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

{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2015-310391","DOIUrl":"https://doi.org/10.1136/archdischild-2015-310391","url":null,"abstract":"We wage a perpetual battle about what not to read. There are so many factors which stop us from reading as much as we feel we ought to, but I would put highest amongst these the sheer volume that we could actually read. I was recently in a talk by Professor Neal Maskrey who quoted some work looking at the reading requirements generated by a ward round. The researchers reckoned that the time needed to read simply to keep up to date with the guidelines on the conditions encountered on the round was easily an order of magnitude greater than the time needed to see the patients. There are some flaws in this of course—we don’t factor the time spent at medical school into the time it takes us to understand the average patient’s condition on a round, in the same way that we also learn the guidelines through use and, unless we’re in a remarkably disparate speciality, we are able to re-use knowledge. But the challenge remains; there is a huge amount of information out there. Further barriers to our reading— other than the need to eat, drink, sleep, and interact with friends and family from time to time—are the way things are written. I can entirely understand why a Cochrane review needs to be 50 pages long, or a NICE guideline 150 pages long. I wouldn’t criticise that they need to explain their robust methodology for each reader. I’d just observe that I rarely read more than a few pages of either. Paul Glazsiou describes a vivid experience of discovering a cellar full of unread, shrink-wrapped guidelines at the WHO headquarters; he dubbed this “mummified evidence”—and his blog post offers some helpful tips about how to avoid the phenomenon. Philippa Prentice has taken the role of section editor for Guidelines at E&P very seriously, and I was struck, looking through this edition, what an excellent job she is doing of it. We’re quite hard task-masters when commissioning these reviews. We try to avoid authors who hate the guideline, or who love it unconditionally. We try to get them to present why it is that you, the reader, should be interested in the guideline—or part of it—and to think about what you should start doing, stop doing, or reflect on why you are doing it. We have two guideline reviews. Nkem Onyeador, Siba Prosad Paul and Bhupinder Kaur Sandhu look at the PGHAN bodies’ joint guideline on diagnosis and management of gastroeosophageal reflux and gastroesophageal reflux disease (see page 190). Emily Stenke and Séamus Hussey look at the NICE guidance on management of ulcerative colitis (see page 194). One of these conditions is more specialist than the other—and I’d guess that one is more poorly managed than the other, with a proliferation of non evidence-based treatment in the last decade. They each provide an extremely helpful summary of what we need to know from the guideline; for its day to day practicality for many child health professionals I’ve made the reflux paper my editor’s choice this month. I’d argue that “What won’t I read” is a more p","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73378532","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":"Congenital abdominal wall defects","authors":"Anup Varghese, S. Vause, S. Kamupira, A. Emmerson","doi":"10.1136/archdischild-2015-309030","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309030","url":null,"abstract":"A 24-year-old Caucasian, nulliparous woman had an abnormal antenatal ultrasound scan at 14 weeks gestation (see figure 1). A repeat scan at 20 weeks confirmed the findings. A fetomaternal medicine consultant counselled parents. At 33+5 weeks gestation, she delivered a 1.9 kg male infant by caesarean section for fetal distress following spontaneous preterm labour.\u0000\u0000What is the anomaly seen? \u0000\u0000A. Bladder exstrophy\u0000\u0000B. Abdominal wall defect\u0000\u0000C. Umbilical hernia\u0000\u0000\u0000\u0000Figure 1 \u000014 weeks antenatal scan (arrow).\u0000\u0000\u0000\u0000You are the paediatric registrar on call and have been called to attend the delivery of the baby. You arrive with the neonatal team. A pink, crying baby is brought to the resuscitaire (see figure 2). No scars or other anomalies are visible.\u0000\u0000What would be your next course of action? \u0000\u0000A. Baby to remain with mother and allowed to feed\u0000\u0000B. Admit to neonatal intensive care unit (NICU) and allow to …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84015754","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":"Article metrics: measuring the impact and importance of papers","authors":"I. Wacogne","doi":"10.1136/archdischild-2015-309312","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309312","url":null,"abstract":"There is plenty written about metrics, both comparing one type with another and also trying to decide whether they are any use or not. The function of this article is not to endorse any particular metric, but instead to give you some basics so that you can understand conversations about them.