Archives of Disease in Childhood - Education and Practice current issue

Highlights from this issue

Wacogne, I. — 2012-03-23T07:36:13-07:00

When is a Picket not a Picket? It's not a joke – or at least, I can't think of a very good punchline if it is. You will recall that Picket is our section which looks for sentinel papers, re-writes the abstract in a structured way, and then puts this paper in the context of the broader literature with a commentary. It is an approach which we ripped off from the earlier layout of the journal, Evidence Based Medicine, and which we – and our feedback from readers would confirm this – think works fairly well. We have written elsewhere about how we go about selecting papers to abstract1 but of course sometimes we hear of papers in other ways. Sometimes an article has made quite a splash in the media, and this is where we hit a bit of a problem. These are important and interesting...

Developing and running an adolescent inpatient ward

Payne, D., Kennedy, A., Kretzer, V., Turner, E., Shannon, P., Viner, R. — 2012-03-23T07:36:13-07:00

Advocates of adolescent health have long argued for the development of dedicated inpatient units. In the UK, many recently built children's hospitals have included adolescent wards, with further wards actively planned for new builds. In Australia, adolescent wards have been established in all but one of the major children's hospitals and will be a feature of all three new children's hospitals currently being built (in Melbourne, Brisbane and Perth). Despite growing interest in the development of adolescent inpatient facilities, and evidence that they improve quality, there is little in the recent literature to guide those tasked with setting up or running such units. Those who currently operate such wards thus have the regular task of fielding enquiries from colleagues about developing and operating hospital-based services for young people. The aim of this article is therefore to describe our experiences of developing and working on adolescent wards in Australia and the UK, focusing on the ward design, case-mix, staffing requirements and ward philosophy and discussing the benefits and potential disadvantages of a dedicated adolescent ward.

What I've learned from BMJ Case Reports: Excellent learning points

Almeida, B. — 2012-03-23T07:36:13-07:00

To continue sharing what I have learnt while reviewing articles on BMJ Case Reports, I have come across the following articles that highlight some simple but excellent learning points that I thought should be brought over to E&P.

Skin to skin after birth can be dangerous – a case of a term neonate found apnoeic, pale and with no heart rate after the neonate and mother were left unattended.1 Okay, so I know many of you might think ‘It doesn’t take a genius to work that one out', but it's not often that the neonatal senior house officeris called to attend ‘because mum and baby are having skin to skin.’ It can in some (thankfully rarely) cases be a risk factor for sudden unexpected death and we (or maybe midwives) should be more vigilant during this potentially risky time.

And paintballing – I was terrified of it...

Medical management of acute severe anorexia nervosa

Norrington, A., Stanley, R., Tremlett, M., Birrell, G. — 2012-03-23T07:36:13-07:00

Anorexia nervosa (AN) is a common condition affecting young people. The medical management of AN on a general paediatric ward is challenging. It is important to identify young people who are at risk of medical complications, so early intervention can be instigated. This article aims to review the clinical practice and evidence supporting the current medical management of young people with AN. It provides a system-based approach to potential complications of the disease, guidance on feeding and the management of re-feeding syndrome. Approaches to legal and ethical challenges are also considered. While the importance of psychiatric treatment is recognised, the same is not discussed within this article.

'Nothing about us without us': considerations for research involving young people

McDonagh, J. E., Bateman, B. — 2012-03-23T07:36:13-07:00

Research development in the adolescent health arena is increasingly called for, given the relative lack of robust data on the health of young people. However, specific issues need to be considered when researching this age group. Such issues include participation of young people in the research process, availability of adolescent-specific data, developmental considerations and the interface between paediatric and adult-orientated healthcare. The aim of this paper is to highlight the importance of participation of young people in research and to discuss the key areas for consideration for practitioners when conducting research involving young people.

Maximising learning on ward rounds

Reece, A., Klaber, R. — 2012-03-23T07:36:13-07:00

This study considers different ways of maximising learning opportunities during ward rounds, with particular emphasis on the strengths and challenges of the paediatric environment. The focus is on the most common types of ward round – in acute units involving predominantly trainees – but we hope there will also be much that will interest those who work in other settings such as community clinics. Alongside a review of the best available evidence from the literature, and underpinned by educational theory, suggestions for maximising learning on ward rounds are presented. Many of these ideas were generated from working in small groups with over 90 experienced paediatricians, each with particular experience and interest in medical education, as part of the Royal College of Paediatrics and Child Health's Paediatric Educators' Programme, the PEP.

Subspecialty neonatal trainees views on being prepared for the consultant role

Shaw, B. N. J., Stenson, B. J., Fenton, A. C., Morrow, G., Brown, J. — 2012-03-23T07:36:13-07:00

Higher specialist training offers an opportunity to focus on non-clinical skills as well as clinical issues. The authors wished to determine whether doctors who complete neonatal higher specialist training in the UK feel prepared for the consultant role with respect to management, research and teaching, as well as clinical activities.

