Archives of Disease in Childhood-Education and Practice Edition最新文献

A low platelet count (thrombocytopenia) is a common finding especially in neonates who are admitted to the neonatal intensive care unit. Due to the varied causes that can lead to neonatal thrombocytopenia, assessment and management can be challenging. Having an understanding of the causes of neonatal thrombocytopenia and their natural progression would help guide subsequent management. Therefore, we will be exploring the different circumstances where thrombocytopenia occurs and how to interpret and manage the neonate with thrombocytopenia in this interpretations article.

Objectives: The London School of Paediatrics (LSP) surveys trainees annually regarding their training placements. There is a wide variation in satisfaction. We explored the last 5 years of data to identify trends and determine predictors of overall trainee satisfaction.

Methods: The survey is distributed annually to all London paediatric trainees with response rates of 86-90%. It explores overall placement satisfaction, followed by key questions covering staffing, supervision, teaching, facilities and other facets. The survey blends both quantitative and qualitative feedback.Satisfaction levels were analysed using time series trend analysis. Overall levels were compared using t-tests. Associations between satisfaction and components of the survey were identified using a convergence of multiple regression and other multivariate analyses.

Results: Overall trainee satisfaction increased steadily until 2020. There was a considerable variation across sites, some having consistently higher or lower scores than the median, while others showed an upward or downward trend, or very variable pattern.By training levels, ST3 trainees consistently rated their placement below average and ST7 trainees above average. There was also a considerable variation in responses by training level with regard to perceived staffing levels and teaching.To understand the influences on overall satisfaction, regression coefficients were derived between specific metrics and overall satisfaction using multiple regression and then normalised to 100%. The explanatory power of this list to explain satisfaction overall is high at 82% R².Trainee satisfaction was most strongly correlated with workplace atmosphere and consultant support. Staffing, educational supervision, facilities and wider MDT (Multidisciplinary Team) support are associated with overall satisfaction, but to a lesser degree.

Conclusions: Trainee satisfaction is crucial, affecting patient safety, retention and trainee mental health. Our analysis identified significant associations with satisfaction including modifiable elements such as consultant engagement and team morale. Staffing levels were less related to satisfaction than expected.Experimental data exploring the components of clinical training in real-world situations are lacking. These data use the natural experiment of placing trainees in different training locations to explore the factors that relate to their overall experience.

Neonatal bradycardia is characterised by a heart rate below 80 bpm, irrespective of gestational age. It is generally self-resolving but, in some cases, represents an underlying pathology which may be cardiac or non-cardiac in origin. The common causes for bradycardia are non-cardiac in origin such as autonomic immaturity in premature infants, electrolyte imbalances, hypothyroidism and medications. Cardiac causes include-sinus bradycardia, conduction system abnormalities, congenital heart disease and channelopathies. Diagnostic investigations typically include a standard 12-lead ECG, 24-hour Holter monitor and an echocardiogram. This article aims to provide a practical framework for the management of neonates with bradycardia and guide further investigation and/or referral to specialist paediatric cardiology services.

Raised intracranial pressure (ICP) in children can be very challenging to recognise and manage. In order to minimise secondary brain injury, measures to reduce intracranial pressure must be initiated as soon as possible. Initial management is often commenced in District General Hospitals prior to transfer for definitive treatment. This article is aimed at general paediatricians and provides a framework for the initial stabilisation and management of a child with raised ICP, with discussion of the underlying physiological principles.

Inhalers are the mainstay of asthma treatment, but are responsible for a disproportionately high level of carbon emissions compared with other aspects of healthcare. There is a growing interest among CYP in discussing the environmental impact of their treatment with healthcare staff. In this article, we outline an individualised approach to modifying asthma treatment to be more sustainable. We explore options including prescribing dry powder inhalers over pressurised metered dose inhalers, choosing inhaler devices with lower carbon footprints, improving disposal and recycling of inhalers, and optimising basic asthma care through routine reviews, prescription management and during exacerbations.