Education & Practice最新文献

{"title":"Epistle","authors":"Neelam Gupta","doi":"10.1136/archdischild-2024-327078","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327078","url":null,"abstract":"The alarming rise in vaping and the use of e-cigarettes by children and young persons (CYP) is a topical issue.1 Although vaping nicotine and its toxic by-products have been established to have many harmful effects, e-cigarette use has been misleadingly advertised as a viable strategy in aiding smoking cessation. There is, however, limited evidence to support this suggestion. This perception that vaping products are safe and harmless compared with combustible tobacco, together with attractive advertising and media influences, have contributed to the growing popularity of e-cigarettes among the young. Over the years, appropriate smoking legislation has proven to be effective in reducing the use of harmful combustible tobacco products. The landmark announcement by the UK government to introduce bans on disposable e-cigarettes will come in effect later this year or by early 2025. The legislation introduces not only penalties for the sale of these products, but also restrictions on flavours …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140165995","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}

{"title":"Interpretation: use of autoantibodies in children","authors":"Hayley King, Antonis Tofias, Abbie Greenhill, Aidan Grimes, Khuen Foong Ng","doi":"10.1136/archdischild-2023-326327","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326327","url":null,"abstract":"Judicious use of autoantibodies in paediatrics can be challenging. Autoimmune conditions can present with a wide range of signs and symptoms, many of which are non-specific. In combination with clinical features and laboratory findings, autoantibodies can facilitate diagnosis and in certain cases inform prognosis. Evidence for use of autoantibodies to guide and monitor treatment is limited. Caution is necessary when interpreting adult studies. We summarise the use of autoantibodies in paediatric practice with a guide on how they may be used.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140165897","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}

{"title":"UK Kidney Association guideline review: ‘The initial management of IgA vasculitis (Henoch-Schönlein purpura) in children and young people’ in conjunction with ‘The management of complications-associated IgA vasculitis (Henoch-Schönlein purpura) in children and young people’","authors":"Charlotte Day, Rachel Shute","doi":"10.1136/archdischild-2023-326239","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326239","url":null,"abstract":"IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura (HSP), is an IgA-mediated autoimmune vasculitis typically affecting the skin, joints, gastrointestinal (GI) tract and kidneys. In IgAV, IgA complexes are deposited on the endothelium of the small vessels in these organs, causing inflammation. IgAV has an incidence of approximately 1 in 5000, predominantly affects children between the ages of 2 and 10 years and peaks between 4 and 7 years,1 can affect teenagers and adults, and is a common childhood condition seen by paediatricians, general practitioners (GPs) and emergency department (ED) doctors across the UK. Despite this, the research in this field is still limited, so currently, there are discrepancies in both the initial management and management of complications related to IgAV. While most cases of IgAV self-resolve with conservative management or management in primary and secondary care, some children will develop severe, life-changing or life-threatening complications such as acute GI bleeding and end-stage renal disease requiring tertiary centre involvement.2 It is important that careful specialist referral, screening and early management of these children occur to ensure that these complications are prevented or treated in a timely manner. ### Information about the current guideline The current guidelines were published in December 2022 by the UK Kidney Association (UKKA), and are the first national guidelines for the initial management of IgAV and the management of complications associated with IgAV in children and young people. In 2019, the first international guidelines providing recommendations for diagnosis and treatment were published by SHARE (Single Hub and Access Point for paediatric Rheumatology in Europe) with the same aim to provide evidence-based recommendations and to standardise treatments throughout countries and centres.3 Until now, due to lack of best practice recommendations in the UK, experts in different National Health Service trusts have been formulating guidelines based on the most recent research. …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139919459","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}

