 0.9% saline plus epinephrine. The second RCT was larger, included 186 ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585770 Wed, 11 Jan 2012 05:00:00 +0100 5585770 http://www.medworm.com/index.php?rid=5585769&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F29%3Frss%3D1 Background Hypersensitivity (adverse reaction) to a food can be broadly divided into allergic hypersensitivity (food allergy) and non-allergic hypersensitivity (food intolerance).1 Food allergy is defined as an adverse immune response to a food allergen, whereas food intolerance is generally non-immune mediated. Food allergy can be subdivided into two main categories: IgE-mediated and non–IgE-mediated food allergy. The differences between the two are shown in table 1. Food intolerance incorporates several other adverse reactions to foods. These include toxic contaminants in food (eg, histamine in scombroid fish poisoning), pharmacological properties (eg, tyramine in aged cheese or caffeine), host characteristics (eg, lactase deficiency) and food aversion. Food allergies are common in... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585769 Wed, 11 Jan 2012 05:00:00 +0100 5585769 http://www.medworm.com/index.php?rid=5585768&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F23%3Frss%3D1 Neonatologists often feel helpless in the management of procedural pain. While we acknowledge that our patients are more frequently and chronically exposed to tissue damaging procedures than any other hospital population, and that they are more vulnerable both in the short and long term, it is not certain that we have any techniques that are proven to be effective. Although we have developed numerous guidelines1 2 they are not reliably applied in clinical practice.3 It is widely recognised that newborns undergoing intensive care are necessarily subjected to numerous painful procedures.4 Despite the availability of clinical guidelines the majority of painful procedures on neonatal intensive care units (NICUs) are still carried out without any form of analgesia. Even outside the NICU term ne... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585768 Wed, 11 Jan 2012 05:00:00 +0100 5585768 http://www.medworm.com/index.php?rid=5585767&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F22%3Frss%3D1 While reviewing over on BMJ Case Reports, I have come across some very curious paediatric articles and some that are not even catalogued under the paediatric specialty section but related to our practice. They can be found in the archive under the clinical and non-clinical sections. There is an abundance of weird and wonderful information on the website that serves to demonstrate unusual and unique learning points but also in some instances reiterate simpler things that we can sometimes take for granted in our busy working lives. My area of interest within paediatrics is rheumatology, so to start this series here are a couple of things from adult case reports that I thought I’d share with you here. Photosensitivity is an important counselling issue in children with systemic lupus ery... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585767 Wed, 11 Jan 2012 05:00:00 +0100 5585767 http://www.medworm.com/index.php?rid=5585766&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F17%3Frss%3D1 ‘Presentation—3 years old’ Alice is referred by her general practitioner (GP) for a paediatric neurology opinion with a history of episodes of her legs giving way. The referral letter from her GP mentions that when Alice is picked up when she has one of these episodes, she cannot control her legs, which move abnormally. Alice is seen by the registrar. Her parents' say that these episodes are occurring at a frequency of one every month, and they describe non-rhythmic jerky movements involving her legs lasting approximately 20 min. She falls and cannot walk or stand when these happen. Recovery occurs without intervention. She has experienced a total of five episodes, and they all occurred in the evening following exertion. Her consciousness is not impaired during these even... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585766 Wed, 11 Jan 2012 05:00:00 +0100 5585766 http://www.medworm.com/index.php?rid=5585765&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F9%3Frss%3D1 Introduction Puberty is the physiological sequence of events when secondary sexual characteristics develop and reproductive capacity is achieved. The start of puberty is characterised by the appearance of a palpable breast bud (stage B2) in girls and testicular volumes of >3.5 ml in boys. These changes are brought about in response to the pulsatile secretion of gonadotropin releasing hormone (GnRH) from the hypothalamus stimulating the release of follicle stimulating hormone (FSH) and luteinising hormone (LH) from the anterior pituitary. It is still unclear why the GnRH neurons are usually inhibited after infancy until the start of puberty, although fat mass (via leptin signalling) and kisspeptin secreting neurons stimulating the GnRH system certainly play a role. LH acts on the gonads ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585765 Wed, 11 Jan 2012 05:00:00 +0100 5585765 http://www.medworm.com/index.php?rid=5585764&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F2%3Frss%3D1 The paediatrician's role in the developmental assessment of children under the age of 5 is well established, and so he/she might also have a role in the assessment of school-age children, particularly as (i) it is increasingly recognised that subtle presentations of developmental disorders may escape professional notice until school age, (ii) these disorders are interweaving and overlapping, necessitating a truly holistic view and (iii) no another professional group is equipped to deliver a single diagnostic assessment encompassing cognitive, communication, social, emotional and physical domains. However, assessment in the over-5s requires a different set of skills to the under-5s. The emphasis in this age group shifts from assessing developmental impairment, for example, a specific delay ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585764 Wed, 11 Jan 2012 05:00:00 +0100 5585764 http://www.medworm.com/index.php?rid=5585763&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F1%3Frss%3D1 Welcome to the February Epistle, and to an edition of Education and Practice which looks – and perhaps feels – a little different, but which contains most of the sections you are familiar with. Here is a summary of the changes. First, those of you reading this on paper will have noticed the new cover; this is traditional with a change in Editor in Chief and because we publish on even months you would have also seen the redesign on the blue journal and F&N first. Next, those of you reading on paper or as downloaded pdfs, we have changed the way the articles are laid out on the page. We think this looks better on the page, and hope that the papers feel a bit better when you read them. Ideally of course, you will not notice anything. Finally, one of the bugbears of a journal i... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5585763 Wed, 11 Jan 2012 05:00:00 +0100 5585763 http://www.medworm.com/index.php?rid=5402116&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F240%3Frss%3D1 Study design Design Randomised, placebo-controlled trial. Allocation Age stratified randomisation. Blinding Partially double-blinded (investigators were blinded; ‘no treatment’ group was not blinded; the attempt to blind both treatment groups was likely ineffective). Study question Setting A paediatric outpatient practice in the USA. Patients 144 children aged 2–11 years presenting with moderately severe upper respiratory tract infection (URTI) symptoms (cough, congestion, rhinorrhoea) for ≥7 days. Children with asthma, pneumonia, laryngotracheobronchitis, sinusitis, chronic lung disease or seizure disorder were excluded. Intervention Participants were allocated to one of the following: (1) vapour rub (petrolatum containing camphor, eucalyptus oil and menthol; n=44), (... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402116 Thu, 10 Nov 2011 05:00:00 +0100 5402116 http://www.medworm.com/index.php?rid=5402115&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F239%3Frss%3D1 Design: Single centre randomised controlled trial. Allocation: Computer generated random-digit randomisation. Blinding: Participants, physicians and statisticians. Setting: Tertiary hospital paediatric outpatient department, Turin, Italy, March 2008 to August 2009. Patients: Breast-fed infants (n=46) aged 2–16 weeks with persistent crying fulfilling Wessel's criteria for colic: crying for more than 3 h/day for more than 3 days/week for more than 3 weeks. Intervention: A 5 ml oil suspension of Lactobacillus reuteri or an identically appearing and tasting placebo oil. Outcomes: Primary: Reduction in mean daily crying time at day 21 of treatment to less than 3 h/day. Secondary: Reduction in daily mean crying time to less than 50% of baseline at 7, 14 and 21 days. Follow-up period: 21 da... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402115 Thu, 10 Nov 2011 05:00:00 +0100 5402115 http://www.medworm.com/index.php?rid=5402114&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F238%3Frss%3D1 Question In hospitalised children (patients) does treatment with Lactobacillus rhamnosus GG (LGG) (treatment) prevent the development of nosocomial gastrointestinal or respiratory tract infections (outcome)? MethodsDesign Randomised placebo-controlled trial. Allocation Computer generated random number list. Concealment method not explicitly stated. Blinding Double-blind. Setting Children's Hospital Zagreb. Patients Children older than 12 months admitted to hospital from November 2007 to May 2008. Excluded children with immunodeficiency, cow's milk allergy, cancer, chronic illness or anticipated hospital stay <3 days. Intervention 376 children allocated to LGG product (109 CFU) in 100 ml of fermented milk product and 366 to fermented milk only (placebo), then monitored clinically each da... