Paediatrics and Child Health (United Kingdom)最新文献

Simulation-based education (SBE) has become an integral part of postgraduate medical education in the last decade. More settings are using SBE to deliver teaching sessions, both in simulation laboratories and in the day-to-day clinical environment (in situ). This article draws on the experience in SBE course development from the paediatric simulation team at The Royal Wolverhampton NHS Trust. We address several considerations in setting up effective SBE teaching. This includes technical and practical aspects such as acquiring equipment and involving appropriate faculty, as well as more abstract principles such as how to embed simulation in your workplace culture. We also include an introduction to effective debriefing using the Diamond Debrief model. We aspire to empower other paediatric practitioners to develop and deliver high quality SBE for postgraduate paediatric healthcare professionals.

Recognizing what is normal constitutes a key skill for medical practitioners, especially paediatricians. It is a necessary requisite to providing reassurance and avoiding unnecessary referrals, investigations and treatment. Normal variants are atypical or uncommon findings in a given population which are of no clinical or pathological significance yet fall within the spectrum of what is considered the normal range. The list of conditions discussed in this article is by no means complete or comprehensive but merely a reflection of frequently encountered issues in primary care, paediatric outpatients and the paediatric emergency department; they include infantile dyschezia, ‘catch down’ growth, familial macrocephaly, positional plagiocephaly, asymmetrical thigh creases, sacral dimples, physiological anisocoria, PURPLE screaming episodes, gastro-oesophageal reflux and infant gratification and also provide guidance on what not to miss. This short article provides essential guidance for those new to paediatric outpatients or those less familiar with providing advice and guidance to worried parents.

Advancements in genomics have had a significant impact on our ability to diagnose and treat several health conditions, notably cancer. In this article, we discuss the evolution of genomic methods from the early first-generation genome sequencing methods such as Sanger sequencing to the latest technology. We also discuss how clinicians can decide which test to use depending on what type of result is required. We discuss the clinical significance of genomic testing including identification of cancer predispositions syndromes, the role of genomics in accurately diagnosing a number of cancers, as well as the utility of genomic data to predict response to targeted therapies. Finally, we detail some of the targeted therapies currently available to treat the various types of childhood cancers. The expansion of genomic testing within the NHS and the essential nature of genomic data to accurately diagnose and optimally treat childhood cancers also poses challenges to the healthcare system both in terms of infrastructure and personnel.

Health equity enables everyone to have the best possible opportunity for good health regardless of their social circumstance. In this article we set out why it is so vital that this begins in childhood, particularly at a time when increased costs of living in many countries are exacerbating health inequities further. We examine the impact of addressing the social determinants of health at individual, population and systems levels, and why this is the business of all partners involved in the local health economy. In the UK, integrated care systems (ICS) are early in their development. In this short article, we describe the work of the Children and Young People's Health Equity Collaborative: a collaboration between children's charity Barnardo's, the Institute of Health Equity, Birmingham and Solihull ICS, Cheshire and Merseyside ICS, and South Yorkshire ICS. This details a three-year programme designed to establish enablers for this whole systems approach. This includes a Children and Young People's Health Equity Framework, a dynamic data measurement tool to direct action for longer term outcomes and supporting child health equity interventions. Children and young people's voice is central to our work, combining academic evidence with lived experience of what really matters to them.

The UK immunisation programme for children and adolescents is highly successful with generally high uptake of vaccines and low rates of vaccine preventable diseases. However, for the past 10 years there has been a year on year small but concerning decrease in vaccine uptake. This was accelerated by the impact of the COVID-19 pandemic. In this article we consider the reasons for less-than-optimal vaccine uptake, discuss recent changes to the schedule and describe the significant further changes in prospect.

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research.

In the UK, school nurses play a crucial role in promoting the health and wellbeing of children and young people, giving them the best start in life and supporting them to sustain optimal health. They have a vital and unique link between education settings, home and the community. Their key role is within the public health arena, they are an important part of the primary health care team and a key link for acute and community paediatric teams and therapies. The onset of school nursing came in the Victorian era with a focus on improving the health of children living in poverty, this coincided with a report from the British army at the time which highlighted that young men joining the service were unfit for purpose. Now, in the 21^st century, we are faced with widening health inequalities, shocking levels of poverty and increases in the number of people living with major illness and mental health problems. It is argued that the school nurse has never been more essential in supporting the health and well-being of children and young people which includes their integral role in safeguarding. In this article we will explore why this might be the case, the difficulties and opportunities and, importantly, how, alongside our paediatric colleagues in both community and acute settings, we can best garner our combined efforts to rise above and beyond the escalating challenges.

The social determinants of health are increasingly well understood by paediatricians. Policy and individual practitioner actions are emerging and have been described in previous Social Paediatrics symposia in this journal. This article describes a Poverty Truth Commission; an innovative approach to addressing the impact of poverty of children's health. This brings people who may not otherwise spend much time together, takes away job titles and uses the power of storytelling to effect change in the members of the commission and beyond.

Evidence based medicine is all well and good, but what should you do when there is no evidence? How might you act differently if the absence of evidence relates to an acute problem, a complex chronic issue or a life-limiting situation? This is even more likely to be an issue when dealing with particular groups of patients. There is often a paucity of evidence when considering treatments or interventions for children and young people. This paper will guide the readers through various levels of absence of evidence, and while it won't be able to tell you what to do, it will give you different ways of looking at the problem.

Research is increasingly important for the delivery of the best possible paediatric care and in the training of healthcare professionals. Many young clinicians are now looking for some way of becoming involved in research during their training, and some will wish to develop a formal academic component to their career or study for a higher postgraduate degree. Research funding is essential to enable high quality research, but training in how to apply for such funding is limited. While it is no substitute for detailed guidance and support from a trusted and experienced research colleague, this article aims to provide practical guidance for new researchers setting out to write their first grant proposal. It stresses the importance of being proactive in selecting the correct research environment, ensuring adequate support and supervision and identifying the necessary knowledge and expertise needed to deliver the project efficiently and effectively. It also highlights the important steps involved in developing a proposal, writing and submitting the application, and provides suggestions for maximizing chances of success. Whilst the focus of this article is based upon the authors' experience in the UK, the general principles are more widely applicable to healthcare professionals working with babies, children and young people everywhere.