Education & Practice最新文献

Epistle 书信

Education & Practice Pub Date : 2024-10-01 DOI: 10.1136/archdischild-2024-327916

Neelam Gupta

引用次数: 0

NICE guideline review: type 2 diabetes in children and young people – diagnosis and management (NG18) NICE 指南审查：儿童和青少年 2 型糖尿病--诊断和管理 (NG18)

Education & Practice Pub Date : 2024-09-18 DOI: 10.1136/archdischild-2024-326911

Isabella Weber, Benjamin G Fisher, Cliodhna Myles, A Emile J Hendriks, M Loredana Marcovecchio

{"title":"NICE guideline review: type 2 diabetes in children and young people – diagnosis and management (NG18)","authors":"Isabella Weber, Benjamin G Fisher, Cliodhna Myles, A Emile J Hendriks, M Loredana Marcovecchio","doi":"10.1136/archdischild-2024-326911","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326911","url":null,"abstract":"Type 2 diabetes (T2D) is becoming progressively more common among young people concomitantly with the epidemic of childhood obesity.1 The incidence of youth-onset T2D is projected to rise by >600% by 2060,2 and the UK has the fastest increase in incidence rate globally.3 Compared with type 1 diabetes (T1D), youth-onset T2D is associated with higher rates and earlier onset of complications and a 50% higher mortality rate.1 Appropriate intervention is therefore key to improve outcomes.4 In May 2023, the National Institute for Health and Care Excellence (NICE) updated the section on T2D of the guideline on ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’.5 Additionally, relevant guidelines have been recently published by the (UK) Association of Children’s Diabetes Clinicians (ACDC) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) (box 1). Here, we focus on updates to NICE guideline relevant to T2D. Box 1 ### Resources National Institute for Health and Care Excellence (NICE) guideline (2023)5: https://www.nice.org.uk/guidance/ng18 Association of Children’s Diabetes Clinicians (ACDC) guideline (2023): https://www.a-c-d-c.org/wp-content/uploads/2012/08/TYpe-2-guideline-ACDC-format-publish-2.pdf International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline (2022): https://www.ispad.org/page/ISPADGuidelines2022 ### Immediate actions at T2D diagnosis A child or young person (CYP) with suspected T2D should be referred to a multidisciplinary paediatric diabetes team to ‘confirm diagnosis and provide immediate and continuing care’ (box 2).5 CYP with T2D should be given tailored information about T2D and offered dietary advice and support including weight management, metformin therapy and equipment for capillary blood glucose (BG) monitoring. Additionally, they should be offered long-acting …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What makes a good paediatrician? A focused review of Good Medical Practice 2024 怎样才能成为一名优秀的儿科医生？对《2024 年良好医疗规范》的重点审查

Education & Practice Pub Date : 2024-09-16 DOI: 10.1136/archdischild-2023-326506

Rebecca Jeyaraj, Deirdre Kelly

{"title":"What makes a good paediatrician? A focused review of Good Medical Practice 2024","authors":"Rebecca Jeyaraj, Deirdre Kelly","doi":"10.1136/archdischild-2023-326506","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326506","url":null,"abstract":"Modern healthcare is complex. Expectations of care and the responsibilities of medical professionals are evolving. New challenges include, among other things, disease outbreaks, novel technologies, health misinformation and workforce shortages. Despite this changing medical scene, doctors and patients continue to want to provide and receive the best possible care. In difficult situations, doctors may thus find professional guidance, ethical codes and legal advice or precedents helpful. ### Information about the current guidance The General Medical Council (GMC) regulates doctors in the UK. Its Good Medical Practice guidance describes professional standards for registered doctors.1 The 2024 guidance (published August 2023) was effective from 30 January 2024. It will apply to physician associates and anaesthesia associates once they are regulated by the GMC. A version of Good Medical Practice was first published in 1995, with updates every 3–10 years thereafter.2 The last major update was in 2013. The 2024 guidance was developed using (1) evidence from public inquiries, published reports and commissioned research, (2) advice from an external forum of 11 medical and non-medical experts, and (3) consultation with medical professionals, patients and the public. It is considered a shared agreement of good practice. While its core principles remain largely similar, Good Medical Practice 2024 incorporates several updates to reflect the needs and values of the profession and wider society (box 1). In this review, we focus on aspects of the guidance with particular implications or nuances in paediatric practice. Box 1 ### What do I need to know: key updates highlighted by the General Medical Council16","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reducing unplanned extubation in tertiary NICU: a quality improvement project 减少三级新生儿重症监护室的意外拔管：质量改进项目