A questionnaire related to the preparedness of the consultant to carry out a range of activities was sent to all doctors who were appointed to the UK higher specialist training programme in neonatology from 2002 to 2008 who were currently working as consultants.

Seventy-one of the 83 eligible participants completed the questionnaire. Roles that consultants felt extremely well prepared for related to clinical care, communication, team-working, prioritising tasks, teaching and audit. Trainees reported that roles that they had been not at all well prepared for were related to roles in management and service delivery, medicolegal issues and complaints, job planning and personal development, supporting doctors in difficulty and chairing meetings.

Four key themes emerged from the analysis of free-text responses regarding specialty training: the influence of shift patterns/service provision, the lack of non-clinical preparation, learning on the job as a consultant later on and problems with grid training itself.

This study showed that for neonatal paediatrics in the UK, new consultants feel confident about managing ill babies but are unprepared for other aspects of the consultant's role. Neonatal higher specialist training needs to allow opportunities for non-clinical training.

What I've learned from Clinical Evidence: Peculiar treatments for gastroenteritis in children

Perez-Gaxiola, G. — 2012-03-23T07:36:13-07:00

The gastroenteritis in children review in Clinical Evidence was updated to include two peculiar treatments. I say peculiar because they are not your classic drugs, they may be considered ‘supplements’.

Zinc has been studied more in developing countries. There are quite a few randomised controlled trials (RCTs): 18 with more than 6000 children. But overall, there is a lot of heterogeneity between them (dose and duration of treatment, causes of diarrhoea). And the effect seems to be modest: compared with placebo, it reduces the duration of diarrhea by about half a day. Also, it does not reduce stool volume and it may increase vomiting in children. It may be worth trying in very specific cases.

Probiotics have even more studies. There are five systematic reviews about probiotics for acute gastroenteritis in children. These include 30 RCTs, but again, there is a lot of heterogeneity between them, and...

How to use serum ammonia

Broomfield, A., Grunewald, S. — 2012-03-23T07:36:13-07:00

Hyperammonaemia is a potentially extremely important indicator of impairment in intermediate metabolism. However, lack of experience in sample handling and confusion about what level is significant, can lead to its devaluation as a test. The aim of this article is to help the non-metabolic specialist to decide when it is appropriate to investigate for hyperammonaemia, to discuss potential investigatory pitfalls and to help in interpretation of results.

MRI-imaged brain morphology may differ between adults who have autism and non-autistic controls

Sekaran, D. — 2012-03-23T07:36:13-07:00

MethodsDesign

Case-control study.

Setting

Tertiary psychiatric hospital outpatient clinics and locally resident volunteers.

Patients

Adults, aged 18–68 years, consisting of 20 controls without autism, 20 subjects with autism and 19 subjects with attention-deficit hyperactivity disorder (ADHD). All subjects were male, IQ>75, right handed and without major psychiatric illness or medical condition affecting brain function.

Diagnostic strategy

Reference testing/standardisation: Participants underwent a psychiatric interview, physical examination and blood tests to exclude other disorders (eg, fragile X). Autism was diagnosed by ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) criteria and confirmed using the Autism Diagnostic Interview–Revised (17 cases) or the Autism Diagnostic Observation Schedule (3 cases). Patients with ADHD were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria, http://allpsych.com/disorders/dsm.html).

Study test

All patients had an MRI scan of their...

Metformin and placebo therapy in adjunct with lifestyle intervention both improve weight loss and insulin resistance in obese adolescents

2012-03-23T07:36:13-07:00

Setting

Paediatric Obesity Clinic in Germany

Patients

Adolescents aged 10 to 17years at risk of developing type 2 diabetes according to American Diabetes Association criteria who had enrolled in an individualised ‘lifestyle intervention’ weight loss programme (Phase 1). Candidates for the trial (phase 2) were those whose outcome in phase 1 at 6 months was classified unsuccessful; a reduction in body mass index (BMI) of <2 kg/m² and persistent insulin resistance expressed as HOMA-IR (Homeostatic Model Assessment-estimated insulin resistance) > 3 or 95th percentile.

Intervention

Metformin 500 mg twice per day or placebo for 6 months. Multiprofessional individualised lifestyle intervention continued throughout both phases of the study.

Outcomes

Improvement in insulin resistance (IR) measured by HOMA-IR after 6 months of treatment with Metformin/placebo.

HOMA-IR = fasting insulin x fasting glucose/22.5.

A clinically significant effect was defined as a decrease in HOMA-IR by...

Answers to the quiz on page 77

2012-03-23T07:36:13-07:00

QUESTION 1

Answer: D. A struggling neonate

QUESTION 2

Answer: D. Ammonia sampling can be adequately performed by capillary sampling

QUESTION 3

Answer:

True

False

True

False