Archives of Disease in Childhood - Education and Practice current issue

Epistle

Wacogne, I. — Tue, 09 Feb 2010 06:53:09 PST

Excluding medical and haematological conditions as a cause of bruising in suspected non-accidental injury

Minford, A M B, Richards, E M — Tue, 09 Feb 2010 06:53:09 PST

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.

Management of suspected appendicitis in children

Acheson, J, Banerjee, J — Tue, 09 Feb 2010 06:53:09 PST

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.

Investigation of the child with permanent hearing impairment

Ardle, B. M., Bitner-Glindzicz, M. — Tue, 09 Feb 2010 06:53:09 PST

NICE guideline: attention deficit hyperactivity disorder

Atkinson, M, Hollis, C — Tue, 09 Feb 2010 06:53:09 PST

Evaluation - the educational context

Macdougall, C F — Tue, 09 Feb 2010 06:53:09 PST

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 it and how to deal with evaluation that is external and imposed.