Education & Practice Pub Date : 2024-05-02 DOI: 10.1136/archdischild-2023-326753

Rashida Javed, Kanwal Mahadev, Harsha Gowda

{"title":"Reducing unplanned extubation in tertiary NICU: a quality improvement project","authors":"Rashida Javed, Kanwal Mahadev, Harsha Gowda","doi":"10.1136/archdischild-2023-326753","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326753","url":null,"abstract":"Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-intubations. This could have serious side effects like cardiorespiratory deterioration and airway trauma. The aim of this quality improvement project (QIP) is to reduce the rate of UEs among intubated infants in a tertiary NICU over a period of 24 months. ### Making a case for change We engaged local stakeholders (clinicians, nurses, governance team, risk assessment team, X-ray technicians and education team) to evaluate risk factors for …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain 十五分钟会诊：先天性疼痛不敏感患儿的治疗方法

Education & Practice Pub Date : 2024-04-30 DOI: 10.1136/archdischild-2023-326479

Muhamad Azamin Anuar, Emily Rose Whitehouse, Uma Varma, Gary McCullagh, Imelda Hughes

引用次数: 0

Neonate with a large neck mass 新生儿颈部肿块较大

Education & Practice Pub Date : 2024-04-17 DOI: 10.1136/archdischild-2023-325613

Jessica Joanne Thompson, Sarah Kidd, Lucinda C Winckworth

引用次数: 0

Use of corticosteroids for croup in children 使用皮质类固醇治疗儿童哮喘

Education & Practice Pub Date : 2024-04-15 DOI: 10.1136/archdischild-2023-326773

Owen Hibberd, Agata Anna Chylinska, Katie Finn, Melanie Ranaweera, Dani Hall

{"title":"Use of corticosteroids for croup in children","authors":"Owen Hibberd, Agata Anna Chylinska, Katie Finn, Melanie Ranaweera, Dani Hall","doi":"10.1136/archdischild-2023-326773","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326773","url":null,"abstract":"### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net.2 7 It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care.3–6 8 As such, although the treatment is the same, clinicians should be mindful of the probability of a more severe illness when treating children with COVID-19 and croup.3–6 8 View this table: Table 1 Differentials of stridor in children The Westley Croup Score (table 2) is a standardised scoring …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140590216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acute Safeguarding Essentials in Modern-day Paediatrics: Sexual Relationships, Consent and Confidentiality 现代儿科急症保障要点：性关系、同意和保密

Education & Practice Pub Date : 2024-04-09 DOI: 10.1136/archdischild-2023-326654

Helen Thomas, Daniel Cromb, Hannah Jacob, Anastasia Alcock

引用次数: 0

Aminoglycoside administration in paediatrics: a literature search comparing international practices of intravenous injection or intravenous infusion 儿科氨基糖苷类药物用药：比较静脉注射或静脉输注国际惯例的文献检索

Education & Practice Pub Date : 2024-04-09 DOI: 10.1136/archdischild-2024-326924

Abigail Manning, Anna Burgess

{"title":"Aminoglycoside administration in paediatrics: a literature search comparing international practices of intravenous injection or intravenous infusion","authors":"Abigail Manning, Anna Burgess","doi":"10.1136/archdischild-2024-326924","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326924","url":null,"abstract":"### Key messages Aminoglycosides are a class of broad-spectrum, bactericidal antibiotics of which amikacin, gentamicin and tobramycin are the most commonly prescribed. These antibiotics are frequently prescribed for children, usually for infections, which are caused by aerobic Gram-negative pathogens. 1 Aminoglycosides are very poorly absorbed from the gastrointestinal tract, due to their lack of lipophilicity. Therefore, they must be administered parenterally. They are also concentration dependent, which means that the ratio between the peak concentrations (Cmax) to the pathogen’s minimum inhibitory concentration (MIC) is the pharmacokinetic-pharmacodynamic index, which is a marker for antimicrobial activity and effectiveness. To achieve an effective clinical response, a Cmax/MIC ratio between 8 and 12 has been advised, although this is based on adult data.1 Aminoglycosides have a narrow therapeutic margin, so therapeutic drug monitoring must be used to monitor for toxicity. High serum levels may result in ototoxicity and nephrotoxicity.1 Aminoglycosides are administered as once-daily or multiple-daily (previously known as ‘standard dose’) regimes. Once-daily …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Public health for paediatricians: how an evolutionary perspective can help us improve children’s well-being 儿科医生的公共卫生：进化论观点如何帮助我们改善儿童福祉

Education & Practice Pub Date : 2024-04-05 DOI: 10.1136/archdischild-2023-326522

Annie Swanepoel

引用次数: 0