Archives of Disease in Childhood: Education & Practice Edition最新文献

{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2019-316783","DOIUrl":"https://doi.org/10.1136/archdischild-2019-316783","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84455235","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2018-316456","DOIUrl":"https://doi.org/10.1136/archdischild-2018-316456","url":null,"abstract":"Is NICE ageist? In the UK, new health technologies are assessed by the National Institute for Clinical Excellence (NICE). NICE determines the cost incurred for each additional quality-adjusted life-year (QALY) that the new technology provides over and above the currently standard treatment. Though there is considerable flexibility in the process, technologies which offer a costper-QALYof £20 000-£30 000 or less would normally be recommended for use. The thought is that, given a fixed total health budget, use of technologies with a higher cost-per-QALY will generally decrease aggregate health by displacing more cost-effective interventions. One criticism levelled at NICE maintains that its methodology is ageist. Since younger people typically have a longer life expectancy than older people, a life-saving treatment will tend to produce more QALYs in a younger person. So too will a quality-of-life-improving intervention, since it will improve quality of life over a longer period. The NICE approach might be said to systematically favour younger people. In this issue, Stevens and collaborators (see page 258) respond to this charge. They concede that the cost-per-QALY approach could disfavour the elderly, but argue that it will do so only in rare casesd cases that have never occurred. These would most likely be cases of extremely expensive interventions that cure imminently fatal conditions and restore normal life-expectancy. Moreover, even if such a case did occur, NICE might nevertheless recommend the intervention for use. Stevens and collaborators note that NICE’s expert advisory committees have considerable leeway to consider factors besides cost-per-QALY. They also point to various other features of the NICE process that tend to protect against ageist decisions. In a commentary (see page 263), John Harris and Sadie Regmi respond to this defence of NICE by arguing that the NICE approach is ageist in theory even if not in practice. They claim that it expresses the view that old people ‘are not worth the expenditure of resources’ and uses ‘arbitrary ’ considerations, such as one’s baseline life expectancy and quality of life, to inform decisions. Harris and Regmi are surely right to note that a resource allocation process could be ageist ‘in theory ’. But the points made by Stevens and collaborators might yet have significance, for ageism in practice may matter too. Harris and Regmi draw an analogy between ageism and racism, and suggest that NICE is rather like a racist person who, despite having racist beliefs, never acts in a racist way. But surely this racist is a less bad sort of racist than one who is thoroughly racist both in thought and action. Even if NICE’s methodology is ageist, the fact that this ageism rarely if ever finds its way into NICE decisions may mitigate the problem. Moreover, as Harris and Regmi acknowledge, one might dispute whether NICE’s methodology really is ageist even in theory. Baseline quality of life and life expectancy","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72861290","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2018-316109","DOIUrl":"https://doi.org/10.1136/archdischild-2018-316109","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81845049","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2018-315766","DOIUrl":"https://doi.org/10.1136/archdischild-2018-315766","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74779480","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2018-315075","DOIUrl":"https://doi.org/10.1136/archdischild-2018-315075","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82299864","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2017-314684","DOIUrl":"https://doi.org/10.1136/archdischild-2017-314684","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88487908","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2017-314368","DOIUrl":"https://doi.org/10.1136/archdischild-2017-314368","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91227816","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2017-313862","DOIUrl":"https://doi.org/10.1136/archdischild-2017-313862","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74331592","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2017-313633","DOIUrl":"https://doi.org/10.1136/archdischild-2017-313633","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80077618","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":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2017-312951","DOIUrl":"https://doi.org/10.1136/archdischild-2017-312951","url":null,"abstract":"I’m very aware that it may look a bit smug, my writing here each edition about what a wonderful set of articles we have in the journal on this occasion. So I’d like, this time, to emphasise that I’m very aware that this is, as far as I can tell, pretty good luck. The main luck I have is that I’ve managed to surround myself with some very fine authors, and some very talented commissioning editors. You should be aware that for every article we publish, there is at least one additional, uncredited author —the editor who takes the excellent ideas and expression of the author and improves it further still. Most of what I do, therefore, is sit here and ask questions. The first questions I ask are things which puzzle me on ward rounds, in clinics, or when grinding through a pile of correspondence. Questions like: How ought I use a blood culture? That’s been answered—at least in part—this month in an interpretation from Surjo Kiran De, Nandini Shetty and Michael Kelsey (see page 144). I found out a long while ago that a fast way to make my microbiology colleagues feel faint was to suggest that I’d base a clinical decision to cease antibiotics entirely on negative cultures at 48 hours. These authors try to answer a variety of other helpful questions —but as you’d expect, strongly advocate basing decisions on the clinical presentation of the child. How ought I to manage the child with chest pain? I have colleagues in cardiology who worry about a very cardiac focused approach to chest pain; an article by Samuel Collins and Michael Griksaitis and Julian Legg redresses any imbalance (see page 122), and in particular their table 2 gives a superb summary of everything that you should worry—or not worry— about. This paper is of such value that it’s this month’s editor’s choice. How ought I to manage the needs of my patients and families who contact with me? Anthony Cohn’s article (see page 152) outlining how he has developed his practice of being in email contact with patients was a fearful read for me in the first instance. There can’t be many of us who think “You know, I could do with a few more emails in my life...” Anthony’s response to increasing demands from his patients was to get them to email him: he describes how he went about it, and how he feels it improved his practice, without, apparently, crushing him under the weight of thousands of extra emails. What really should we be doing with tongue tie? Well, that question has been addressed elsewhere in the Archives family; 2 here’s a companion piece which describes this procedure (see page 127), and looks at why some surgeons are so perplexed at our reluctance to embrace it. Should we be treating fever? Well, that’s a big one—and would require the most enormous culture change, especially after a few decades of our fueling of fever phobia, but Giordano Perez Gaxiola, Catherine Williams and Damian Roland have a nice little fight about it in these pages (see page 158). Anyway, that’s five good questions, an","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76340836","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}