Pub Date : 2024-10-01DOI: 10.1136/archdischild-2024-327916
Neelam Gupta
While working in a neonatal intensive care setting, I often come across a heavy burden of infections and frequent use of antibiotics. Although there is established guidance for how common antibiotics such as aminoglycosides should be prescribed, administered and monitored, challenges remain about how to facilitate intravenous access for drug delivery in newborns. The actual administration of antibiotics in neonatal and paediatric patients is often more complex than it seems. The delivery kinetics of medications especially for drugs with narrow therapeutic window like aminoglycosides are not well studied. This leads to difficulties in accurately determining the pharmacodynamic and pharmacokinetic drug relationships. In our medicine update section, Abigail Manning and Anna Burgess presents a concise literature review which compares methods of administration of aminoglycosides using intravenous injection vs intravenous infusion in the paediatric setting …
{"title":"Epistle","authors":"Neelam Gupta","doi":"10.1136/archdischild-2024-327916","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327916","url":null,"abstract":"While working in a neonatal intensive care setting, I often come across a heavy burden of infections and frequent use of antibiotics. Although there is established guidance for how common antibiotics such as aminoglycosides should be prescribed, administered and monitored, challenges remain about how to facilitate intravenous access for drug delivery in newborns. The actual administration of antibiotics in neonatal and paediatric patients is often more complex than it seems. The delivery kinetics of medications especially for drugs with narrow therapeutic window like aminoglycosides are not well studied. This leads to difficulties in accurately determining the pharmacodynamic and pharmacokinetic drug relationships. In our medicine update section, Abigail Manning and Anna Burgess presents a concise literature review which compares methods of administration of aminoglycosides using intravenous injection vs intravenous infusion in the paediatric setting …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260797","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}
Pub Date : 2024-09-18DOI: 10.1136/archdischild-2024-326911
Isabella Weber, Benjamin G Fisher, Cliodhna Myles, A Emile J Hendriks, M Loredana Marcovecchio
Type 2 diabetes (T2D) is becoming progressively more common among young people concomitantly with the epidemic of childhood obesity.1 The incidence of youth-onset T2D is projected to rise by >600% by 2060,2 and the UK has the fastest increase in incidence rate globally.3 Compared with type 1 diabetes (T1D), youth-onset T2D is associated with higher rates and earlier onset of complications and a 50% higher mortality rate.1 Appropriate intervention is therefore key to improve outcomes.4 In May 2023, the National Institute for Health and Care Excellence (NICE) updated the section on T2D of the guideline on ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’.5 Additionally, relevant guidelines have been recently published by the (UK) Association of Children’s Diabetes Clinicians (ACDC) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) (box 1). Here, we focus on updates to NICE guideline relevant to T2D. Box 1 ### Resources National Institute for Health and Care Excellence (NICE) guideline (2023)5: https://www.nice.org.uk/guidance/ng18 Association of Children’s Diabetes Clinicians (ACDC) guideline (2023): https://www.a-c-d-c.org/wp-content/uploads/2012/08/TYpe-2-guideline-ACDC-format-publish-2.pdf International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline (2022): https://www.ispad.org/page/ISPADGuidelines2022 ### Immediate actions at T2D diagnosis A child or young person (CYP) with suspected T2D should be referred to a multidisciplinary paediatric diabetes team to ‘confirm diagnosis and provide immediate and continuing care’ (box 2).5 CYP with T2D should be given tailored information about T2D and offered dietary advice and support including weight management, metformin therapy and equipment for capillary blood glucose (BG) monitoring. Additionally, they should be offered long-acting …
{"title":"NICE guideline review: type 2 diabetes in children and young people – diagnosis and management (NG18)","authors":"Isabella Weber, Benjamin G Fisher, Cliodhna Myles, A Emile J Hendriks, M Loredana Marcovecchio","doi":"10.1136/archdischild-2024-326911","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326911","url":null,"abstract":"Type 2 diabetes (T2D) is becoming progressively more common among young people concomitantly with the epidemic of childhood obesity.1 The incidence of youth-onset T2D is projected to rise by >600% by 2060,2 and the UK has the fastest increase in incidence rate globally.3 Compared with type 1 diabetes (T1D), youth-onset T2D is associated with higher rates and earlier onset of complications and a 50% higher mortality rate.1 Appropriate intervention is therefore key to improve outcomes.4 In May 2023, the National Institute for Health and Care Excellence (NICE) updated the section on T2D of the guideline on ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’.5 Additionally, relevant guidelines have been recently published by the (UK) Association of Children’s Diabetes Clinicians (ACDC) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) (box 1). Here, we focus on updates to NICE guideline relevant to T2D. Box 1 ### Resources National Institute for Health and Care Excellence (NICE) guideline (2023)5: https://www.nice.org.uk/guidance/ng18 Association of Children’s Diabetes Clinicians (ACDC) guideline (2023): https://www.a-c-d-c.org/wp-content/uploads/2012/08/TYpe-2-guideline-ACDC-format-publish-2.pdf International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline (2022): https://www.ispad.org/page/ISPADGuidelines2022 ### Immediate actions at T2D diagnosis A child or young person (CYP) with suspected T2D should be referred to a multidisciplinary paediatric diabetes team to ‘confirm diagnosis and provide immediate and continuing care’ (box 2).5 CYP with T2D should be given tailored information about T2D and offered dietary advice and support including weight management, metformin therapy and equipment for capillary blood glucose (BG) monitoring. Additionally, they should be offered long-acting …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260796","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}