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402114 Thu, 10 Nov 2011 05:00:00 +0100 5402114 http://www.medworm.com/index.php?rid=5402113&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F237%3Frss%3D1 From questions on page 209 The answer is A, lichen planus (LP). This patient presents with the classic ‘6 Ps’ seen in LP: purple, planar, pruritic, polygonal plaques and papules. Its surface has subtle white dots and lines in a reticulated pattern, called Wickham's striae. This finding is often visible only on close inspection. LP has a predilection for flexoral surfaces, though scalp, mucous membranes, nail and genital involvement may occur as well. Papular lesions erupting in a linear fashion after mechanical trauma, such as scratching, is known as the Koebner phenomenon. Paediatric cases comprise only 2–3% of LP and occur more frequently in children of African heritage. Although the exact aetiology is unknown, genetic predisposition and autoimmune processes may play a ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402113 Thu, 10 Nov 2011 05:00:00 +0100 5402113 http://www.medworm.com/index.php?rid=5402112&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F234%3Frss%3D1 This article summarises the key recommendations from the National Institute for Health and Clinical Excellence (NICE) guideline1 and highlights areas that may represent a change of practice for some clinicians. Differences between this guideline and the Scottish intercollegiate guideline (SIGN) on meningitis2 (table 1) have been highlighted. The NICE recommendations are shown in italics. The key areas covered by the guideline are described below; however, not all are reviewed within this article. The guideline covers Symptoms and signs of bacterial meningitis and meningococcal septicaemia. Management in the prehospital setting. Diagnosis in secondary care. Management in secondary care. Long-term management. Flowcharts for the management of... (Source: Archives of Disease in Childhood ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402112 Thu, 10 Nov 2011 05:00:00 +0100 5402112 http://www.medworm.com/index.php?rid=5402111&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F228%3Frss%3D1 Introduction ‘Calcitonin’ was first identified during studies of parathyroid function in dogs1 – a new parathyroid hormone that caused a transient hypocalcaemia. Subsequently demonstrated in the human serum of patients with medullary thyroid carcinoma, its heterogeneity hinted at the existence of multiple forms of this new hormone and of a precursor prohormone.2 The identification of this procalcitonin (PCT) in the hypocalcaemia of Staphylococcal toxic shock syndrome3 first drew the association of PCT with sepsis and inflammatory states, which was confirmed by subsequent studies. The first prospective study of PCT in children with sepsis revealed a rapid and dramatic increase in the levels of PCT, which normalised with appropriate antibiotic therapy.4 Elevated PCT has bee... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402111 Thu, 10 Nov 2011 05:00:00 +0100 5402111 http://www.medworm.com/index.php?rid=5402110&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F223%3Frss%3D1 Introduction Life, as we know it, evolved in water that contained a steady concentration of salts. Consequently, the functioning of living cells is dependent on the provision of an environment with just this right concentration of electrolytes. The emergence of organisms from the sea and onto land was only possible because of the evolution of kidneys, which preserved the environment of the sea within the organisms. Without the kidneys providing volume, electrolyte and acid-base homoeostasis, no heart could beat, no muscle move, no thought be thought.1 Disturbances of this homoeostasis are thus serious conditions that pose grave dangers to the patient.2 3 Treatment is influenced by the correct identification of the underlying problem: hyponatraemia requires a different approach if it is due... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402110 Thu, 10 Nov 2011 05:00:00 +0100 5402110 http://www.medworm.com/index.php?rid=5402109&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F216%3Frss%3D1 Introduction Inotropes are medicines that increase the force of cardiac muscle contraction. Inotropes are used to improve cardiac output and so increase oxygen delivery to tissues. There are very few pure inotropes. Most have other effects, which can help or hinder therapy. Deciding which inotrope to use, and when, is complicated for several reasons. The evidence base for these medicines is patchy, particularly with respect to how development affects the targets for the medicines and how the body handles the medicines at different ages. The clinical signs and biomarkers we use to guide treatment have not been validated (can we measure them reliably?) nor qualified (do the markers predict important outcomes?). The short-term clinical outcomes and biomarkers we can measure readily may not be... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402109 Thu, 10 Nov 2011 05:00:00 +0100 5402109 http://www.medworm.com/index.php?rid=5402108&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F210%3Frss%3D1 We present one such scenario with complex diagnostic and management challenges. Emily was born at 35+6 weeks. This was the first pregnancy for her 19-year-old mum who had no significant medical or obstetric history. She was known to fetal medicine because of fetal growth retardation, with an estimated fetal weight at 33+4 weeks below the third percentile. Following a 3-week period of static growth labour was induced for fetal wellbeing. Shortly after induction following fetal bradycardia Emily was delivered by caesarean section. Emily weighed 1.58 kg (<0.4th centile) with a head circumference (OFC) of 28.5 cm (0.4th centile) and was admitted to the neonatal unit. On arrival Emily was noted to be dusky, with nasal flaring and oxygen saturations of 40% in air. She was commenced on continu... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402108 Thu, 10 Nov 2011 05:00:00 +0100 5402108 http://www.medworm.com/index.php?rid=5402107&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F209%3Frss%3D1 Select one best answer from the following: Lichen planus Lichen planopilaris Lichen nitidus Lichen striatus Pityriasis lichenoides chronica Lichen simplex chronicus Lichen sclerosus Answers to the following quiz questions can be found on page 237. Question 1 A 12-year-old boy presented with 6 months of widespread, intensely itchy purple papules on flexor wrists and ankles (figure 1). On close examination, the papules are topped with subtle fine white lines. He was initially treated for eczema with unsatisfactory improvement. New lesions continue to develop on his wrists in a linear pattern at the places where he has been scratching. He is otherwise healthy. What is the most likely diagnosis? Question 2 A 7-year-old boy presented with 2 months of widespread, asymptomatic, reddish-brown, shi... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402107 Thu, 10 Nov 2011 05:00:00 +0100 5402107 http://www.medworm.com/index.php?rid=5402106&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F202%3Frss%3D1 This article describes the evidence base behind the associated historical, clinical and neuroradiological features of AHT and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where AHT is suspected. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402106 Thu, 10 Nov 2011 05:00:00 +0100 5402106 http://www.medworm.com/index.php?rid=5402105&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F6%2F201%3Frss%3D1 If you know your Ecclesiastes, you will know that there is nothing new under the sun. Well, sometimes medicine feels like this; sometimes it feels a little like medicine, and paediatrics, does go around in circles. I suspect that it is a good barometer of your state of mind at a particular point whether you regard this as a good or a bad thing. Right now, having reviewed the contents of this edition of E&P I’m finding it fun, and I hope you do too. There are a lot of old subjects from new angles. Or, if you prefer, new subjects from old angles. I hope I can persuade you, also, that there are some genuinely new things out there too. Three Picket papers involve retreads of quite well worn themes. You will recall that Picket is about us keeping an eye out for quality papers, re-abst... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5402105 Thu, 10 Nov 2011 05:00:00 +0100 5402105 http://www.medworm.com/index.php?rid=5212608&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F200%3Frss%3D1 Study design Design Randomised controlled trial. Allocation Stratified block randomisation of clusters. Treatment allocation was concealed. Blinding Double-blind. Setting Clinical research sites and hospital departments in the UK, Ireland, France and Israel. Patients The inclusion criteria comprised: aged 2 years or older, weight 15 kg or greater and a history of failure of previous head lice treatment (defined as persistence of head lice despite topical application of a pyrethroid- or malathion-based insecticide 2–6 weeks before recruitment). Intervention 812 participants (in 376 households) were randomised to receive either oral Ivermectin (Stromectol, 400 µg/kg) on days 1 and 8, or 0.5% alcoholic malathion lotion (Prioderm). Within each participating household (cluster), all... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212608 Mon, 12 Sep 2011 04:00:00 +0100 5212608 http://www.medworm.com/index.php?rid=5212607&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F199%3Frss%3D1 Question In preterm neonates [patients] do probiotics [intervention] reduce the risk of necrotising enterocolitis (NEC) and death [outcome]? Review scope Trials were selected which compared probiotics to control in neonates of <34 weeks' gestation and birth weight of <1500 g. Outcomes included prevention of stage II NEC or higher, all cause mortality, sepsis and time to reach full feeds (TFF). Review methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, proceedings of the Pediatric Academic Society meetings and gastroenterology conferences and reference lists were searched for randomised controlled trials (RCTs). No language restriction was applied. The quality of studies was assessed using the Jadad score. Eleven RCTs were included. Trial sequential an... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212607 Mon, 12 Sep 2011 04:00:00 +0100 5212607 http://www.medworm.com/index.php?rid=5212606&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F198%3Frss%3D1 Question In children [patients] with and without vesicoureteric reflux (VUR), do long-term antibiotics [intervention] prevent urinary tract infection (UTI) [outcome]? Review scope Trials were selected which compared long-term (at least 2 months) antibiotic prophylaxis versus placebo or no treatment, in children <18 years old. The primary outcome was recurrence of symptomatic UTI. Other outcomes were repeat positive urinary culture, renal scarring and adverse events. Review methods MEDLINE, Embase, CENTRAL, the Cochrane Library and reference lists were searched for randomised controlled trials (RCTs) and quasi-RCTs. No language restriction was applied. The quality of studies, assessed by two reviewers, was based on allocation concealment, standardisation and blinding of outcome assessmen... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212606 Mon, 12 Sep 2011 04:00:00 +0100 5212606 http://www.medworm.com/index.php?rid=5212605&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F197%3Frss%3D1 From questions on page 191 The answer is B, molluscum-associated dermatitis. The patient's presentation is consistent with molluscum contagiosum caused by the molluscipox virus. These small, pearly, dome-shaped papules with central umbilication tend to favour intertriginous areas, although the lesions may appear anywhere on the body. Occasionally, infection with molluscum contagiosum may result in an associated dermatitis thought to be secondary to a delayed hypersensitivity reaction to the virus.1 While the dermatitis may commonly be mistaken for atopic dermatitis, the specific onset of dermatitis confined to the site of the molluscum favours the diagnosis of molluscum-associated dermatitis. Although molluscum is generally self-limited, the pruritus experienced with molluscum-associated d... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212605 Mon, 12 Sep 2011 04:00:00 +0100 5212605 http://www.medworm.com/index.php?rid=5212604&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F192%3Frss%3D1 Antipsychotic (neuroleptic) drugs are used in the treatment of various psychiatric disorders in children and adolescents. There is a lack of information about the efficacy and safety of antipsychotics in young people. Much of the information available is extrapolated from adult studies; in particular, little is known about the long-term effects of these drugs on the development of the central nervous system. Over the last two decades, typical antipsychotics have largely been replaced by atypical antipsychotics. With this increase in use of atypical antipsychotic drugs, there has been growing concern about the appropriate use of these drugs and the fact that they appear to be associated with metabolic abnormalities such as weight gain, diabetes and related cardiovascular effects. This paper... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212604 Mon, 12 Sep 2011 04:00:00 +0100 5212604 http://www.medworm.com/index.php?rid=5212603&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F191%3Frss%3D1 For each question, select one option from the following: A. Lichen planus B. Molluscum-associated dermatitis C. Lichen nitidus D. Atopic dermatitis E. Scabies infestation F. Prurigo nodularis G. Allergic contact dermatitis Answers to the following quiz questions can be found on page 197. Question 1 This 6-year-old boy (figure 1) presents with a 1-month history of localised red, itchy areas on the thighs. On closer inspection, there are 1–3 mm pearly, dome-shaped papules in the erythematous, scaly and slightly oedematous area. He is otherwise healthy with no history of skin disease or atopy. What is the most likely diagnosis? Question 2 This 9-year-old girl (figure 2) presents with a long history of intermittent itchy rash, particularly on the arms and legs. The itch is usually worse ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212603 Mon, 12 Sep 2011 04:00:00 +0100 5212603 http://www.medworm.com/index.php?rid=5212602&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F183%3Frss%3D1 Introduction Streptococcus pneumoniae, the pneumococcus, is a Gram-positive diplococcus with more than 90 serotypes determined by the polysaccharide composition of its capsule. It is carried asymptomatically in approximately 50% of people.1 It can cause both non-invasive and invasive disease. Invasive pneumococcal disease (IPD) refers to disease in which the bacterium enters a sterile site such as blood, cerebrospinal fluid (CSF), pleural fluid, joint fluid or pericardial fluid. Non-invasive disease includes otitis media, sinusitis and bronchitis. Among infectious diseases, IPD is a leading cause of morbidity and mortality in children and adults. Vaccination against pneumococcal infection was introduced into the UK routine childhood immunisation programme in 2006 with Prevenar 7 (Pfizer, T... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212602 Mon, 12 Sep 2011 04:00:00 +0100 5212602 http://www.medworm.com/index.php?rid=5212601&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F176%3Frss%3D1 Introduction Takayasu arteritis is a large and medium size vessel vasculitis involving the aorta, its major branches and the pulmonary arteries. It is the most common large vessel vasculitis in childhood and is of unknown aetiology. The presentation is often non-specific, making a timely diagnosis difficult. It predominantly presents in the second or third decade of life, although it has been described in children1 and there is a strong female predisposition (8:1).2 The clinical presentation is varied but can be divided into early (prepulseless) and late (pulseless) phases. The challenge for the clinician is to consider Takayasu arteritis during the early phase when the symptoms are non-specific and often systemic. We highlight three cases, seen at a tertiary referral centre for paediatric... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212601 Mon, 12 Sep 2011 04:00:00 +0100 5212601 http://www.medworm.com/index.php?rid=5212600&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F162%3Frss%3D1 The objective of helping the child is best achieved when the interpretation of findings, management guidance and management plan are shared through good communication with parents, carers and other agencies. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212600 Mon, 12 Sep 2011 04:00:00 +0100 5212600 http://www.medworm.com/index.php?rid=5212599&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F5%2F161%3Frss%3D1 I'm often spoilt for choice when I sit down to write about the current edition of Education and Practice. There are so many interesting articles, I'm not sure which area I'd most like to discuss further in this introduction. I could write about developmental examination (see page 162), antipsychotics (see page 192) or Takayasu arteritis (see page 176). There's an article on invasive pneumococcal disease (see page 183), and a few thought-provoking Pickets (see pages 198–200) – the section where we write a structured abstract of a seminal article and then commission a commentary to put this article into context. And finally, there's an article that includes choices itself – a great Dermatophile article (see page 191), complete with multiple choice questions, which should ma... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5212599 Mon, 12 Sep 2011 04:00:00 +0100 5212599 http://www.medworm.com/index.php?rid=5023287&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F160%3Frss%3D1 Question Do physical interventions (isolation, barriers and hygiene) reduce the transmission of respiratory viruses? Review scope Studies were selected which compared physical interventions to prevent transmission of respiratory viruses and controls with no intervention. Outcomes included deaths, cases of viral illness, severity of viral illness and clinical symptoms. Review methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, OLDMEDLINE, CINAHL and archives of the MRC Common Cold Unit were searched for any comparative study to reduce transmission of respiratory viruses: randomised controlled trials (RCTs), cohort studies, case–control studies, and controlled before and after studies (CBAs). References of included studies were checked. No language restrictions... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023287 Mon, 11 Jul 2011 23:00:00 +0100 5023287 http://www.medworm.com/index.php?rid=5023286&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F159%3Frss%3D1 Question In children, does the use of higher-fluoride toothpaste compared with lower-fluoride toothpaste or placebo reduce the incremental development of dental caries, and do baseline caries or supervised brushing influence the effect? Review scope Selected studies were randomised controlled trials (RCT) or cluster RCT in which children were randomly assigned to fluoride/non-fluoride groups or to fluoride groups of different concentrations and were followed up for 12 months or more. Outcomes The prevented fraction (PF) of caries is calculated by comparing an indicator of caries progression (decayed teeth and filled surfaces at follow-up/decayed teeth and filled surfaces at baseline) between the intervention and control groups. The difference between the two is expressed as a proportion of... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023286 Mon, 11 Jul 2011 23:00:00 +0100 5023286 http://www.medworm.com/index.php?rid=5023285&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F158%3Frss%3D1 Question 1 A: True, this is a crucial part of the new guidance. The degree of jaundice should be checked using a transcutaneous or serum measurement. A visual estimate of the depth of jaundice should not be used. B: False, gestational age <38 weeks, a previous sibling with neonatal jaundice, mother's intention to breastfeed exclusively and visible jaundice are all factors which may predispose to significant hyperbilirubinaemia. C: False, this method can be used in babies aged 35 weeks and over who are also >24 h old. D: False, the guideline suggests seeking expert advice if the level is >25. Question 2 A: False, extra fluid should not routinely be given, this should be assessed on an individual basis by assessing hydration using daily weights and weighing nappies. B: True. C: Fals... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023285 Mon, 11 Jul 2011 23:00:00 +0100 5023285 http://www.medworm.com/index.php?rid=5023284&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F153%3Frss%3D1 Peter was born by normal vaginal delivery at 32 weeks gestational age weighing 2.49 kg. This was the first pregnancy for his 22-year-old mother who had no significant past medical history and had been well throughout pregnancy. Antenatal ultrasound at 20 weeks showed no fetal abnormality, a well grown fetus and mild polyhydramnios. The pregnancy was unremarkable until the onset of spontaneous labour at 32 weeks. Amniotic membranes remained intact until just before delivery. Cardiotocographic monitoring was within normal limits prior to delivery and there was no history of vaginal bleeding. Peter cried immediately following cephalic vaginal delivery; his heart rate was more than 100 beats/min and he did not require any resuscitation. By 10 min of age Peter was noted to be dusky and was grun... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023284 Mon, 11 Jul 2011 23:00:00 +0100 5023284 http://www.medworm.com/index.php?rid=5023283&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F148%3Frss%3D1 It is sad that this area where teaching is of the greatest importance, is the one where the needs of the patient and the needs of the student conflict most. While this quote from Professor Sir Roy Meadow1 dates back to 1979, the sentiment still holds, although the challenges we face in delivering high quality undergraduate teaching in today's NHS are different. Current challenges and problems Medical school teaching in child health has traditionally been focused on the clinical problems seen in children, as inpatients, in tertiary care teaching hospitals. In recent years there has been a move to reduce inpatient stays and develop a more ambulatory model, with children being seen in rapid access or review clinics, to try to minimise the frequency and duration of inpatient stays. It is there... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023283 Mon, 11 Jul 2011 23:00:00 +0100 5023283 http://www.medworm.com/index.php?rid=5023282&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F141%3Frss%3D1 α-Fetoprotein (AFP) measurements have clinical implications in fetal medicine and, in infants and older children, in detection, differential diagnosis and monitoring of malignant disease. Maternal serum AFP levels constitute part of a multiple-marker test used in early second-trimester screening to predict risk of fetal chromosomal abnormalities. Those individuals with increased risk are offered further definitive diagnostic investigation. Second-trimester screening is now increasingly being superseded by first-trimester screening with other serum markers and ultrasound. As AFP is only produced physiologically during fetal development, elevated serum levels after the first two post-natal years usually indicate the presence of a malignant disease process. Before this time, levels may ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023282 Mon, 11 Jul 2011 23:00:00 +0100 5023282 http://www.medworm.com/index.php?rid=5023281&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F136%3Frss%3D1 Introduction The new guidance from National Institute for Health and Clinical Excellence (NICE)1 on recognition and treatment of neonatal jaundice is discussed in this review. Maternity units across the UK have differing guidelines for the management of neonatal jaundice, which is confusing for doctors, nurses and parents. The difference is responsible for wide variation in practice throughout the UK.2 This guidance will standardise practice in both the hospital and community settings. Areas where practice may change as a result of this guideline have been highlighted. Elements the guideline covers Management of neonatal jaundice in babies from birth to 28 days. Recognition, assessment and treatment of neonatal jaundice. These recommendations are combined in three care pathways: care for ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023281 Mon, 11 Jul 2011 23:00:00 +0100 5023281 http://www.medworm.com/index.php?rid=5023280&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F128%3Frss%3D1 This article explores the differential diagnosis of respiratory distress in this population and presents an evidence based approach to treatment. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023280 Mon, 11 Jul 2011 23:00:00 +0100 5023280 http://www.medworm.com/index.php?rid=5023279&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F122%3Frss%3D1 We are inexorably entering an era where a wide range of multiply antibiotic-resistant bacteria are commonplace. Until recently, multiresistance was mainly seen in Gram-positive bacteria. However, vancomycin remains adequate as a treatment of most infections with these bacteria. The potential threat from vancomycin-resistant bacteria has never fully materialised, and now there is a growing number of new anti-Gram-positive antibiotics. Of these, there is sufficient experience of using linezolid and daptomycin in neonates for these drugs to be recommended for some specific indications. The recent rapid international spread of multiresistant Gram-negative bacteria, including carbapenem-resistant strains, is much more ominous. Treatment options are extremely limited, which has prompted renewed ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023279 Mon, 11 Jul 2011 23:00:00 +0100 5023279 http://www.medworm.com/index.php?rid=5023278&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F4%2F121%3Frss%3D1 It is always good to hear from you how you think your journal could be improved. I try to respond positively when people email me (see email address below). I am writing this on the train on the way home from the journal's annual retreat, which, when I was first invited to one, I thought would be held in a monastery or some suitably contemplative place. Actually, we were in one of those conferencing rooms which could have been in any place in the world, but was in fact in London. The journal editors were from across the UK, Europe and the US, all with huge expertise in their areas, some with national and international reputations. I had to give a short presentation, sandwiched between the data on how the journal is doing and robust discussions about our new manuscript handling system. I us... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=5023278 Mon, 11 Jul 2011 23:00:00 +0100 5023278 http://www.medworm.com/index.php?rid=4816134&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F120%3Frss%3D1 Question In children who experience out-of-hospital cardiac arrest (patients) does the type of cardio-pulmonary resuscitation (CPR) (risk factor) or cause of arrest (risk factor) influence the likelihood of favourable neurological outcome (outcome)? MethodsDesign Population based observational cohort study. Data were collected from the All-Japan Utstein Registry for the Fire and Disaster Management Agency. Setting Population based study, Japan. Patients Children under 17 years of age with an out-of-hospital cardiac arrest. The cause of arrest was presumed to be cardiac unless there was evidence of trauma, hanging, drowning, drug overdose, respiratory disease, etc, as attributed by physicians working with emergency personnel. All emergency medical providers undertook CPR in accordance with ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816134 Wed, 11 May 2011 23:00:00 +0100 4816134 http://www.medworm.com/index.php?rid=4816133&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F119%3Frss%3D1 Study designDesign Randomised controlled trial. Allocation Computer-generated random schedule stratified by age and centre. Blinding Care givers and assessors blind to treatment. Blinded medications were prepared, based on body weight, at a central pharmacy and sent to the participants. Blinding of different preparations was maintained with a double dummy and overencapsulation approach. Study questionSetting 32 outpatient sites in the USA. Patients 453 children aged 2.5–13 years, with absence epilepsy as defined clinically and confirmed on EEG. Children with high body mass index, evidence of haematopoietic or liver dysfunction and girls who were post-menarchal were excluded. Intervention Patients were randomised to receive ethosuximide, valproic acid or lamotrigine, with escalation ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816133 Wed, 11 May 2011 23:00:00 +0100 4816133 http://www.medworm.com/index.php?rid=4816132&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F118%3Frss%3D1 Question 1 Solution: B, C, D are correct. A: Norepinephrine is released from the sympathetic postganglionic neural endings. E: Phaeochromocytoma in children is extremely rare, accounting for fewer than 1% of hypertension cases. Question 2 Solution: B is correct. A, C, D: In these situations a normal result cannot rule out the diagnosis, as some tumours do not secrete higher levels of catecholamines (see table 2 for more detail). Question 3 Solution: A, B, D are correct. C: See table 2. In pilot screening programmes in the 1990s mostly those tumours were identified that regress spontaneously and the programmes resulted in a high number of unnecessary further tests and some complications. E: The evidence suggests the opposite, that single specimens are clinically as useful as 24 h samples. W... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816132 Wed, 11 May 2011 23:00:00 +0100 4816132 http://www.medworm.com/index.php?rid=4816131&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F112%3Frss%3D1 Approximately 30 years ago, the myth that nervous system immaturity precluded neonates from pain perception and its negative effects was rejected. Neurobiologists further explored neurodevelopmental nociception. These observations strongly suggest that early pain experience contributes to neurodevelopmental outcome, pain thresholds, pain or stress-related behaviour and physiological responses in later life. Effective management of pain therefore remains an important indicator of the quality of care provided to neonates, not only from an ethical, but also from a short and long-term outcome perspective. Simultaneously, neonatal care itself has changed and data on neuro-apoptosis and impaired synaptogenesis following exposure to analgosedatives emerged. When developmental pharmacology concept... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816131 Wed, 11 May 2011 23:00:00 +0100 4816131 http://www.medworm.com/index.php?rid=4816130&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F107%3Frss%3D1 Introduction In paediatric clinical practice, tests for urinary catecholamines and their metabolites are most often requested to aid in the diagnosis and follow-up of patients with neural crest tumours, particularly neuroblastomas. Neuroblastoma is the most common extracranial solid tumour in children. Each year 80–90 new patients are diagnosed in the UK, most of them infants or toddlers. Neuroblastoma usually arises from either the adrenal medulla or the paravertebral sympathetic chain. It shows a wide variety of biological activity and has a correspondingly diverse range of presenting features and subsequent prognoses. Younger patients below 18 months of age generally have less aggressive forms of the tumour and require less intensive treatment, and indeed some children may not req... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816130 Wed, 11 May 2011 23:00:00 +0100 4816130 http://www.medworm.com/index.php?rid=4816129&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F101%3Frss%3D1 To obtain high-quality CT and MRI scans, children may need to stay immobile in a particularly uncomfortable environment for a reasonable length of time. Although young infants may sleep after a feed and older children can be accommodating, many infants and children are not cooperative. The use of sedation or anaesthetics in children to provide a sleep-induced state and reduce anxiety is therefore often necessary for successful radiological practice. As anaesthetic resources and suitable equipment may be limited in some paediatric departments, many drugs have become used in children to provide safe and effective sedation. Within the UK, the only licensed drugs for sedation during radiological procedures in children are midazolam by intravenous, intramuscular or rectal routes and oral temaze... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816129 Wed, 11 May 2011 23:00:00 +0100 4816129 http://www.medworm.com/index.php?rid=4816128&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F91%3Frss%3D1 Allergic rhinitis and asthma are examples of allergic airways disease. Despite their differing symptomatology, both disorders affect the mucosal lining of the respiratory tract and are linked by common underlying cellular processes, thus, using the ‘united airways’ approach, they can be considered part of the same allergic disease. The conditions are often comorbid, and there is evidence to suggest that allergic rhinitis in children is a significant risk factor for subsequent development of asthma. Management strategies that target the underlying cause of allergic rhinitis in children have the potential to offer additional symptom control above that of symptomatic medications, and prevent disease progression. Specific immunotherapy (SIT) is the only currently available treatmen... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816128 Wed, 11 May 2011 23:00:00 +0100 4816128 http://www.medworm.com/index.php?rid=4816127&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F87%3Frss%3D1 Imported malaria has become an increasingly significant cause of mortality and morbidity in children travelling to areas of the world endemic for malaria. Malaria is one of the commonest imported tropical diseases in the UK, with children accounting for 15–20% of all cases. Over 80% of all cases of malaria are due to Plasmodium falciparum infection, which can cause severe or life-threatening multi-organ disease in children. The clinical features of malaria in children are often non-specific, resulting in missed or delayed diagnosis. Children are more likely than adults to deteriorate rapidly and to develop severe malaria, particularly cerebral malaria. Malaria should be suspected in all children with a history of travel to a malaria-endemic country who present with fever. Diagnosis i... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816127 Wed, 11 May 2011 23:00:00 +0100 4816127 http://www.medworm.com/index.php?rid=4816126&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F82%3Frss%3D1 Liver transplantation in childhood has evolved quickly and is now a highly successful treatment for end-stage liver disease. One-year survival is greater than 90% in experienced centres, and the vast majority of these children will survive into adult life.1 World wide, many thousands of adults have received a liver transplant in childhood. These survivors require active monitoring, which will involve collaboration between transplant centres and local services. While the specifics of the monitoring process will differ between programmes, there are some general principles. Monitoring can be considered in the following general areas: liver function, complications and consequences of immunosuppression and lifestyle and quality issues. The risk of acute rejection is time related and in most pat... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816126 Wed, 11 May 2011 23:00:00 +0100 4816126 http://www.medworm.com/index.php?rid=4816125&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2F81%3Frss%3D1 One of the challenges in delivering an journal like E&P is getting the balance right between articles on conditions, tests or skills that you, the readers, will need on a daily basis, and those which you might need only once in a while but have other appeal. This other appeal may have a number of aspects. They may simply be interesting, or contain important information, or they may stimulate other serendipitous thoughts. This issue has a range of articles which I hope will do all of these for you. This month's editor's choice is a thought provoking paper about the measurement of urine catecholamines by Daniel Erdelyi, Martin Elliott and Bob Phillips (see page 107). You'll probably suspect a little bit of ‘Old Boys Club’ with this choice – me focusing on another paper ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816125 Wed, 11 May 2011 23:00:00 +0100 4816125 http://www.medworm.com/index.php?rid=4816124&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F3%2Fe1%3Frss%3D1 I was interested in the excellent article on ‘How to use: C-reactive protein’ in Education & Practice by McWilliam and Riordan.1 I was particularly interested in the section on ‘ "Ruling in" sepsis’ and the comment that a raised C-reactive protein (CRP) is not diagnostic for sepsis in the neonate because it may be raised for other reasons. The article quotes prolonged rupture of membranes, and maternal fever both of which can be caused by local sepsis which may lead to infection in the neonate. An elevated CRP in such circumstances should not be dismissed as due to factors other than sepsis. Among the other reasons listed are fetal distress, perinatal asphyxia, shock and periventricular or intraventricular haemorrhages. Fetal distress, perinatal asphyxia and sho... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4816124 Wed, 11 May 2011 23:00:00 +0100 4816124 http://www.medworm.com/index.php?rid=4572314&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F80%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572314 Thu, 10 Mar 2011 00:00:00 +0100 4572314 http://www.medworm.com/index.php?rid=4572313&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F79%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572313 Thu, 10 Mar 2011 00:00:00 +0100 4572313 http://www.medworm.com/index.php?rid=4572312&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F73%3Frss%3D1 Paediatric gynaecological problems, especially those involving the vulvar area, are common in childhood. The conditions frequently seen include recurrent bacterial vulvovaginitis, vulvar irritation, labial adhesions and dermatological conditions. The presentation and management of these conditions will be reviewed. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572312 Thu, 10 Mar 2011 00:00:00 +0100 4572312 http://www.medworm.com/index.php?rid=4572311&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F67%3Frss%3D1 This paper describes a patient initially diagnosed with autoimmune thyroiditis who undergoes a diagnostic and investigatory journey (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572311 Thu, 10 Mar 2011 00:00:00 +0100 4572311 http://www.medworm.com/index.php?rid=4572310&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F61%3Frss%3D1 This article discusses the important recent advances in the evidence-base and current expert opinions which are helping to delineate improved outcomes for young children with wheeze. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572310 Thu, 10 Mar 2011 00:00:00 +0100 4572310 http://www.medworm.com/index.php?rid=4572309&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F49%3Frss%3D1 This article discusses the aetiology of coagulopathy, describes the commonly available diagnostic tests and outlines the evidence available to guide paediatricians when treating acutely ill children with acquired coagulopathy. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572309 Thu, 10 Mar 2011 00:00:00 +0100 4572309 http://www.medworm.com/index.php?rid=4572308&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F42%3Frss%3D1 This article discusses the need for person-specific planning for the increasing numbers of disabled children with life-limiting and life-threatening conditions. It describes the system developed in Nottingham for this client group to have a family-held personal resuscitation plan, (PRP) which is developed with the child and family by their lead paediatrician. The PRP is an emergency medical care plan which supports the provision of the most appropriate level of intervention for the child whether they are at home, school, short break unit or hospital. The PRP template is presented with advice on implementation and case examples. Feedback from families, medical and nursing staff is that PRPs are useful and empowering. The system supports timely discussions about appropriate care in an emerge... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572308 Thu, 10 Mar 2011 00:00:00 +0100 4572308 http://www.medworm.com/index.php?rid=4572307&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F2%2F41%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4572307 Thu, 10 Mar 2011 00:00:00 +0100 4572307 http://www.medworm.com/index.php?rid=4339970&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F40%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339970 Wed, 12 Jan 2011 00:00:00 +0100 4339970 http://www.medworm.com/index.php?rid=4339969&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F39%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339969 Wed, 12 Jan 2011 00:00:00 +0100 4339969 http://www.medworm.com/index.php?rid=4339968&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F38%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339968 Wed, 12 Jan 2011 00:00:00 +0100 4339968 http://www.medworm.com/index.php?rid=4339967&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F37%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339967 Wed, 12 Jan 2011 00:00:00 +0100 4339967 http://www.medworm.com/index.php?rid=4339966&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F31%3Frss%3D1 This is a case of a 6-month-old child who presented to the local paediatric department with a relatively short history of developmental regression, hypotonia, weight loss, irritability and hepatosplenomegaly. The child then proceeded to spike temperatures up to 39°C. The case demonstrates the logical investigative process involved in such a case and discusses the differential diagnoses at each stage. It also highlights the importance of multi-specialty work in complex cases and the potential consequence of premature closure of diagnosis. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339966 Wed, 12 Jan 2011 00:00:00 +0100 4339966 http://www.medworm.com/index.php?rid=4339965&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F25%3Frss%3D1 Drooling beyond the age of 4 years is neurodevelopmentally abnormal. Chronic "sialorrhoea" is seen in children with abnormal oral sensation and/or motor control and more infrequently when there is excessive production of saliva. Salivary production from the paired glands is under autonomic parasympathetic control. Management of the problem relies on multidisciplinary teams with a focus on assessment and when appropriate conservative interventions, oral motor training, dental appliances, medical and surgical treatment programs. Medically, the focus is on modifying the neuroglandular control of saliva with the use of anticholinergic agents. The article covers these areas of background, assessment and management in detail. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339965 Wed, 12 Jan 2011 00:00:00 +0100 4339965 http://www.medworm.com/index.php?rid=4339964&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F24%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339964 Wed, 12 Jan 2011 00:00:00 +0100 4339964 http://www.medworm.com/index.php?rid=4339963&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F22%3Frss%3D1 Dermatophile has a new format. From now on, it will take the form of a short quiz to test and inform your knowledge of dermatology relevant to paediatrics. Any suggestions for improvement or topics you would like to be covered are welcome. Please email comments and feedback to p-lio@northwestern.edu. Theme: Scaly rashesSelect the one best answer from the following:a. Tinea corporis (ringworm) b. Acanthosis nigricans c. Confluent and reticulated papillomatosis (CARP) d. Pityriasis (tinea) versicolor e. Drug hypersensitivity eruption f. Scabies infestation g. Terra firma-forme dermatosis Answers to the following quiz questions can be found on page 39. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339963 Wed, 12 Jan 2011 00:00:00 +0100 4339963 http://www.medworm.com/index.php?rid=4339962&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F21%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339962 Wed, 12 Jan 2011 00:00:00 +0100 4339962 http://www.medworm.com/index.php?rid=4339961&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F9%3Frss%3D1 Every paediatrician, generalist or specialist, at every level and in every setting will come across the child or young person with disordered development and has a duty of care to ensure that appropriate assessment and investigations are undertaken, if each individual is to be given the best possible opportunities to achieve the highest possible level of participation and enjoy the best possible quality of life. Using a structured approach, all paediatricians have the potential to make a significant positive difference and should seek every opportunity to do so, even if seeing the child for an entirely different reason. Key messages of this article include: (1) each child is unique and requires careful, individual, clinical assessment and thought before any investigations are undertaken; (... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339961 Wed, 12 Jan 2011 00:00:00 +0100 4339961 http://www.medworm.com/index.php?rid=4339960&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F2%3Frss%3D1 Head lice infestation (pediculosis capitis) is a common problem in paediatric practice. It can cause considerable distress to children and their families and may lead to bullying and social stigmatisation. Therapy with "conventional" topical pediculicides with neurotoxic mode of action—such as malathion, permethrin, phenothrin and carbaryl—is increasingly associated with treatment failure as a result of the emergence of resistance within the parasite population. This review provides an overview of the natural history, clinical symptoms and diagnosis of head lice infestation. It also discusses general management principles and summarises the current data on novel treatment strategies, including wet combing, dimeticone, isopropyl myristate, benzyl alcohol, plant-based compounds a... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339960 Wed, 12 Jan 2011 00:00:00 +0100 4339960 http://www.medworm.com/index.php?rid=4339959&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F1%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4339959 Wed, 12 Jan 2011 00:00:00 +0100 4339959 http://www.medworm.com/index.php?rid=4193941&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F204%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193941 Mon, 22 Nov 2010 00:00:00 +0100 4193941 http://www.medworm.com/index.php?rid=4193940&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F203%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193940 Mon, 22 Nov 2010 00:00:00 +0100 4193940 http://www.medworm.com/index.php?rid=4193939&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F199%3Frss%3D1 This article focuses on a practical approach to managing menorrhagia, dysmenorrhoea, oligomenorrhoea and premenstrual syndrome (PMS) and reviews the literature on this topic. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193939 Mon, 22 Nov 2010 00:00:00 +0100 4193939 http://www.medworm.com/index.php?rid=4193938&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F198%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193938 Mon, 22 Nov 2010 00:00:00 +0100 4193938 http://www.medworm.com/index.php?rid=4193937&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F197%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193937 Mon, 22 Nov 2010 00:00:00 +0100 4193937 http://www.medworm.com/index.php?rid=4193936&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F196%3Frss%3D1 Answers to the two quiz questions can be found on page 204. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193936 Mon, 22 Nov 2010 00:00:00 +0100 4193936 http://www.medworm.com/index.php?rid=4193935&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F195%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193935 Mon, 22 Nov 2010 00:00:00 +0100 4193935 http://www.medworm.com/index.php?rid=4193934&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F194%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193934 Mon, 22 Nov 2010 00:00:00 +0100 4193934 http://www.medworm.com/index.php?rid=4193933&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F190%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193933 Mon, 22 Nov 2010 00:00:00 +0100 4193933 http://www.medworm.com/index.php?rid=4193932&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F189%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193932 Mon, 22 Nov 2010 00:00:00 +0100 4193932 http://www.medworm.com/index.php?rid=4193931&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F183%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193931 Mon, 22 Nov 2010 00:00:00 +0100 4193931 http://www.medworm.com/index.php?rid=4193930&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F182%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193930 Mon, 22 Nov 2010 00:00:00 +0100 4193930 http://www.medworm.com/index.php?rid=4193929&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F178%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193929 Mon, 22 Nov 2010 00:00:00 +0100 4193929 http://www.medworm.com/index.php?rid=4193928&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F170%3Frss%3D1 This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article. It will examine the pattern of accidental and abusive bruises, fractures, burns, abdominal injuries and oral injuries focusing on discriminating features and necessary investigations. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193928 Mon, 22 Nov 2010 00:00:00 +0100 4193928 http://www.medworm.com/index.php?rid=4193927&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F6%2F169%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=4193927 Mon, 22 Nov 2010 00:00:00 +0100 4193927 http://www.medworm.com/index.php?rid=3971110&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F168%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971110 Tue, 14 Sep 2010 23:22:56 +0100 3971110 http://www.medworm.com/index.php?rid=3971109&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F167%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971109 Tue, 14 Sep 2010 23:22:56 +0100 3971109 http://www.medworm.com/index.php?rid=3971108&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F165%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971108 Tue, 14 Sep 2010 23:22:56 +0100 3971108 http://www.medworm.com/index.php?rid=3971107&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F157%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971107 Tue, 14 Sep 2010 23:22:56 +0100 3971107 http://www.medworm.com/index.php?rid=3971106&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F151%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971106 Tue, 14 Sep 2010 23:22:56 +0100 3971106 http://www.medworm.com/index.php?rid=3971105&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F145%3Frss%3D1 Asthma is a common chronic illness in children and a successful symptom control improves quality of life. Guidelines for the use of drugs in its management are widely available, but for children are often based on consensus opinion and extrapolation of data from studies in adolescents and adults. The aim of this review is to describe the clinical pharmacology of the drugs commonly used to manage chronic asthma in children and identify areas where further study might be useful to determine their best use. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971105 Tue, 14 Sep 2010 23:22:56 +0100 3971105 http://www.medworm.com/index.php?rid=3971104&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F134%3Frss%3D1 Cow's milk protein (CMP) is usually one of the first complementary foods to be introduced into the infant's diet and is commonly consumed throughout childhood as part of a balanced diet. CMP is capable of inducing a multitude of adverse reactions in children, which may involve organs like the skin, gastrointestinal (GI) tract or respiratory system. The diagnosis of CMP-induced adverse reactions requires an understanding of their classification and immunological basis as well as the strengths and limitations of diagnostic modalities. In addition to the well-recognised, immediate-onset IgE-mediated allergies, there is increasing evidence to support the role of CMP-induced allergy in a spectrum of delayed-onset disorders ranging from GI symptoms to chronic eczema. The mainstay of treatment is... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971104 Tue, 14 Sep 2010 23:22:56 +0100 3971104 http://www.medworm.com/index.php?rid=3971103&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F5%2F133%3Frss%3D1 (No abstract is available for this citation) (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3971103 Tue, 14 Sep 2010 23:22:56 +0100 3971103 http://www.medworm.com/index.php?rid=3825605&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F132%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825605 Thu, 05 Aug 2010 13:48:00 +0100 3825605 http://www.medworm.com/index.php?rid=3825604&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F131%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825604 Thu, 05 Aug 2010 13:48:00 +0100 3825604 http://www.medworm.com/index.php?rid=3825603&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F124%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825603 Thu, 05 Aug 2010 13:48:00 +0100 3825603 http://www.medworm.com/index.php?rid=3825602&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F119%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825602 Thu, 05 Aug 2010 13:48:00 +0100 3825602 http://www.medworm.com/index.php?rid=3825601&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F118%3Frss%3D1 Answers to the following two quiz questions can be found on page 132 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825601 Thu, 05 Aug 2010 13:48:00 +0100 3825601 http://www.medworm.com/index.php?rid=3825600&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F112%3Frss%3D1 With the epidemic of childhood obesity, it is not uncommon for prescribers to puzzle over an appropriate drug dose for an obese child. Defining the optimum therapeutic dose of a drug relies on an understanding of pharmacokinetics and pharmacodynamics. Both these processes can be affected by body composition and the physiological changes that occur in obese children. As a rule of thumb, 75% of excess weight in obese subjects is fat mass, and the remainder lean mass. Although it is reasonable to assume that increases in fat mass alter the distribution of lipophilic drugs and increases in lean mass alter drug clearance, good quality and consistent clinical data supporting these assumptions are lacking for the majority of drugs. The relatively few clinical studies that have evaluated the impac... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825600 Thu, 05 Aug 2010 13:48:00 +0100 3825600 http://www.medworm.com/index.php?rid=3825599&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F105%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825599 Thu, 05 Aug 2010 13:48:00 +0100 3825599 http://www.medworm.com/index.php?rid=3825598&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F98%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825598 Thu, 05 Aug 2010 13:48:00 +0100 3825598 http://www.medworm.com/index.php?rid=3825597&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F4%2F97%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3825597 Thu, 05 Aug 2010 13:48:00 +0100 3825597 http://www.medworm.com/index.php?rid=3593960&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F96%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593960 Tue, 25 May 2010 09:18:39 +0100 3593960 http://www.medworm.com/index.php?rid=3593959&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F95%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593959 Tue, 25 May 2010 09:18:39 +0100 3593959 http://www.medworm.com/index.php?rid=3593958&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F94%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593958 Tue, 25 May 2010 09:18:39 +0100 3593958 http://www.medworm.com/index.php?rid=3593957&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F93%3Frss%3D1 Illuminations have a new format. From now on, it will take the form of a short quiz to test and inform your knowledge of imaging relevant to paediatrics, and should soon be available as a web-based teaching aid. Any suggestions for improvement or topics you would like to be covered are welcome. Please email comments and feedback to helen.willliams@bch.nhs.uk. Answers to the following two quiz questions can be found on page 96. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593957 Tue, 25 May 2010 09:18:39 +0100 3593957 http://www.medworm.com/index.php?rid=3593956&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F88%3Frss%3D1 The first of this pair of papers outlined what a clinical decision rule is and how one should be created. This section examines how to use a rule, by checking that it is likely to work (examining how it has been validated), understanding what the various numbers that tell us about "accuracy" mean, and considers some practical aspects of how clinicians think and work in order to make that information usable on the front lines. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593956 Tue, 25 May 2010 09:18:39 +0100 3593956 http://www.medworm.com/index.php?rid=3593955&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F83%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593955 Tue, 25 May 2010 09:18:39 +0100 3593955 http://www.medworm.com/index.php?rid=3593954&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F73%3Frss%3D1 An increase in the frequency of diagnosing non-cystic fibrosis bronchiectasis in children is due to heightened awareness of the disease and the wider availability of high-resolution computed tomography. The most common underlying conditions leading to bronchiectasis include infections, immunodeficiency, aspiration and primary ciliary dyskinesia. Treatment centres on airway clearance with aggressive antibiotic regimens and physiotherapy; more specific approaches are available for some of the underlying conditions. A high index of suspicion that a child may have underlying bronchiectasis must be maintained in the presence of prolonged or recurrent "wet/productive" cough. The classic definition of bronchiectasis is of irreversible bronchial dilatation; however, at the milder end of the spectr... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593954 Tue, 25 May 2010 09:18:39 +0100 3593954 http://www.medworm.com/index.php?rid=3593953&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F66%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593953 Tue, 25 May 2010 09:18:39 +0100 3593953 http://www.medworm.com/index.php?rid=3593952&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F3%2F65%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3593952 Tue, 25 May 2010 09:18:39 +0100 3593952 http://www.medworm.com/index.php?rid=3418660&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F59%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418660 Mon, 29 Mar 2010 15:47:39 +0100 3418660 http://www.medworm.com/index.php?rid=3418659&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F55%3Frss%3D1 C-reactive protein (CRP) is an acute-phase protein that increases 4–6 h after an inflammatory trigger and peaks at 36–50 h. Levels decrease rapidly with the resolution of inflammation. CRP is generally highly elevated in invasive bacterial infections and is often used as a marker of inflammation. A single CRP level is neither sensitive nor specific enough to identify all children with serious bacterial infection. However, a raised CRP does suggest serious bacterial infection and should suggest further assessment is needed. CRP levels that fail to decrease, or continue to rise, after 48 h of antibiotic therapy suggest treatment failure. In infants with suspected neonatal sepsis, two CRP measurements 24 h apart that are <10 mg/l are useful in excluding sepsis. (Source: Archive... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418659 Mon, 29 Mar 2010 15:47:39 +0100 3418659 http://www.medworm.com/index.php?rid=3418658&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F47%3Frss%3D1 This article reviews the pathology and presentation of spine and spinal cord tumours in children and advises on the appropriate assessment of a child who may have a spine or spinal cord tumour. The principles underlying the management of these tumours are discussed and the management strategies for individual tumour types summarised. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418658 Mon, 29 Mar 2010 15:47:39 +0100 3418658 http://www.medworm.com/index.php?rid=3418657&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F40%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418657 Mon, 29 Mar 2010 15:47:39 +0100 3418657 http://www.medworm.com/index.php?rid=3418656&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F34%3Frss%3D1 Evidence based medicine (EBM) consists of four separate processes. Asking a clinical question Locating the evidence Appraising and synthesizing the evidence Applying the evidence Most people are familiar with the third step but not so familiar with the first two. Well-designed clinical questions can help clarify in a clinicians mind exactly what information is being sought and also help with the search. This clinical question can be framed around the PICO format. With a well-structured PICO information can then be located in a timely manner using the concept of Haynes's 5 S's and a range of websites including trial registers and meta-search engines. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418656 Mon, 29 Mar 2010 15:47:39 +0100 3418656 http://www.medworm.com/index.php?rid=3418655&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F2%2F33%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3418655 Mon, 29 Mar 2010 15:47:39 +0100 3418655 http://www.medworm.com/index.php?rid=3256994&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F28%3Frss%3D1 Evaluation comes in many shapes and sizes. It can be as simple and as grounded in day to day work as a clinical teacher reflecting on a lost teaching opportunity and wondering how to do it better next time or as complex, top down and politically charged as a major government led evaluation of use of teaching funds with the subtext of re-allocating them. Despite these multiple spectra of scale, perceived ownership, financial and political implications, the underlying principles of evaluation are remarkably consistent. To evaluate well, it needs to be clear who is evaluating what and why. From this will come notions of how it needs to be done to ensure the evaluation is meaningful and useful. This paper seeks to illustrate what evaluation is, why it matters, where to start if you want to do ... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256994 Tue, 09 Feb 2010 14:53:09 +0100 3256994 http://www.medworm.com/index.php?rid=3256993&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F24%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256993 Tue, 09 Feb 2010 14:53:09 +0100 3256993 http://www.medworm.com/index.php?rid=3256992&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F14%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256992 Tue, 09 Feb 2010 14:53:09 +0100 3256992 http://www.medworm.com/index.php?rid=3256991&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F9%3Frss%3D1 Acute appendicitis is the most important cause of abdominal pain in children and is the commonest that requires emergency surgery. Prompt diagnosis, immediate referral and expeditious surgery should be undertaken to reduce the risk of a perforated appendix. The initial presentation may be atypical or be similar to another pathological process which makes the diagnosis extremely difficult. Risk assessment forms an important part in the management of these cases. We consider the difficulties in making the diagnosis including: (A) the pitfalls of clinical examination; (B) the usefulness of laboratory testing; (C) the relevance of clinical scoring systems; and (D) the controversial issue of imaging. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256991 Tue, 09 Feb 2010 14:53:09 +0100 3256991 http://www.medworm.com/index.php?rid=3256990&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F2%3Frss%3D1 A mistaken diagnosis of child abuse can occur in a number of medical conditions, many of which can be readily diagnosed by experienced paediatricians. Bleeding disorders offer a greater challenge, especially when court proceedings may demand their exclusion. Some of these disorders are rare but more prevalent in areas which have a high incidence of consanguinity. We advocate two stages of laboratory investigations but the limitations of some of these tests and their inability to exclude a bleeding disorder with absolute certainty should be recognised. However, if personal and family histories are absent and both first-stage and second-stage investigations are normal, it is highly unlikely that a bleeding disorder will be missed. (Source: Archives of Disease in Childhood - Education and Pra... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256990 Tue, 09 Feb 2010 14:53:09 +0100 3256990 http://www.medworm.com/index.php?rid=3256989&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F1%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3256989 Tue, 09 Feb 2010 14:53:09 +0100 3256989 http://www.medworm.com/index.php?rid=3014267&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F6%2F191%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3014267 Fri, 20 Nov 2009 18:01:22 +0100 3014267 http://www.medworm.com/index.php?rid=3014266&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F6%2F186%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3014266 Fri, 20 Nov 2009 18:01:22 +0100 3014266 http://www.medworm.com/index.php?rid=3014265&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F6%2F177%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3014265 Fri, 20 Nov 2009 18:01:22 +0100 3014265 http://www.medworm.com/index.php?rid=3014264&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F6%2F169%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3014264 Fri, 20 Nov 2009 18:01:22 +0100 3014264 http://www.medworm.com/index.php?rid=3014263&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F6%2F161%3Frss%3D1 Autism spectrum disorders are of high prevalence and have a potentially complex range of presentations within the core impaired domains of social communication, reciprocal social interaction, imaginary thought and restricted and repetitive behaviours. Paediatricians need to recognise the possibility of these conditions among the high-risk populations of children with whom they work. This includes those presenting in the preschool years to child development clinics with delayed acquisition of language or general development delay or those presenting in the school years with coordination, academic, peer interaction and behavioural difficulties. In addition, paediatricians are essential members of the multidisciplinary teams charged with specialist assessment and their clinical history and ex... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=3014263 Fri, 20 Nov 2009 18:01:22 +0100 3014263 http://www.medworm.com/index.php?rid=2849146&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F157%3Frss%3D1 There is a growing need for healthcare professionals to extend their knowledge in adolescent health care. Formal training curricula in adolescent medicine have been developed in only the United States, Canada and Australia. The Israeli experience in building an infrastructure that allows physicians to train in adolescent medicine is described. It includes the development of hospital-based and community-based multidisciplinary adolescent health services, a 3-year diploma course in adolescent medicine and a simulated patient-based programme regarding communication with adolescents. In the course of one decade an infrastructure has been developed to create a cadre of physicians who are able to operate adolescent clinics and to teach adolescent medicine. Consequently a formal fellowship traini... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2849146 Mon, 21 Sep 2009 21:31:14 +0100 2849146 http://www.medworm.com/index.php?rid=2849145&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F151%3Frss%3D1 Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with significant long-term morbidity and mortality. Major advances have taken place in recent years in our understanding and the evidence base of JIA. The advent of biological therapies has opened a major new era in the medical management of JIA with recent trials published of etanercept, infliximab, adalimumab, abatacept, tocilizumab and anakinra. National and international collaborative clinical and research networks are ideally placed to enable future advances in the management of JIA and all paediatric rheumatic disorders. This review follows on from Part 1 of a review of recent advances in non-biological therapies in JIA, and focuses on the significant new advances in biological therapies in managing J... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2849145 Mon, 21 Sep 2009 21:31:14 +0100 2849145 http://www.medworm.com/index.php?rid=2849144&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F144%3Frss%3D1 Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with significant long-term morbidity and mortality. Major advances have taken place in recent years in our understanding and the evidence base of JIA. Key to this has been the serious collaborative efforts of clinicians, academics, scientists and the whole of the multidisciplinary team. This has led to the important recognition and development of specialised expertise for the management of patients, improvement in global outcome measures and aggressive treatment of the significant complications of JIA. Important steps have taken place in optimising treatment of JIA. Clinical trials demonstrate that early use of intra-articular corticosteroid injections alone or in addition to other systemic treatments can h... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2849144 Mon, 21 Sep 2009 21:31:14 +0100 2849144 http://www.medworm.com/index.php?rid=2849143&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F138%3Frss%3D1 Chronic meningitis is a syndrome characterised by persistent and progressive signs and symptoms of meningitis along with cerebrospinal fluid (CSF) pleocytosis and elevated protein that fail to improve over 4 weeks. A detailed and careful history and examination is required along with CSF parameters to guide a clinician towards the aetiology of the problem. Neuroimaging modalities have become a useful tool in the quest for a diagnosis in such cases. An interesting case is described in real time illustrating the process of making a diagnosis in chronic meningitis with an insight into investigations and subsequent management. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2849143 Mon, 21 Sep 2009 21:31:14 +0100 2849143 http://www.medworm.com/index.php?rid=2849142&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F129%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2849142 Mon, 21 Sep 2009 21:31:14 +0100 2849142 http://www.medworm.com/index.php?rid=2817414&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F157%3Frss%3D1 There is a growing need for healthcare professionals to extend their knowledge in adolescent health care. Formal training curricula in adolescent medicine have been developed in only the United States, Canada and Australia. The Israeli experience in building an infrastructure that allows physicians to train in adolescent medicine is described. It includes the development of hospital-based and community-based multidisciplinary adolescent health services, a 3-year diploma course in adolescent medicine and a simulated patient-based programme regarding communication with adolescents. In the course of one decade an infrastructure has been developed to create a cadre of physicians who are able to operate adolescent clinics and to teach adolescent medicine. Consequently a formal fellowship traini... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2817414 Sun, 20 Sep 2009 23:00:00 +0100 2817414 http://www.medworm.com/index.php?rid=2817413&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F151%3Frss%3D1 Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with significant long-term morbidity and mortality. Major advances have taken place in recent years in our understanding and the evidence base of JIA. The advent of biological therapies has opened a major new era in the medical management of JIA with recent trials published of etanercept, infliximab, adalimumab, abatacept, tocilizumab and anakinra. National and international collaborative clinical and research networks are ideally placed to enable future advances in the management of JIA and all paediatric rheumatic disorders. This review follows on from Part 1 of a review of recent advances in non-biological therapies in JIA, and focuses on the significant new advances in biological therapies in managing J... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2817413 Sun, 20 Sep 2009 23:00:00 +0100 2817413 http://www.medworm.com/index.php?rid=2817412&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F144%3Frss%3D1 Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with significant long-term morbidity and mortality. Major advances have taken place in recent years in our understanding and the evidence base of JIA. Key to this has been the serious collaborative efforts of clinicians, academics, scientists and the whole of the multidisciplinary team. This has led to the important recognition and development of specialised expertise for the management of patients, improvement in global outcome measures and aggressive treatment of the significant complications of JIA. Important steps have taken place in optimising treatment of JIA. Clinical trials demonstrate that early use of intra-articular corticosteroid injections alone or in addition to other systemic treatments can h... Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2817412 Sun, 20 Sep 2009 23:00:00 +0100 2817412 http://www.medworm.com/index.php?rid=2817411&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F138%3Frss%3D1 Chronic meningitis is a syndrome characterised by persistent and progressive signs and symptoms of meningitis along with cerebrospinal fluid (CSF) pleocytosis and elevated protein that fail to improve over 4 weeks. A detailed and careful history and examination is required along with CSF parameters to guide a clinician towards the aetiology of the problem. Neuroimaging modalities have become a useful tool in the quest for a diagnosis in such cases. An interesting case is described in real time illustrating the process of making a diagnosis in chronic meningitis with an insight into investigations and subsequent management. (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2817411 Sun, 20 Sep 2009 23:00:00 +0100 2817411 http://www.medworm.com/index.php?rid=2817410&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F5%2F129%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2817410 Sun, 20 Sep 2009 23:00:00 +0100 2817410 http://www.medworm.com/index.php?rid=2669494&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F123%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669494 Thu, 23 Jul 2009 23:00:00 +0100 2669494 http://www.medworm.com/index.php?rid=2669493&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F118%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669493 Thu, 23 Jul 2009 23:00:00 +0100 2669493 http://www.medworm.com/index.php?rid=2669492&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F115%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669492 Thu, 23 Jul 2009 23:00:00 +0100 2669492 http://www.medworm.com/index.php?rid=2669491&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F108%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669491 Thu, 23 Jul 2009 23:00:00 +0100 2669491 http://www.medworm.com/index.php?rid=2669490&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F102%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669490 Thu, 23 Jul 2009 23:00:00 +0100 2669490 http://www.medworm.com/index.php?rid=2669489&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F4%2F97%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2669489 Thu, 23 Jul 2009 23:00:00 +0100 2669489 http://www.medworm.com/index.php?rid=2430348&cid=s_32763_33_f&fid=32763&url=http%3A%2F%2Fep.bmj.com%2Fcgi%2Fcontent%2Fshort%2F94%2F3%2F96%3Frss%3D1 (Source: Archives of Disease in Childhood - Education and Practice) Archives of Disease in Childhood - Education and Practice journals http://www.medworm.com/rss/comments.php?id=2430348 Thu, 21 May 2009 04:00:00 +0100 2430348