{"title":"Emergency and perioperative management of adrenal insufficiency in children and young people: BSPED consensus guidelines","authors":"Martha McKenna, Rhiannon McBay-Doherty, Emmeline Heffernan","doi":"10.1136/archdischild-2023-325725","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325725","url":null,"abstract":"Adrenal insufficiency (AI) is characterised by a deficiency in adrenal cortisol production. It can arise due to a primary adrenal disorder (eg, autoimmune Addison’s disease or congenital adrenal hyperplasia) which is commonly associated with glucocorticoid and mineralocorticoid deficiency. Secondary AI occurs when a pathology in the pituitary gland causes a lack of adrenocorticotropic hormone leading to a cortisol deficiency (eg, hypopituitarism) or as a result of suppression of the hypothalamic–pituitary–adrenal axis from exogenous glucocorticoids.1 The glucocorticoid deficiency in AI is managed by replacing hydrocortisone. During times of physiological stress, additional glucocorticoids are required. Diagnosis is often delayed due to the non-specific symptoms. Failure to recognise AI and initiate treatment can result in an adrenal crisis.1 ### Information about the current guideline The Paediatric Adrenal Insufficiency Group comprising a multidisciplinary team of paediatric endocrinologists, endocrine nurse specialists and a pharmacist was established with the support of the British Society of Paediatric Endocrinology and Diabetes (BSPED) to standardise the management of paediatric AI.2 This guideline published in November 2022 focuses on management of AI in children during an acute illness with oral sick day dosing, intramuscular and intravenous regimens in emergencies and management during the perioperative period. ### Previous guideline and current practice Prior to this guideline, there were no unified guidelines for managing paediatric AI leading to substantial variations in treatment. National Institute for Health and Care Excellence (NICE) 2020 guidance on Addison’s disease recommends the paediatric endocrinology team provide emergency management for adrenal crisis with the same age-based …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663742","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}

{"title":"Fourteen-year-old girl with complicated hypothyroidism","authors":"Rhiannon McBay-Doherty, Noina Abid, Karen Thompson, Andrew Thompson","doi":"10.1136/archdischild-2023-326493","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326493","url":null,"abstract":"A 14-year-old girl presented to her general practioner with neck swelling and lethargy. Initial thyroid function showed a free T4 of 6.6 pmol/L (12.6–21.0 pmol/L) and thyroid stimulating hormone 34.9 mIU/L (0.51–4.3 mIU/L). An ultrasound of the thyroid was in keeping with active thyroiditis and anti-TPO antibodies were positive indicating autoimmune hypothyroidism. She had no family history of note. She was started on levothyroxine 75 µg daily with normalisation of her thyroid function within 3 weeks. She was admitted to the emergency department 4 weeks later with progressive fatigue and acute nausea and vomiting. At presentation, she was lethargic, tachycardic at 122 bpm, hypotensive at 95/57 mmHg and afebrile. Initial venous blood gas: pH 7.23, HCO3 13.6 mmol/L, pCO2 4.2 kPa, BE −12.9 mmol/L, Cl 100 mmol/L, Lac 1.5 mmol/L, Glu 3 mmol/L, Na 121 mmol/L and K 4.1 mmol/L. Initial investigations: urea 4.2 mmol/L, creatinine 43 µmol/L, adjusted calcium 2.45 mmol/L. 1. What is the most likely diagnosis? 1. Acute renal failure 2. Adrenal crisis 3. Myxoedema crisis 4. Sepsis …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139670328","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}

{"title":"Fifteen-minute consultation: Palpitations in children","authors":"Heechan Kang, Maturu Ravi Kumar, Nicholas Hayes","doi":"10.1136/archdischild-2023-325817","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325817","url":null,"abstract":"Palpitations are a common presenting symptom in the paediatric population and generate understandable anxiety around issues regarding the heart and the possible consequences of an underlying cardiac arrhythmia. That said, many patients will be describing a benign sensation with no associated underlying cardiac pathology. This article aims to provide a practical framework when encountering children with palpitations to assess the likelihood of an underlying arrhythmia and to determine whether further investigation and/or referral to specialist paediatric cardiac services is required. A 10-year-old boy has been referred to the local paediatric outpatient clinic by his general practitioner. He has experienced three episodes of palpitations, each lasting around 10–15 min, over the past couple of months. These have come without warning and stopped spontaneously. He is otherwise fit and well, with no significant medical or family history. His parents are concerned about the possibility of an underlying arrhythmia. Palpitations vary in sensation between individuals, but collectively describe an unpleasant awareness of one’s own heartbeat due to speed, strength and/or irregularity. Often children will report feeling a more rapid and forceful heartbeat, although for others it can be a single ‘thump’ in the chest or ‘skipped beats’. Sometimes parents will report having felt this through the chest wall or seen pulsations in the neck. They may occur in isolation, or in association with a variety of other symptoms, including shortness of breath, chest pain, abdominal pain, neck pain, feeling weak, visual disturbance, headache and dizziness. When presenting acutely with continuing symptoms, assessment of heart rate and contemporaneous ECG can usually accurately identify the presence of an underlying arrhythmia and need for further management. Often, however, as in the scenario above, the encounter is following a symptomatic episode (or episodes) that has since resolved spontaneously prior to evaluation. Baseline cardiac examination and ECG are …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138825493","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}

