Archives of Disease in Childhood最新文献

Evaluation and medical management of poisoning is often aided by laboratory tests. These range from basic analyses used widely in general clinical care to highly specific and sophisticated toxicology assays. For most poisonings, routine investigations such as measurement of blood glucose and electrolytes provide adequate information needed for management. Specific laboratory tests, such as quantitative assays for paracetamol, ethanol or other toxins, may be necessary. In some cases quantitative serum assays provide the primary information on which clinical management is based.Quantitative testing confirms the concentration of a toxin present and may help predict the anticipated clinical effects and guide management decisions such as the use of antidotes or haemodialysis. Qualitative testing to confirm the presence or absence of a toxin is less frequently helpful in clinical management of poisoning. Drug of abuse (DOA) testing is sometimes included in laboratory evaluation of poisoned patients. Though reported qualitatively as negative or positive, DOA testing is highly complex and easily misinterpreted.This review will discuss laboratory investigations for care of poisoned patients, including available tests and their indications, proper interpretation of results and testing limitations.

Objectives: In this article, we identify and summarise articles describing 10 current, impactful topics related to paediatric healthcare overuse for articles published between 2023 and 2024.

Design: Articles were identified using a manual table of contents review of high-impact journals and a PubMed search strategy and then scored using an established three-score rubric based on strength of methods, magnitude of potential harm and number of patients harmed. Afterwards, the most impactful articles were selected by author consensus and summarised in this review.

Results: We identified 212 articles related to paediatric healthcare overuse between the manual and PubMed search strategies. Twelve articles describing 10 topics were selected by author consensus in the following areas: harms of proton pump inhibitors, constraints of lipid screening, early discharge for patients with febrile neutropenia, oral antibiotics for bone and joint infections, ultrasound evaluation of fractures, opioid stewardship for neonatal opioid withdrawal syndrome and reduced treatment duration, imaging and prophylaxis for urinary tract infections.

Conclusion: Our review identifies and highlights impactful articles that build on a previous body of literature and introduces more recent areas of paediatric healthcare overuse.

Background: Achondroplasia (ACH), the most common skeletal dysplasia, arises from gain-of-function variants in the fibroblast growth factor receptor 3 gene. Children with ACH experience lifelong medical, functional and psychosocial challenges requiring coordinated and anticipatory care. Although international guidance exists, the UK lacks national clinical care recommendations specific to its healthcare systems.

Objective: To develop UK-specific, multidisciplinary clinical recommendations for the care of children and young people (CYP) with ACH.

Methods: The UK Achondroplasia Network developed guidance in stages: stakeholder mapping of the care pathway, integration of contemporary literature with clinical expertise to draft age-specific guidance and Delphi statements, and a modified Delphi process with 25 multidisciplinary experts. The Delphi process involved two voting rounds and an in-person meeting, with consensus defined as ≥80% agreement.

Results: In the first Delphi round, all 20 statements achieved consensus; nine achieved 100% agreement. To strengthen consensus, after meeting in person, 17 statements were refined (four were divided into two statements), one created and one removed, resulting in 24 statements for Round 2; all achieved consensus, with 21 reaching 100% agreement. The guidance outlines age-specific monitoring and referral from infancy to adolescence. Recommendations address medical management of complications, psychosocial support, educational planning and transfer to adult care.

Conclusion: These are the first UK-specific multidisciplinary recommendations for the care of CYP with ACH. Aligned with international best practices and tailored to UK healthcare systems, they support anticipatory care, promote independence and enhance health and psychosocial outcomes. The guidelines offer a foundation for service planning, standardisation and equitable care.