Pub Date : 2024-09-16DOI: 10.1136/archdischild-2023-326506
Rebecca Jeyaraj, Deirdre Kelly
Modern healthcare is complex. Expectations of care and the responsibilities of medical professionals are evolving. New challenges include, among other things, disease outbreaks, novel technologies, health misinformation and workforce shortages. Despite this changing medical scene, doctors and patients continue to want to provide and receive the best possible care. In difficult situations, doctors may thus find professional guidance, ethical codes and legal advice or precedents helpful. ### Information about the current guidance The General Medical Council (GMC) regulates doctors in the UK. Its Good Medical Practice guidance describes professional standards for registered doctors.1 The 2024 guidance (published August 2023) was effective from 30 January 2024. It will apply to physician associates and anaesthesia associates once they are regulated by the GMC. A version of Good Medical Practice was first published in 1995, with updates every 3–10 years thereafter.2 The last major update was in 2013. The 2024 guidance was developed using (1) evidence from public inquiries, published reports and commissioned research, (2) advice from an external forum of 11 medical and non-medical experts, and (3) consultation with medical professionals, patients and the public. It is considered a shared agreement of good practice. While its core principles remain largely similar, Good Medical Practice 2024 incorporates several updates to reflect the needs and values of the profession and wider society (box 1). In this review, we focus on aspects of the guidance with particular implications or nuances in paediatric practice. Box 1 ### What do I need to know: key updates highlighted by the General Medical Council16
{"title":"What makes a good paediatrician? A focused review of Good Medical Practice 2024","authors":"Rebecca Jeyaraj, Deirdre Kelly","doi":"10.1136/archdischild-2023-326506","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326506","url":null,"abstract":"Modern healthcare is complex. Expectations of care and the responsibilities of medical professionals are evolving. New challenges include, among other things, disease outbreaks, novel technologies, health misinformation and workforce shortages. Despite this changing medical scene, doctors and patients continue to want to provide and receive the best possible care. In difficult situations, doctors may thus find professional guidance, ethical codes and legal advice or precedents helpful. ### Information about the current guidance The General Medical Council (GMC) regulates doctors in the UK. Its Good Medical Practice guidance describes professional standards for registered doctors.1 The 2024 guidance (published August 2023) was effective from 30 January 2024. It will apply to physician associates and anaesthesia associates once they are regulated by the GMC. A version of Good Medical Practice was first published in 1995, with updates every 3–10 years thereafter.2 The last major update was in 2013. The 2024 guidance was developed using (1) evidence from public inquiries, published reports and commissioned research, (2) advice from an external forum of 11 medical and non-medical experts, and (3) consultation with medical professionals, patients and the public. It is considered a shared agreement of good practice. While its core principles remain largely similar, Good Medical Practice 2024 incorporates several updates to reflect the needs and values of the profession and wider society (box 1). In this review, we focus on aspects of the guidance with particular implications or nuances in paediatric practice. Box 1 ### What do I need to know: key updates highlighted by the General Medical Council16","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260798","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}
Pub Date : 2024-05-02DOI: 10.1136/archdischild-2023-326753
Rashida Javed, Kanwal Mahadev, Harsha Gowda
Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-intubations. This could have serious side effects like cardiorespiratory deterioration and airway trauma. The aim of this quality improvement project (QIP) is to reduce the rate of UEs among intubated infants in a tertiary NICU over a period of 24 months. ### Making a case for change We engaged local stakeholders (clinicians, nurses, governance team, risk assessment team, X-ray technicians and education team) to evaluate risk factors for …
{"title":"Reducing unplanned extubation in tertiary NICU: a quality improvement project","authors":"Rashida Javed, Kanwal Mahadev, Harsha Gowda","doi":"10.1136/archdischild-2023-326753","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326753","url":null,"abstract":"Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-intubations. This could have serious side effects like cardiorespiratory deterioration and airway trauma. The aim of this quality improvement project (QIP) is to reduce the rate of UEs among intubated infants in a tertiary NICU over a period of 24 months. ### Making a case for change We engaged local stakeholders (clinicians, nurses, governance team, risk assessment team, X-ray technicians and education team) to evaluate risk factors for …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836721","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}
Pub Date : 2024-04-30DOI: 10.1136/archdischild-2023-326479
Muhamad Azamin Anuar, Emily Rose Whitehouse, Uma Varma, Gary McCullagh, Imelda Hughes
The hereditary sensory and autonomic neuropathies (HSANs) are a group of rare genetic disorders characterised by variable phenotypic expression affecting both sensory and autonomic dysfunction. Diagnosing these conditions can be a challenge as the presenting symptoms can be diverse and may overlap. This often leads to a delay in referral and diagnosis. Pain is often used by clinicians as a marker for systemic diseases. The key feature of HSAN conditions is the absence of pain perception and its consequences such as unexplained injuries. When a child presents with an unexplained injury, a diagnosis of non-accidental injuries must be considered, but rarely HSAN could be a possibility. The diagnosis of HSANs in children is both important and rare. This article aims to discuss an approach to the diagnosis and management of HSANs.