\u0000\u0000If you publish a piece, your wish is for that piece to change practice or alter the world’s understanding of your area in some way. The metric intends, therefore, to tell you something about how far your message may spread. The bodies who fund research will be keen that their research is read and has an impact, which brings us to the first of the three major metrics we will discuss here.\u0000\u0000This is a journal-level metric, meaning that it assesses the whole journal, and not a specific article. It is described in a number of papers1 but, in short, it is a ratio of the number of citations of articles to the number of articles over a time period—2 years for the standard impact factor (IF). So, imagine a journal through 2013 …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79956895","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":"NICE clinical guideline: bronchiolitis in children","authors":"E. Caffrey Osvald, J. Clarke","doi":"10.1136/archdischild-2015-309156","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309156","url":null,"abstract":"Bronchiolitis is a lower respiratory tract infection commonly seen in children less than 1 year of age.1 ,2 Predominantly occurring in winter months, bronchiolitis is in the majority managed in the primary care setting, but it contributes to a significant proportion of the admissions to paediatric wards with a small number requiring intensive care. The National Institute for Health and Care Excellence (NICE) guideline ‘Bronchiolitis in Children’ was published in June 2015.1 It aims to direct management of bronchiolitis in both primary and secondary care. The guideline was developed by the National Collaborating Centre for Women's and Children's Health.\u0000\u0000This is the first NICE guideline that covers bronchiolitis. The Scottish Intercollegiate College Network published a guideline in 2006 detailing diagnosis, management and prevention of bronchiolitis.3 The American Association of Paediatrics published a guideline with a similar scope in October 2014.2 Traditionally, there is discrepancy in terminology between the UK and the USA, with clinical conditions described in the UK as virus-induced wheeze or infantile asthma termed bronchiolitis in USA. This makes it difficult to compare studies and guidelines (see table 1 and box 1). Box 1 \u0000### Resources\u0000\u0000▸ http://www.nice.org.uk/guidance/ng9 ( link to NICE guideline and full guideline )\u0000\u0000▸ http://www.nice.org.uk/guidance/ng9/ifp/chapter/About-this-information ( link to public information on bronchiolitis in children in English )\u0000\u0000▸ http://www.nice.org.uk/guidance/ng9/resources ( link …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90192610","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":"A girl with gastric distension and hyperamylasemia","authors":"G. Cozzi, Federico Poropat, S. Naviglio, E. Barbi","doi":"10.1136/archdischild-2015-308986","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308986","url":null,"abstract":"A 3-year-old girl was admitted with abrupt onset of acute severe abdominal pain and drowsiness, without vomiting or diarrhoea. No history of abdominal trauma was reported. On admission, she was moaning, her heart rate was 161 bpm, blood pressure was 108/72 mm Hg, capillary refill time was <2 s and she was apyrexial. On physical examination, there was marked abdominal distension, with generalised abdominal tenderness without peritoneal signs. Blood tests showed hyperamylasemia (780 IU/L), neutrophilia (white cell count 14×10^9/L; neutrophil 11.9×10^9/L) and hyperglycaemia (155 mg/dL–8.6 mmol/L). A supine plain abdominal X-ray showed a huge gastric bubble (figure 1). A nasogastric tube was inserted, and 500 mL of non-bilious fluid and 150 mL of gas were suctioned, with prompt improvement of symptoms.\u0000\u0000\u0000\u0000Figure 1 \u0000Huge gastric bubble; patient lying supine.\u0000\u0000\u0000\u00001. Which of the following is the most common cause of hyperamylasemia …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84481980","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":"An acutely collapsed patient","authors":"Abhinav Singh, Arnold Dunga, M. Wimalendra","doi":"10.1136/archdischild-2015-308506","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308506","url":null,"abstract":"A previously well 14-year-old boy presented with a 3-day history of diarrhoea and vomiting with a background of week-long coryzal symptoms. On arrival he was confused, tachycardic, tachypneic and hypotensive. His blood sugar in the ambulance was 3.0 mmol/L. In total, 15 mL/kg 0.9% saline bolus and 250 mL of 5% dextrose were given via intraosseous access in the emergency department. The patient was pyrexial with an elevated C reactive protein (63 mg/L), hence, prophylactic ceftriaxone (4 g intravenous) was commenced. His first venous blood gas showed:\u0000\u0000pH 7.09, pCO2 5.28 kPa, PO2 4.61 kPa, BE −16.6, HCO3 11.4 mmol/L\u0000\u0000Potassium 7.1 mmol/L, sodium 116 mmol/L, glucose 8.8 mmol/L, lactate 7.4 mmol/L, urea 11.9 mmol/L.