{"title":"Fifteen-minute consultation: Pathophysiology of postural orthostatic tachycardia syndrome in children and adolescents: diagnosis and management strategies","authors":"Jiashi Li, Angas Hamer, Samuel Menahem","doi":"10.1136/archdischild-2023-325933","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325933","url":null,"abstract":"Postural orthostatic tachycardia syndrome (POTS) affects children and adolescents—normally fit and well and yet troubled by a myriad of everyday symptoms. Understanding the pathophysiology of this not uncommon disorder together with a review of the clinical features may well assist the attending clinicians to arrive at a clear diagnosis without the need for extensive testing and multiple investigations. Simple lifestyle measures such as increasing fluid intake, electrolyte and/or salt supplements, adequate sleep, not missing out on meals and instituting an exercise programme to improve muscle tone and strength may avoid the need of pharmacological management. These simple measures may benefit symptoms which generally improve as adulthood approaches. In addition, it is important to recognise the comorbidities that may be associated with POTS, each of which may require specific management strategies. This paper reviews the pathophysiology, clinical features and recommended treatment in the management of POTS.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743652","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}

{"title":"Child bereavement—what matters to the families. Part 1: Immediate and short-term communication and care","authors":"Shona Elizabeth Johnston, Suzanne McAllister, Catriona Norden, Keta Keens, Katharine Jones, Gillian Smith, Rebecca Duncombe, Laura Barnett, Amy Krepska","doi":"10.1136/archdischild-2023-326386","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326386","url":null,"abstract":"The death of a child is a complex and hugely significant time for a family and community. Sophisticated but sensitive management by clinicians can have both short-term and long-term impacts on how families process the death. There is a paucity of guidance for optimal child bereavement care. A description of the child death review process including key legalities is provided here, and other essential aspects such as memory making, cultural aspects and sibling involvement are explored. Useful agencies and resources are also detailed. We, as both clinicians and bereaved parents, can uniquely provide an overview of the logistics of managing such a challenging event and highlight important subtleties in communication. We attempt, using our own experiences, to provide a framework and best inform future practice.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138546067","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}

{"title":"Child bereavement—what matters to the families. Part 2: The long term","authors":"Shona Elizabeth Johnston, Suzanne McAllister, Catriona Norden, Keta Keens, Katharine Jones, Gillian Smith, Rebecca Duncombe, Laura Barnett, Amy Krepska","doi":"10.1136/archdischild-2023-326387","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326387","url":null,"abstract":"The death of a child is a devastating event. Families experience profound grief and loss immediately following the death, and this remains and evolves as time progresses. In this, the second in a series, we discuss the importance of longer term bereavement care and how continuing contact with healthcare can be navigated. As bereaved parents who are also doctors, we again share our experiences. The complex nature of parenting, supporting siblings or managing a pregnancy after loss are explored, and we look at the involvement of bereaved parents in developing bereavement services.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138545936","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}

{"title":"Fifteen-minute consultation: Management of albuminuria in children and young people with diabetes","authors":"Isabella Weber, Cliodhna Myles, A Emile J Hendriks, M Loredana Marcovecchio, Benjamin G Fisher","doi":"10.1136/archdischild-2023-326275","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326275","url":null,"abstract":"Albuminuria is a marker of diabetic kidney disease. Raised albuminuria in children and young people with diabetes is associated with an increased risk of microvascular and macrovascular complications. This review provides guidance for paediatricians caring for children and young people with type 1 and type 2 diabetes on screening, investigations and treatments for albuminuria in line with relevant national and international recommendations.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138511770","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}