{"title":"Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain","authors":"Muhamad Azamin Anuar, Emily Rose Whitehouse, Uma Varma, Gary McCullagh, Imelda Hughes","doi":"10.1136/archdischild-2023-326479","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326479","url":null,"abstract":"The hereditary sensory and autonomic neuropathies (HSANs) are a group of rare genetic disorders characterised by variable phenotypic expression affecting both sensory and autonomic dysfunction. Diagnosing these conditions can be a challenge as the presenting symptoms can be diverse and may overlap. This often leads to a delay in referral and diagnosis. Pain is often used by clinicians as a marker for systemic diseases. The key feature of HSAN conditions is the absence of pain perception and its consequences such as unexplained injuries. When a child presents with an unexplained injury, a diagnosis of non-accidental injuries must be considered, but rarely HSAN could be a possibility. The diagnosis of HSANs in children is both important and rare. This article aims to discuss an approach to the diagnosis and management of HSANs.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836456","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}
Pub Date : 2024-04-17DOI: 10.1136/archdischild-2023-325613
Jessica Joanne Thompson, Sarah Kidd, Lucinda C Winckworth
A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …
{"title":"Neonate with a large neck mass","authors":"Jessica Joanne Thompson, Sarah Kidd, Lucinda C Winckworth","doi":"10.1136/archdischild-2023-325613","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325613","url":null,"abstract":"A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"301 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140608639","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}
Pub Date : 2024-04-15DOI: 10.1136/archdischild-2023-326773
Owen Hibberd, Agata Anna Chylinska, Katie Finn, Melanie Ranaweera, Dani Hall
### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net.2 7 It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care.3–6 8 As such, although the treatment is the same, clinicians should be mindful of the probability of a more severe illness when treating children with COVID-19 and croup.3–6 8 View this table: Table 1 Differentials of stridor in children The Westley Croup Score (table 2) is a standardised scoring …
{"title":"Use of corticosteroids for croup in children","authors":"Owen Hibberd, Agata Anna Chylinska, Katie Finn, Melanie Ranaweera, Dani Hall","doi":"10.1136/archdischild-2023-326773","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326773","url":null,"abstract":"### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net.2 7 It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care.3–6 8 As such, although the treatment is the same, clinicians should be mindful of the probability of a more severe illness when treating children with COVID-19 and croup.3–6 8 View this table: Table 1 Differentials of stridor in children The Westley Croup Score (table 2) is a standardised scoring …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140590216","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}
Pub Date : 2024-04-09DOI: 10.1136/archdischild-2023-326654
Helen Thomas, Daniel Cromb, Hannah Jacob, Anastasia Alcock
As the third case in the acute safeguarding essentials in modern-day paediatrics series, this article focuses on sexual relationships, consent and confidentiality. Using the scenario of a 15-year-old girl presenting to the emergency department with a positive pregnancy test, it begins with a guide to taking a psychosocial history in young people followed by discussion about some of the legality surrounding sexual relationships in adolescents, issues around consent and considerations for confidentiality in this age group.