\u0000\u00001. What is the most likely diagnosis? \u0000\u00001. Diabetic ketoacidosis\u0000\u00002. Non-ketotic hyperosmolar state\u0000\u00003. Renal failure\u0000\u00004. Pancreatitis\u0000\u00005. Addisonian crisis\u0000\u00002. After aggressive fluid resuscitation, what is the next step in this patient's management? \u0000\u00001. Inotropic support and antibiotics\u0000\u00002. Parenteral hydrocortisone and …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89170159","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":"A rare cause of virilisation","authors":"R. Poole, T. Makaya","doi":"10.1136/archdischild-2015-309411","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309411","url":null,"abstract":"A previously well 2½-year-old girl presented to primary care with a 4-month history of greasy hair, acne, increased hair growth and weight gain. Within the last month, her acne had worsened, and her appetite had increased. She complained of abdominal pain and worryingly developed pubic hair. On examination, she had flushed cheeks with moon facies. Weight was on 91st centile, yet height, 2nd–9th centile. Abdominal examination and blood pressure were unremarkable, but there were signs of virilisation—pubic hair stage 2; enlarged, reddened labia majora and clitoris; and acne over the nose, cheeks and scalp line. She was urgently referred to secondary care (figure 1).\u0000\u0000\u0000\u0000Figure 1 \u0000Appearance at presentation.\u0000\u0000\u0000\u00001. What is the differential diagnosis of female childhood virilisation?\u0000\u00002. What are the key initial investigations for the probable diagnosis?\u0000\u00003. How should these patients be managed?\u0000\u00001. There are three main differential diagnoses: premature adrenarche, non-classic congenital adrenal hyperplasia (CAH) and virilising tumours . …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72755133","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-2015-310050","DOIUrl":"https://doi.org/10.1136/archdischild-2015-310050","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73994288","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: a structured approach to the recognition and management of concussion in children and adolescents","authors":"A. Kanani, S. Hartshorn","doi":"10.1136/archdischild-2015-308533","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308533","url":null,"abstract":"Concussion is a disturbance in brain function caused by a direct or indirect force, which is transmitted to the head. The incidence of concussion is rising, and poor recognition of symptoms, with inappropriate management strategies, increases the risk of long-term cognitive and neuropsychiatric complications. We address some common questions that arise when assessing and managing patients with suspected concussion.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82612127","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":"Postnatal care: a neonatal perspective (NICE guideline CG 37)","authors":"N. Holme, L. Boullier, C. Harrison","doi":"10.1136/archdischild-2015-308743","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308743","url":null,"abstract":"This 2015 National Institute for Health and Care Excellence (NICE) guideline outlines essential routine postnatal care of women and their babies up to 6–8 weeks post partum and offers advice on when, and how, to provide additional support.\u0000\u0000A previous version of this guideline was published in 2006. In 2013, new information on the association between co-sleeping and sudden infant death syndrome (SIDS) was published, and the NICE guideline has been updated to include this advice (see box 1 and full evidence review at https://www.nice.org.uk/guidance/cg37/evidence/cg37-postnatal-care-full-guideline-addendum2). The rest of the guideline remains predominantly unchanged from 2006. Box 1 \u0000### Resources\u0000\u0000Postnatal care, NICE clinical guideline 37, issued February 2015.\u0000\u0000http://guidance.nice.org.uk/CG37/Guidance\u0000\u0000Neonatal Jaundice, NICE clinical guideline 98, issued May 2010.\u0000\u0000http://guidance.nice.org.uk/CG98/Guidance\u0000\u0000Antibiotics for early-onset neonatal infection: Antibiotics for the prevention and treatment of early-onset neonatal infection, clinical guidance 149, issued August 2012.\u0000\u0000http://guidance.nice.org.uk/CG149/Guidance\u0000\u0000Division of ankyloglossia (tongue-tie) for breastfeeding, NICE Interventional Procedure Guidance 149, issued December 2005.\u0000\u0000https://www.nice.org.uk/guidance/IPG149/chapter/2-The-procedure-safety\u0000\u0000SANDS: Still birth and neonatal death charity\u0000\u0000http://www.uk-sands.org/\u0000\u0000Breast feeding should be encouraged and supported. This will be mainly midwifery led, but medical staff should be able to recognise when feeding is not adequate (figure 1). This has particular relevance if a specific breastfeeding problem is identified such as ankyloglossia (tongue-tie) or if separation of mother and baby is unavoidable due to medical need.\u0000\u0000\u0000\u0000Figure 1 \u0000Breastfeeding guidance.\u0000\u0000\u0000\u0000The cause of SIDS is unknown but is thought to be multifactorial. NICE has documented a positive association between co-sleeping and SIDS, although evidence supporting co-sleeping as a cause of SIDS is limited. Parents should be made aware of this, …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91515121","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}