{"title":"Acute Safeguarding Essentials in Modern-day Paediatrics: Sexual Relationships, Consent and Confidentiality","authors":"Helen Thomas, Daniel Cromb, Hannah Jacob, Anastasia Alcock","doi":"10.1136/archdischild-2023-326654","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326654","url":null,"abstract":"As the third case in the acute safeguarding essentials in modern-day paediatrics series, this article focuses on sexual relationships, consent and confidentiality. Using the scenario of a 15-year-old girl presenting to the emergency department with a positive pregnancy test, it begins with a guide to taking a psychosocial history in young people followed by discussion about some of the legality surrounding sexual relationships in adolescents, issues around consent and considerations for confidentiality in this age group.","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575302","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}
Pub Date : 2024-04-09DOI: 10.1136/archdischild-2024-326924
Abigail Manning, Anna Burgess
### Key messages Aminoglycosides are a class of broad-spectrum, bactericidal antibiotics of which amikacin, gentamicin and tobramycin are the most commonly prescribed. These antibiotics are frequently prescribed for children, usually for infections, which are caused by aerobic Gram-negative pathogens. 1 Aminoglycosides are very poorly absorbed from the gastrointestinal tract, due to their lack of lipophilicity. Therefore, they must be administered parenterally. They are also concentration dependent, which means that the ratio between the peak concentrations (Cmax) to the pathogen’s minimum inhibitory concentration (MIC) is the pharmacokinetic-pharmacodynamic index, which is a marker for antimicrobial activity and effectiveness. To achieve an effective clinical response, a Cmax/MIC ratio between 8 and 12 has been advised, although this is based on adult data.1 Aminoglycosides have a narrow therapeutic margin, so therapeutic drug monitoring must be used to monitor for toxicity. High serum levels may result in ototoxicity and nephrotoxicity.1 Aminoglycosides are administered as once-daily or multiple-daily (previously known as ‘standard dose’) regimes. Once-daily …
{"title":"Aminoglycoside administration in paediatrics: a literature search comparing international practices of intravenous injection or intravenous infusion","authors":"Abigail Manning, Anna Burgess","doi":"10.1136/archdischild-2024-326924","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326924","url":null,"abstract":"### Key messages Aminoglycosides are a class of broad-spectrum, bactericidal antibiotics of which amikacin, gentamicin and tobramycin are the most commonly prescribed. These antibiotics are frequently prescribed for children, usually for infections, which are caused by aerobic Gram-negative pathogens. 1 Aminoglycosides are very poorly absorbed from the gastrointestinal tract, due to their lack of lipophilicity. Therefore, they must be administered parenterally. They are also concentration dependent, which means that the ratio between the peak concentrations (Cmax) to the pathogen’s minimum inhibitory concentration (MIC) is the pharmacokinetic-pharmacodynamic index, which is a marker for antimicrobial activity and effectiveness. To achieve an effective clinical response, a Cmax/MIC ratio between 8 and 12 has been advised, although this is based on adult data.1 Aminoglycosides have a narrow therapeutic margin, so therapeutic drug monitoring must be used to monitor for toxicity. High serum levels may result in ototoxicity and nephrotoxicity.1 Aminoglycosides are administered as once-daily or multiple-daily (previously known as ‘standard dose’) regimes. Once-daily …","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575306","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}
Pub Date : 2024-04-05DOI: 10.1136/archdischild-2023-326522
Annie Swanepoel
Humans lived as hunter-gatherers for 95% of our 200 000-year history.1 Social scientists call our modern societies ‘WEIRD’: Western, Educated, Industrialised, Rich and Democratic.1 In evolutionary terms, the last 10 000 years that we have not lived as hunter-gatherers is brief. Dobzshansky2 famously stated that ‘Nothing makes sense in biology, except in the light of evolution’. This is also true for medicine and for paediatrics. We suggest that it is important for paediatricians to consider the evolutionary view, as small adjustments from a public health perspective might make it easier for children to thrive. See Box 1 for some key evolutionary concepts, which we discuss in greater detail in the following sections. Box 1 ### : Key concepts in evolutionary science
{"title":"Public health for paediatricians: how an evolutionary perspective can help us improve children’s well-being","authors":"Annie Swanepoel","doi":"10.1136/archdischild-2023-326522","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326522","url":null,"abstract":"Humans lived as hunter-gatherers for 95% of our 200 000-year history.1 Social scientists call our modern societies ‘WEIRD’: Western, Educated, Industrialised, Rich and Democratic.1 In evolutionary terms, the last 10 000 years that we have not lived as hunter-gatherers is brief. Dobzshansky2 famously stated that ‘Nothing makes sense in biology, except in the light of evolution’. This is also true for medicine and for paediatrics. We suggest that it is important for paediatricians to consider the evolutionary view, as small adjustments from a public health perspective might make it easier for children to thrive. See Box 1 for some key evolutionary concepts, which we discuss in greater detail in the following sections. Box 1 ### : Key concepts in evolutionary science","PeriodicalId":501158,"journal":{"name":"Education & Practice","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575309","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}
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